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Reed J, Dong T, Eaton E, Friswold J, Porges J, Al-Kindi SG, Rajagopalan S, Neeland IJ. Continuous glucose monitoring for glycaemic control and cardiovascular risk reduction in patients with type 2 diabetes not on insulin therapy: A clinical trial. Diabetes Obes Metab 2024; 26:2881-2889. [PMID: 38680050 DOI: 10.1111/dom.15608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
AIM To evaluate the impact of the Dexcom G6 continuous glucose monitoring (CGM) device on glycaemic control and cardiometabolic risk in patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk who are not on insulin therapy. MATERIALS AND METHODS Adults with T2DM with glycated haemoglobin (HbA1c) >7% and body mass index (BMI) ≥30 kg/m2 not using insulin were enrolled in a two-phase cross-over study. In phase 1, CGM data were blinded, and participants performed standard glucose self-monitoring. In phase 2, the CGM data were unblinded, and CGM, demographic and cardiovascular risk factor data were collected through 90 days of follow-up and compared using paired tests. RESULTS Forty-seven participants were included (44% women; 34% Black; mean age 63 years; BMI 37 kg/m2; HbA1c 8.4%; 10-year predicted atherosclerotic cardiovascular disease risk 24.0%). CGM use was associated with a reduction in average glucose (184.0 to 147.2 mg/dl, p < .001), an increase in time in range (57.8 to 82.8%, p < .001) and a trend towards lower glucose variability (26.2 to 23.8%). There were significant reductions in HbA1c, BMI, triglycerides, blood pressure, total cholesterol, diabetes distress and 10-year predicted risk for atherosclerotic cardiovascular disease (p < .05 for all) and an increase in prescriptions for sodium-glucose cotransporter 2 inhibitors (36.2 to 83.0%) and glucagon-like peptide-1 receptor agonists (42.5 to 87.2%, p < .001 for both). CONCLUSIONS Dexcom G6 CGM was associated with improved glycaemic control and cardiometabolic risk in patients with T2DM who were not on insulin. CGM can be a safe and effective tool to improve diabetes management in patients at high risk for adverse cardiovascular outcomes.
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Affiliation(s)
- Joseph Reed
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tony Dong
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Elke Eaton
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Janice Friswold
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jodie Porges
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sadeer G Al-Kindi
- Division of Cardiology, Houston Methodist Hospital, Houston, Texas, USA
| | - Sanjay Rajagopalan
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ian J Neeland
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Blood AJ, Chang LS, Hassan S, Chasse J, Stern G, Gabovitch D, Zelle D, Colling C, Aronson SJ, Figueroa C, Collins E, Ruggiero R, Zacherle E, Noone J, Robar C, Plutzky J, Gaziano TA, Cannon CP, Wexler DJ, Scirica BM. Randomized Evaluation of a Remote Management Program to Improve Guideline-Directed Medical Therapy: The DRIVE Trial. Circulation 2024; 149:1802-1811. [PMID: 38583146 DOI: 10.1161/circulationaha.124.069494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Several SGLT2i (sodium-glucose transport protein 2 inhibitors) and GLP1-RA (glucagon-like peptide-1 receptor agonists) reduce cardiovascular events and improve kidney outcomes in patients with type 2 diabetes; however, utilization remains low despite guideline recommendations. METHODS A randomized, remote implementation trial in the Mass General Brigham network enrolled patients with type 2 diabetes with increased cardiovascular or kidney risk. Patients eligible for, but not prescribed, SGLT2i or GLP1-RA were randomly assigned to simultaneous virtual patient education with concurrent prescription of SGLT2i or GLP1-RA (ie, Simultaneous) or 2 months of virtual education followed by medication prescription (ie, Education-First) delivered by a multidisciplinary team driven by nonlicensed navigators and clinical pharmacists who prescribed SGLT2i or GLP1-RA using a standardized treatment algorithm. The primary outcome was the proportion of patients with prescriptions for either SGLT2i or GLP1-RA by 6 months. RESULTS Between March 2021 and December 2022, 200 patients were randomized. The mean age was 66.5 years; 36.5% were female, and 22.0% were non-White. Overall, 30.0% had cardiovascular disease, 5.0% had cerebrovascular disease, and 1.5% had both. Mean estimated glomerular filtration rate was 77.9 mL/(min‧1.73 m2), and mean urine/albumin creatinine ratio was 88.6 mg/g. After 2 months, 69 of 200 (34.5%) patients received a new prescription for either SGLT2i or GLP1-RA: 53.4% of patients in the Simultaneous arm and 8.3% of patients in the Education-First arm (P<0.001). After 6 months, 128 of 200 (64.0%) received a new prescription: 69.8% of patients in the Simultaneous arm and 56.0% of patients in Education-First (P<0.001). Patient self-report of taking SGLT2i or GLP1-RA within 6 months of trial entry was similarly greater in the Simultaneous versus Education-First arm (69 of 116 [59.5%] versus 37 of 84 [44.0%]; P<0.001) Median time to first prescription was 24 (interquartile range [IQR], 13-50) versus 85 days (IQR, 65-106), respectively (P<0.001). CONCLUSIONS In this randomized trial, a remote, team-based program identifies patients with type 2 diabetes and high cardiovascular or kidney risk, provides virtual education, prescribes SGLT2i or GLP1-RA, and improves guideline-directed medical therapy. These findings support greater utilization of virtual team-based approaches to optimize chronic disease management. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT06046560.
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Affiliation(s)
- Alexander J Blood
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
| | - Lee-Shing Chang
- Endocrinology, Diabetes, and Hypertension (L-S.C.), Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
| | - Shahzad Hassan
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | - Jacqueline Chasse
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | - Gretchen Stern
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | - Daniel Gabovitch
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | - David Zelle
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | - Caitlin Colling
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
| | - Samuel J Aronson
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Personalized Medicine, Mass General Brigham, Cambridge (S.J.A.)
| | - Christian Figueroa
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | - Emma Collins
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | - Ryan Ruggiero
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
| | | | - Joshua Noone
- Novo Nordisk, Inc., Plainsboro, NJ (E.Z., J.N., C.R.)
| | - Carey Robar
- Novo Nordisk, Inc., Plainsboro, NJ (E.Z., J.N., C.R.)
| | - Jorge Plutzky
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
| | - Thomas A Gaziano
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
| | - Christopher P Cannon
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Diabetes Center, Massachusetts General Hospital, Boston (C.C., D.J.W.)
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
| | - Deborah J Wexler
- Diabetes Center, Massachusetts General Hospital, Boston (C.C., D.J.W.)
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
| | - Benjamin M Scirica
- Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.)
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Koczo A, Brickshawana A, Zhu J, Thoma F, Countouris M, Berlacher K, Gulati M, Michos ED, Reis S, Mulukutla S, Saeed A. Sex-based utilization of guideline recommended statin therapy and cardiovascular disease outcomes: Data from a multisite healthcare network primary prevention cohort. Am J Prev Cardiol 2024; 18:100667. [PMID: 38779188 PMCID: PMC11108813 DOI: 10.1016/j.ajpc.2024.100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
Background In the US, women have similar cardiovascular death rates as men. However, less is known about sex differences in statin use for primary prevention and associated atherosclerotic cardiovascular disease (ASCVD) outcomes. Methods Statin prescriptions using electronic health records were examined in patients without ASCVD (myocardial infarction (MI), revascularization or ischemic stroke) between 2013 and 2019. Guideline-directed statin intensity (GDSI) at index (at least moderate intensity, defined per pooled-cohort equation) and follow-up visits were compared between sexes across ASCVD risk groups, defined by the pooled-cohort equation. Cox regression hazard ratios were calculated for statin use and outcomes (myocardial infarction, stroke/transient ischemic attack (TIA), and all-cause mortality) stratified by sex. Interaction terms (statin and sex) were applied. Results Among 282,298 patients, (mean age ∼ 50 years) 17.1 % women and 19.5 % men were prescribed any statin at index visit. Time to GDSI was similar between sexes, but the proportion of high-risk women on GDSI at follow-up were lower compared to high-risk men (2-years: 27.7 vs 32.0 %, and 5-years: 47.2 vs 55.2 %, p < 0.05). When compared to GDSI, no statin use was associated with higher risk of MI and ischemic stroke/TIA among both sexes. High-risk women on GDSI had a lower risk of mortality (HR=1.39 [1.22-1.59]) vs. men (HR=1.67 [1.50-1.86]) of similar risk (p value interaction=0.004). Conclusion In a large contemporary healthcare system, there was underutilization of statins across both sexes in primary prevention. High-risk women were less likely to remain on GDSI compared to high-risk men. GDSI significantly improved the survival in both sexes regardless of ASCVD risk group. Future strategies to ensure continued use of GDSI, specifically among women, should be explored.
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Affiliation(s)
- Agnes Koczo
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Adipong Brickshawana
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Jianhui Zhu
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Floyd Thoma
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Malamo Countouris
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Kathryn Berlacher
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Erin D Michos
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD, USA
| | - Steven Reis
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Suresh Mulukutla
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Anum Saeed
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
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Kim DD, Hwang JH, Fendrick AM. Balancing innovation and affordability in anti-obesity medications: the role of an alternative weight-maintenance program. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae055. [PMID: 38828004 PMCID: PMC11138958 DOI: 10.1093/haschl/qxae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024]
Abstract
Despite remarkable clinical advances in highly effective anti-obesity medications, their high price and potential budget impact pose a major challenge in balancing equitable access and affordability. While most attention has been focused on the amount of weight loss achieved, less consideration has been paid to interventions to sustain weight loss after an individual stops losing weight. Using a policy simulation model, we quantified the impact of a weight-maintenance program following the weight-loss plateau from the initial full-dose glucagon-like peptide 1 (GLP-1) receptor agonists or incretin mimetic use. We measured long-term health care savings and the loss of some health benefits (eg, maintenance of weight loss, improvements in cardiometabolic risk factors, and reductions in diabetes and cardiovascular events). Our model suggested that, compared with continuous long-term full-dose GLP-1 receptor agonists or incretin mimetic drugs, the alternative weight-maintenance program would generate slightly fewer clinical benefits while generating substantial savings in lifetime health care spending. Using less expensive and potentially less effective alternative weight-maintenance programs may provide additional headroom to expand access to anti-obesity medications during the active weight-loss phase without increasing total health care spending.
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Affiliation(s)
- David D Kim
- Department of Medicine and Public Health Sciences, University of Chicago, Chicago, IL 60637, United States
| | - Jennifer H Hwang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, United States
| | - A Mark Fendrick
- Department of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI 48109, United States
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Mori Y, Mizuno A, Fukuma S. Low on-treatment blood pressure and cardiovascular events in patients without elevated risk: a nationwide cohort study. Hypertens Res 2024; 47:1546-1554. [PMID: 38355817 DOI: 10.1038/s41440-024-01593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
Insufficient blood pressure control among patients with hypertension without elevated risk is a global concern, suggesting the need for treatment optimization. However, the potential harm of excessive blood pressure lowering among these patients is understudied. This study addressed this evidence gap by using nationally representative public health insurer database covering 30 million working-age population. Patients who were continuously using antihypertensive drugs with 10-year cardiovascular risk <10% were identified. They were categorized by on-treatment systolic and diastolic blood pressures. The primary outcome was a composite of myocardial infarction, stroke, heart failure hospitalization, and peripheral artery disease. Of 920,533 participants (mean age, 57.3 years; female, 48.3%; mean follow-up, 2.75 years), the adjusted hazard ratios for systolic blood pressure of <110, 110-119, 120-129 (reference), 130-139, 140-149, 150-159, and ≥160 mmHg were 1.05 (95% confidence interval: 0.99-1.12), 0.97 (0.93-1.02), 1 (reference), 1.05 (1.01-1.09), 1.15 (1.11-1.20), 1.30 (1.23-1.37), and 1.76 (1.66-1.86), respectively; and for diastolic blood pressure of <60, 60-69, 70-79 (reference), 80-89, 90-99, and ≥100 mmHg were 1.25 (1.14-1.38), 0.99 (0.95-1.04), 1 (reference), 1.00 (0.96-1.03), 1.13 (1.09-1.18), and 1.66 (1.58-1.76), respectively. Among low-risk patients with hypertension, diastolic blood pressure <60 mmHg was associated with increased cardiovascular events, while systolic blood pressure <110 mmHg was not. Compared to previous investigations in high-risk patients, the potential harm of excessive blood pressure lowering was less pronounced in low-risk patients with hypertension. The association between low on-treatment blood pressure and cardiovascular events has been understudied in low-risk patients with hypertension. In our study with nationally representative working-age adults from general population with hypertension without elevated risk, increased risk of cardiovascular events was observed in diastolic blood pressure of <60 mmHg, but not in systolic blood pressure of <110 mmHg. Those results contrasted with previous investigations in high-risk patients where the risk of low on-treatment blood pressure was more pronounced.
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Affiliation(s)
- Yuichiro Mori
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shingo Fukuma
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Iribarren C, Lu M, Elosua R, Gulati M, Wong ND, Blumenthal RS, Nissen S, Rana JS. Polygenic risk and incident coronary heart disease in a large multiethnic cohort. Am J Prev Cardiol 2024; 18:100661. [PMID: 38601895 PMCID: PMC11004687 DOI: 10.1016/j.ajpc.2024.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Objective Many studies support the notion that polygenic risk scores (PRS) improve risk prediction for coronary heart disease (CHD) beyond conventional risk factors. However, PRS are not yet considered risk-enhancing factor in guidelines. Our objective was to determine the predictive performance of a commercially available PRS (CARDIO inCode-Score®) compared with the Pooled Cohorts Equations (PCE) in a contemporary, multi-ethnic cohort. Methods Participants (n = 63,070; 67 % female; 18 % non-European) without prior CHD were followed from 2007 through 12/31/2022. The association between the PRS and incident CHD was assessed using Cox regression adjusting for genetic ancestry and risk factors. Event rates were estimated by categories of PCE and by low/intermediate/high genetic risk within PCE categories; risk discrimination and net reclassification improvement (NRI) were also assessed. Results There were 3,289 incident CHD events during 14 years of follow-up. Adjusted hazard ratio (aHR) for incident CHD per 1 SD increase in PRS was 1.18 (95 % CI:1.14-1.22), and the aHR for the upper vs lower quintile of the PRS was 1.66 (95 % CI:1.49-1.86). The association was consistent in both sexes, in European participants compared with all minority groups combined and was strongest in the first 5 years of follow-up. The increase in the C-statistic was 0.004 (0.747 vs. 0.751; p < 0.0001); the NRI was 2.4 (0.9-3.8) for the entire cohort and 9.7 (7.5-12.0) for intermediate PCE risk individuals. After incorporating high genetic risk, a further 10 percent of participants at borderline/intermediate PCE risk would be candidates for statin therapy. Conclusion Inclusion of polygenic risk improved identification of primary prevention individuals who may benefit from more intensive risk factor modification.
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Affiliation(s)
- Carlos Iribarren
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Meng Lu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Spain and CIBER Cardiovascular Diseases (CIBERCV), Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven Nissen
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jamal S. Rana
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
- Department of Cardiology, The Permanente Medical Group, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Frisvold D, Dogan M, Dogan T, Abdullahi K, Koep T, Philibert R. The Use of Precision Epigenetic Methods for the Diagnosis and Care of Stable Coronary Heart Disease Reduces Healthcare Costs. Adv Ther 2024; 41:2367-2380. [PMID: 38662186 PMCID: PMC11133094 DOI: 10.1007/s12325-024-02860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The cost of secondary prevention of coronary heart disease (CHD) is continuing to increase, with a substantial portion of this acceleration being driven by the expense of confirmatory diagnostic testing. Conceivably, newly developed precision epigenetic technologies could drive down these costs. However, at the current time, their impact on overall expense for CHD care is poorly understood. We hypothesized that the use of a newly developed, highly sensitive, and specific epigenetic test, PrecisionCHD, could decrease the costs of secondary prevention. METHODS To test this hypothesis, we constructed a budget impact analysis using a cost calculation model that examined the effects of substituting PrecisionCHD for conventional CHD diagnostic tests on the expenses of the initial evaluation and first year of care of stable CHD using a 1-year time horizon with no discounting. RESULTS The model projected that for a commercial insurer with one million members, full adoption of PrecisionCHD as the primary method of initial CHD assessment would save approximately $113.6 million dollars in the initial year. CONCLUSION These analyses support the use of precision epigenetic methods as part of the initial diagnosis and care of stable CHD and can meaningfully reduce cost. Real-world pilots to test the reliability of these analyses are indicated.
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Affiliation(s)
- David Frisvold
- Department of Economics, University of Iowa, Iowa City, IA, 52242, USA
| | | | - Timur Dogan
- Cardio Diagnostics Inc, Chicago, IL, 60654, USA
| | | | - Tyler Koep
- Cardio Diagnostics Inc, Chicago, IL, 60654, USA
| | - Robert Philibert
- Cardio Diagnostics Inc, Chicago, IL, 60654, USA.
- Department of Psychiatry, University of Iowa, Iowa City, IA, 52242, USA.
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8
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Wernly S, Semmler G, Rezar R, Schaffler-Schaden D, Flamm M, Aigner E, Datz C, Wernly B. Assessing the association between H. pylori infection and educational status: implications for screening strategies? Minerva Gastroenterol (Torino) 2024; 70:171-176. [PMID: 37310371 DOI: 10.23736/s2724-5985.23.03404-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND H. pylori is a common bacterial infection that can cause gastritis, peptic ulcers, and cancer. The distribution of H. pylori infection is not uniform and can vary based on socio-economic factors. The aim of this study was to investigate the relationship between H. pylori infection and educational status in Central Europe. If the prevalence of H. pylori infection was found to be exceptionally high in one particular educational stratum, then systematic screening in this population group could be a sensible strategy. METHODS Participants were included from the Salzburg Colon Cancer Prevention Initiative (Sakkopi) cohort, consisting of 5313 asymptomatic Austrian patients. Clinical and laboratory parameters and the biopsy proven presence of H. pylori during an esophagoduodenoscopy were obtained, and patients' educational status was categorized into lower (38%), medium (54%), and higher (9%) education. Logistic regression models were fitted to evaluate the relationship between H. pylori infection and educational status. RESULTS Compared to patients with lower educational status (21%), patients with medium (17%) and higher (15%) educational status were less often infected with H. pylori (P<0.001). This association remained after adjustment for age, sex, and concomitant diagnosis of metabolic syndrome in multivariable logistic regression models. Sensitivity analysis showed lower odds for H. pylori infection with both medium and higher education in most strata. CONCLUSIONS We discovered a statistically significant association between low educational status and an elevated risk for H. pylori infection. Nonetheless, the absolute difference is not enough to advocate for partially population-based screening in a specific education status group. As a result, we believe that the information linking low educational attainment to higher H. pylori prevalence should primarily be taken into account in clinical decision-making, but should not replace the existing testing approach for H. pylori, which is based on clinical reasoning and symptoms.
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Affiliation(s)
- Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria -
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Richard Rezar
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dagmar Schaffler-Schaden
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Elmar Aigner
- Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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9
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Huang AL, Navar AM, Ayers C, Rohatgi A, Michos ED, Virani SS, Joshi P, Peterson ED, Khera A. US population qualifying for aspirin use for primary prevention of cardiovascular disease. Am J Prev Cardiol 2024; 18:100669. [PMID: 38681065 PMCID: PMC11046250 DOI: 10.1016/j.ajpc.2024.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/22/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Aspirin has been used for primary prevention of atherosclerotic cardiovascular disease (ASCVD) for decades, but this indication has become controversial with recent trial data. The 2022 US Preventive Services Task Force (USPSTF) provided a recommendation to consider aspirin use for primary prevention in adults 40-59 years with a 10-year ASCVD risk ≥10 % and not at increased risk of bleeding, yet population estimates for the impact of this recommendation are unknown. The objective of this study is to determine the prevalence and demographics of the US population who meet eligibility criteria for aspirin under the new 2022 USPSTF guidelines. Methods This is a serial cross-sectional study using data from the 2011-March 2020 National Health and Nutrition Examination Survey (NHANES) database. Individuals aged 40-59 years without a self-reported history of ASCVD were included. 10-year estimated ASCVD risk ≥10 % as calculated by the Pooled Cohort Equations (PCE) and increased bleeding risk determined using variables adapted from USPSTF guidelines were further applied as inclusion and exclusion criteria, respectively. The weighted frequencies of US adults aged 40-59 years qualifying for primary prevention aspirin, subgrouped by gender, age, and race/ethnicity, were calculated. Results Among 72,840,734 US individuals aged 40-59 years, 7.2 million (10 %) are eligible for consideration of primary prevention aspirin by PCE criteria. Of these, approximately 30 % would be potentially excluded based on increased bleeding risks, resulting in a net eligible cohort of 5 million. This represents 7 % of US adults aged 40-59 years and only 2.6 % of adults ≥18 years. Men, age 50-59 years, and Black race have higher proportions meeting aspirin use eligibility. Conclusions The overall prevalence of US individuals who qualify for aspirin for primary prevention under the 2022 USPSTF guidelines is modest, with larger proportional eligibility among men, older age, and Black individuals.
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Affiliation(s)
- Athena L. Huang
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- The Texas Heart Institute, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Parag Joshi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Eric D. Peterson
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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10
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Dafer RM, Tietjen GE, Rothrock JF, Vann RE, Shrewsbury SB, Aurora SK. Cardiovascular safety of dihydroergotamine mesylate delivered by precision olfactory delivery (INP104) for the acute treatment of migraine. Headache 2024. [PMID: 38800847 DOI: 10.1111/head.14669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To report the cardiovascular (CV) safety of dihydroergotamine mesylate (DHE) administered by precision olfactory delivery (INP104) from two clinical trials. BACKGROUND Although the absolute risk is low, migraine is associated with an increased risk of CV events. DHE is a highly effective acute treatment for migraine, but due to its theoretical risk of promoting arterial vasoconstriction, DHE is contraindicated in patients with CV disease or an unfavorable risk factor profile. The INP104 is a novel drug-device combination product approved for acute treatment of migraine that delivers DHE to the upper nasal space using precision olfactory delivery (POD®). METHODS The STOP 101 was a Phase 1 open-label study that assessed the safety, tolerability, and bioavailability of INP104 1.45 mg, intravenous DHE 1.0 mg, and MIGRANAL (nasal DHE) 2.0 mg in healthy participants. The STOP 301 was a pivotal Phase 3, open-label study that assessed the safety, tolerability, and exploratory efficacy of INP104 1.45 mg over 24 and 52 weeks in patients with migraine. In both studies, active or a history of CV disease, as well as significant CV risk factors, were exclusion criteria. RESULTS In STOP 101, 36 participants received one or more doses of investigational product. Treatment with intravenous DHE, but not INP104 or nasal DHE, resulted in clinically relevant changes from baseline in systolic blood pressure (BP; 11.4 mmHg, 95% confidence interval [CI] 7.9-15.0) and diastolic BP (13.3 mmHg, 95% CI 9.4-17.1) at 5 min post-dose, persisting up to 30 min post-dose for systolic BP (6.3 mmHg; 95% CI 3.0-9.5) and diastolic BP (7.9 mmHg, 95% CI 3.9-11.9). None of the treatments produced any clinically meaningful electrocardiogram (ECG) changes. In STOP 301, 354 patients received one or more doses of INP104. Over 24 weeks, five patients (1.4%) experienced a non-serious, vascular treatment-emergent adverse event (TEAE). Minimal changes were observed for BP and ECG parameters over 24 or 52 weeks. Off-protocol concomitant use of triptans and other ergot derivatives did not result in any TEAEs. CONCLUSION In two separate studies, INP104 demonstrated a favorable CV safety profile when used in a study population without CV-related contraindications.
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Affiliation(s)
- Rima M Dafer
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - John F Rothrock
- Inova Health, Fairfax, Virginia, USA
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Robert E Vann
- Formerly of Impel Pharmaceuticals, Seattle, Washington, USA
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11
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Parsa S, Somani S, Dudum R, Jain SS, Rodriguez F. Artificial Intelligence in Cardiovascular Disease Prevention: Is it Ready for Prime Time? Curr Atheroscler Rep 2024:10.1007/s11883-024-01210-w. [PMID: 38780665 DOI: 10.1007/s11883-024-01210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW This review evaluates how Artificial Intelligence (AI) enhances atherosclerotic cardiovascular disease (ASCVD) risk assessment, allows for opportunistic screening, and improves adherence to guidelines through the analysis of unstructured clinical data and patient-generated data. Additionally, it discusses strategies for integrating AI into clinical practice in preventive cardiology. RECENT FINDINGS AI models have shown superior performance in personalized ASCVD risk evaluations compared to traditional risk scores. These models now support automated detection of ASCVD risk markers, including coronary artery calcium (CAC), across various imaging modalities such as dedicated ECG-gated CT scans, chest X-rays, mammograms, coronary angiography, and non-gated chest CT scans. Moreover, large language model (LLM) pipelines are effective in identifying and addressing gaps and disparities in ASCVD preventive care, and can also enhance patient education. AI applications are proving invaluable in preventing and managing ASCVD and are primed for clinical use, provided they are implemented within well-regulated, iterative clinical pathways.
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Affiliation(s)
- Shyon Parsa
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Sulaiman Somani
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Sneha S Jain
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Center for Digital Health, Stanford University, Stanford, California, USA.
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12
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Triant VA, Lyass A, Hurley LB, Borowsky LH, Ehrbar RQ, He W, Cheng D, Lo J, Klein DB, Meigs JB, Grinspoon SK, Plutzky J, Silverberg MJ, LaValley M, Massaro JM, D'Agostino RB. Cardiovascular Risk Estimation Is Suboptimal in People With HIV. J Am Heart Assoc 2024; 13:e029228. [PMID: 38761071 DOI: 10.1161/jaha.123.029228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/16/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Established cardiovascular disease (CVD) risk prediction functions may not accurately predict CVD risk in people with HIV. We assessed the performance of 3 CVD risk prediction functions in 2 HIV cohorts. METHODS AND RESULTS CVD risk scores were calculated in the Mass General Brigham and Kaiser Permanente Northern California HIV cohorts, using the American College of Cardiology/American Heart Association atherosclerotic CVD function, the FHS (Framingham Heart Study) hard coronary heart disease function and the Framingham Heart Study hard CVD function. Outcomes were myocardial infarction or coronary death for FHS hard coronary heart disease function; and myocardial infarction, stroke, or coronary death for American College of Cardiology/American Heart Association and FHS hard CVD function. We calculated regression coefficients and assessed discrimination and calibration by sex; predicted to observed risk of outcome was also compared. In the combined cohort of 9412, 158 (1.7%) had a coronary heart disease event, and 309 (3.3%) had a CVD event. Among women, CVD risk was generally underestimated by all 3 risk functions. Among men, CVD risk was underestimated by the American College of Cardiology/American Heart Association and FHS hard CVD function, but overestimated by the FHS hard coronary heart disease function. Calibration was poor for women using the FHS hard CVD function and for men using all functions. Discrimination in all functions was good for women (c-statistics ranging from 0.78 to 0.90) and moderate for men (c-statistics ranging from 0.71 to 0.72). CONCLUSIONS Established CVD risk prediction functions generally underestimate risk in people with HIV. Differences in model performance by sex underscore the need for both HIV-specific and sex-specific functions. Development of CVD risk prediction models tailored to HIV will enhance care for aging people with HIV.
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Affiliation(s)
- Virginia A Triant
- Division of General Internal Medicine Massachusetts General Hospital Boston MA
- Division of Infectious Diseases Massachusetts General Hospital Boston MA
- Mongan Institute, Massachusetts General Hospital Boston MA
- Harvard Medical School Boston MA
| | - Asya Lyass
- Department of Mathematics and Statistics Boston University Boston MA
| | - Leo B Hurley
- Kaiser Permanente Northern California Oakland CA
| | - Leila H Borowsky
- Division of General Internal Medicine Massachusetts General Hospital Boston MA
| | - Rachel Q Ehrbar
- Department of Biostatistics Boston University School of Public Health Boston MA
| | - Wei He
- Division of General Internal Medicine Massachusetts General Hospital Boston MA
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital Boston MA
- Harvard Medical School Boston MA
| | - Janet Lo
- Metabolism Unit, Massachusetts General Hospital Boston MA
- Harvard Medical School Boston MA
| | | | - James B Meigs
- Division of General Internal Medicine Massachusetts General Hospital Boston MA
- Harvard Medical School Boston MA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital Boston MA
- Harvard Medical School Boston MA
| | - Jorge Plutzky
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA
- Harvard Medical School Boston MA
| | | | - Michael LaValley
- Department of Biostatistics Boston University School of Public Health Boston MA
| | - Joseph M Massaro
- Department of Biostatistics Boston University School of Public Health Boston MA
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13
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Steinfeldt J, Wild B, Buergel T, Pietzner M, Upmeier Zu Belzen J, Vauvelle A, Hegselmann S, Denaxas S, Hemingway H, Langenberg C, Landmesser U, Deanfield J, Eils R. Medical history predicts phenome-wide disease onset and enables the rapid response to emerging health threats. Nat Commun 2024; 15:4257. [PMID: 38763986 PMCID: PMC11102902 DOI: 10.1038/s41467-024-48568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
The COVID-19 pandemic exposed a global deficiency of systematic, data-driven guidance to identify high-risk individuals. Here, we illustrate the utility of routinely recorded medical history to predict the risk for 1883 diseases across clinical specialties and support the rapid response to emerging health threats such as COVID-19. We developed a neural network to learn from health records of 502,460 UK Biobank. Importantly, we observed discriminative improvements over basic demographic predictors for 1774 (94.3%) endpoints. After transferring the unmodified risk models to the All of US cohort, we replicated these improvements for 1347 (89.8%) of 1500 investigated endpoints, demonstrating generalizability across healthcare systems and historically underrepresented groups. Ultimately, we showed how this approach could have been used to identify individuals vulnerable to severe COVID-19. Our study demonstrates the potential of medical history to support guidance for emerging pandemics by systematically estimating risk for thousands of diseases at once at minimal cost.
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Affiliation(s)
- Jakob Steinfeldt
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik/Centrum, Charitéplatz 1, 10117, Berlin, Germany
- Computational Medicine, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- Friede Springer Cardiovascular Prevention Center@Charite, Charite - University Medicine Berlin, Berlin, Germany
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Benjamin Wild
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
| | - Thore Buergel
- Institute of Cardiovascular Sciences, University College London, London, UK
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
| | - Maik Pietzner
- Computational Medicine, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Precision Health University Research Institute, Queen Mary University of London and Barts NHS Trust, London, UK
| | - Julius Upmeier Zu Belzen
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
| | - Andre Vauvelle
- Institute of Health Informatics, University College London, London, UK
| | - Stefan Hegselmann
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Massachusetts, USA
- Pattern Recognition and Image Analysis Lab, University of Münster, Münster, Germany
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, London, UK
- Health Data Research UK, London, UK
- National Institute for Health Research, Biomedical Research Centre at University College London Hospitals National Institute for Health Research, Biomedical Research Centre, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- National Institute for Health Research, Biomedical Research Centre at University College London Hospitals National Institute for Health Research, Biomedical Research Centre, London, UK
| | - Claudia Langenberg
- Computational Medicine, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Precision Health University Research Institute, Queen Mary University of London and Barts NHS Trust, London, UK
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik/Centrum, Charitéplatz 1, 10117, Berlin, Germany
- Friede Springer Cardiovascular Prevention Center@Charite, Charite - University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Berlin, Germany
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Roland Eils
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany.
- Health Data Science Unit, Heidelberg University Hospital and BioQuant, Heidelberg, Germany.
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14
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Zhu J, Jhang J, Yu H, Mushlin AI, Kamel H, Alemayehu N, Giardina JC, Gupta A, Pandya A. Cost-Effectiveness of Screening Asymptomatic Carotid Stenosis by Atherosclerotic Cardiovascular Risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.11.28.23299146. [PMID: 38798437 PMCID: PMC11118553 DOI: 10.1101/2023.11.28.23299146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Importance Extracranial internal carotid artery stenosis (50-99% arterial narrowing) is an important risk factor for ischemic stroke. Yet, the benefits and harms of targeted screening for asymptomatic carotid artery stenosis (ACAS) have not been assessed in population-based studies. Objective To estimate the cost-effectiveness of one-time, targeted ACAS screening stratified by atherosclerotic cardiovascular disease (ASCVD) risk using the American Heart Association's Pooled Cohort Equations. Design Setting and Participants We developed a lifetime microsimulation model of ACAS and stroke for a hypothetical cohort representative of US adults aged 50-80 years without stroke history. We used the Cardiovascular Health Study to estimate the probability and severity of ACAS based on individual characteristics (e.g., age, sex, smoking status, blood pressure, and cholesterol). Stroke risks were functions of these characteristics and ACAS severity. In the model, individuals testing positive for >70% stenosis with Duplex ultrasound and a confirmatory diagnostic test undergo revascularization, which may reduce the risk of stroke but also introduces complication risks. Diagnostic performance parameters, revascularization benefits and risks, utility weights, and costs were estimated from published sources. Cost-effectiveness was assessed from the health care sector perspective using a $100,000/quality-adjusted life year (QALY) threshold. Main Outcomes and Measures Estimated stroke events prevented, lifetime costs, QALYs, and incremental cost-effectiveness ratios (ICERs) associated with ACAS screening. Costs (2023 USD) and QALYs were discounted at 3% annually. Results We found that screening individuals with a 10-year ASCVD risk >30% was the most cost-effective strategy, with an ICER of $89,000/QALY. This strategy would make approximately 11.9% of the population eligible for screening, averting an estimated 24,084 strokes. Results were sensitive to variations in the efficacy and complication risk of revascularization. In probabilistic sensitivity analysis, screening those in lower ASCVD risk groups (0-20%) only had a 0.6% chance of being cost-effective. Conclusion and Relevance A one-time screening may only be cost-effective for adults at a relatively high ASCVD risk. Our findings provide a framework that can be adapted as future clinical trial data continue to improve our understanding of the role of revascularization and intensive medical therapy in contemporary stroke prevention secondary to carotid disease.
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Matsuda E, Crowe M, Howard VJ, Brown CJ, Sterling MR, Levitan EB. Life-space mobility and cognitive function: The REasons for geographic and racial differences in stroke (REGARDS) study. J Am Geriatr Soc 2024. [PMID: 38745470 DOI: 10.1111/jgs.18923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Emiri Matsuda
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Madeline R Sterling
- Division of Internal Medicine, Weill-Cornell College of Medicine, New York, New York, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
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16
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Oliva-Sánchez PF, Landeros-López S, Rosas-Dossetti MM, Grobeisen-Levin S, Islas-Martínez JA, Aznar-Guerra D, Valdez-Celiz AP, Soto-Ramírez L. Comparison of Four Predictive Scores for Cardiovascular Risk in Mexican People with HIV. AIDS Res Hum Retroviruses 2024. [PMID: 38666685 DOI: 10.1089/aid.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Persons with HIV (PWH) face an increased risk of cardiovascular events due to immune activation, comorbidities, and certain antiretrovirals (ARVs). However, the current cardiovascular risk (CVR) scores are not specifically directed toward PWH. This study aimed to assess the agreement between different predictive CVR scores and explore their relationship with clinical and demographic data in Mexican PWH. A descriptive cross-sectional analysis was conducted in 200 PWH with a mean age of 42 years who were treated at a Mexican urban center from 2017 to 2018. The majority (83%) was on ARV treatment and 79.5% had undetectable viral loads (VLs). Moderate- to high-risk scores were infrequent, with Framingham Risk Score for Hard Coronary Heart Disease scores showing higher values, with very low concordance among all scores. Logistic regression analysis revealed significant associations between the CVR scores and the initial recorded VL, CD4 cell count, and elevated triglyceride levels. However, no associations were found with measures such as body mass index or abdominal circumference. Treatment with integrase strand transfer inhibitors (INSTIs), particularly first-generation inhibitors, showed strong associations with all predictive scores, notably ASCVD (odds ratio = 7.03, 95% confidence interval 1.67-29.64). The poor concordance among the CVR scores in PWH highlights the need for a specific score that considers comorbidities and ARV drugs. Despite the relatively young age of the participants, significant correlations were observed between INSTI use, initial VL, CD4 cell count, and triglyceride levels, which are factors not considered in the existing risk scores. Regardless of the actual value of the scores, screening for CVR in PWH is recommended.
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Affiliation(s)
- P F Oliva-Sánchez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana - Xochimilco, Mexico City, Mexico
| | - S Landeros-López
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - M M Rosas-Dossetti
- Hospital General "Vicente Villada", Instituto de Salud del Estado de México, Toluca, Mexico
| | - S Grobeisen-Levin
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana - Xochimilco, Mexico City, Mexico
| | - J A Islas-Martínez
- Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, Mexico
| | - D Aznar-Guerra
- Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, Mexico
| | - A P Valdez-Celiz
- Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, Mexico
| | - L Soto-Ramírez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
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17
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Han E, Lee YH, Ahn SH, Cha BS, Kim SU, Lee BW. Appendicular Skeletal Muscle Mass to Visceral Fat Area Ratio Predicts Hepatic Morbidities. Gut Liver 2024; 18:509-519. [PMID: 38013477 PMCID: PMC11096915 DOI: 10.5009/gnl230238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 11/29/2023] Open
Abstract
Background/Aims : Reports on the association between sarcopenic visceral obesity and non-alcoholic fatty liver disease (NAFLD)-associated morbidities remain scarce. We investigated the association between sarcopenia and visceral obesity, and the influence of this association on hepatic and coronary comorbidities. Methods : The appendicular skeletal muscle mass to visceral fat area ratio (SV ratio) was evaluated using bioelectric impedance analysis. NAFLD and significant liver fibrosis were assessed using transient elastography, and high atherosclerotic cardiovascular disease (ASCVD) risk was defined as a 10-year ASCVD risk score >10%. Sarcopenia was defined as appendicular skeletal muscle mass adjusted by body mass index (<0.789 for men and <0.512 for women). Results : In total, 82.0% (n=1,205) of the entire study population had NAFLD, and 14.6% of these individuals (n=176) exhibited significant liver fibrosis. Individuals with the lowest SV ratio had a significantly increased risk of NAFLD, significant liver fibrosis, and high ASCVD risk (all p<0.05). Individuals with both the lowest SV ratio and sarcopenia had the highest risk of developing NAFLD (odds ratio [OR]=3.11), significant liver fibrosis (OR=2.03), and high ASCVD risk (OR=4.15), compared with those with a higher SV ratio and without sarcopenia (all p<0.05). Conclusions : Low SV ratio combined with sarcopenia was significantly associated with an increased risk of NAFLD, significant liver fibrosis, and high ASCVD risk among individuals with a high risk of NAFLD.
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Affiliation(s)
- Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yong-ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
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18
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Gaziano TA, Gaziano JM. Can Cardiovascular Risk Assessment Be Improved in the 21st Century? JAMA 2024:2818629. [PMID: 38739381 DOI: 10.1001/jama.2024.7644] [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: 05/14/2024]
Affiliation(s)
- Thomas A Gaziano
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - J Michael Gaziano
- Departments of Medicine, Veterans Affairs Boston Healthcare System and Brigham and Women's Hospital, Boston, Massachusetts
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Zhou D, Mao Q, Sun Y, Cheng H, Zhao J, Liu Q, Deng M, Xu S, Zhao X. Association of Blood Copper With the Subclinical Carotid Atherosclerosis: An Observational Study. J Am Heart Assoc 2024; 13:e033474. [PMID: 38700020 DOI: 10.1161/jaha.123.033474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Copper exposure is reported to be associated with increased risk of stroke. However, the association of copper exposure with subclinical carotid atherosclerosis remains unclear. METHODS AND RESULTS This observational study included consecutive participants from Xinqiao Hospital between May 2020 and August 2021. Blood metals were measured using inductively coupled plasma mass spectrometry and carotid atherosclerosis was assessed using ultrasound. Modified Poisson regression was performed to evaluate the associations of copper and other metals with subclinical carotid plaque presence. Blood metals were analyzed as categorical according to the quartiles. Multivariable models were adjusted for age, sex, body mass index, education, smoking, drinking, hypertension, diabetes, dyslipidemia, estimated glomerular filtration rate, and coronary artery disease history. Bayesian Kernel Machine Regression was conducted to evaluate the overall association of metal mixture with subclinical carotid plaque presence. One thousand five hundred eighty-five participants were finally enrolled in our study, and carotid plaque was found in 1091 subjects. After adjusting for potential confounders, metal-progressively-adjusted models showed that blood copper was positively associated with subclinical carotid plaque (relative risk according to comparing quartile 4 to quartile 1 was 1.124 [1.021-1.238], relative risk according to per interquartile increment was 1.039 [1.008-1.071]). Blood cadmium and lead were also significantly associated with subclinical carotid plaque. Bayesian Kernel Machine Regression analyses suggested a synergistic effect of copper-cadmium-lead mixture on subclinical carotid plaque presence. CONCLUSIONS Our findings identify copper as a novel risk factor of subclinical carotid atherosclerosis and show the potential synergistic proatherogenic effect of copper, cadmium, and lead mixture.
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Affiliation(s)
- Denglu Zhou
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Qi Mao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Yapei Sun
- Center of Laboratory Medicine Chongqing Prevention and Treatment Center for Occupational Diseases Chongqing China
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning Chongqing China
- School of Public Health Nanjing Medical University Nanjing China
| | - Hao Cheng
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Jianhua Zhao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Qingsong Liu
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Mengyang Deng
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Shangcheng Xu
- Center of Laboratory Medicine Chongqing Prevention and Treatment Center for Occupational Diseases Chongqing China
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning Chongqing China
- School of Public Health Nanjing Medical University Nanjing China
| | - Xiaohui Zhao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
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20
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Bianchi D, Sethi NK, Velasco G, Qureshi UA, deWeber K. Care of The Older Fighter: Position Statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024:1-7. [PMID: 38708547 DOI: 10.1080/00913847.2024.2344227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
Older Fighters are defined as combat sports athletes older than 35 years, based on heightened medical risks and historical classification. Age-related changes to the neurological, cardiopulmonary, endocrinological, thermoregulatory, osmoregulatory, and musculoskeletal systems increase these athletes' risks for injury and may prolong their recovery. These age-related risks warrant special considerations for competition, licensure, prefight medical clearance, in-fight supervision, post-fight examination, and counseling regarding training practices and retirement from combat sports. Neurological considerations include increased risk of intracranial lesions, intracranial hemorrhage, and sequelae from traumatic brain injury (TBI), warranting more comprehensive neurological evaluation and neuroimaging. Increased risk of myocardial ischemia and infarction warrant careful assessment of cardiac risk factors and scrutiny of cardiovascular fitness. Older fighters may take longer time to recover from musculoskeletal injury; post-injury clearance should be individualized.
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Affiliation(s)
- Davide Bianchi
- Medbase Cornavin Sports Center, SwissBoxing, Geneva, Switzerland
| | - Nitin K Sethi
- Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - George Velasco
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uneeb A Qureshi
- United States Public Health Service, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kevin deWeber
- Program Director, SW Washington Sports Medicine Fellowship, Vancouver, WA USA
- Affiliate Associate Professor of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- Clinical Assistant Professor of Family Medicine, University of Washington, Seattle, WA, USA
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21
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Chrenka EA, Dehmer SP, Maciosek MV, Essien IJ, Westgard BC. Use of Sequential Hot-Deck Imputation for Missing Health Care Systems Data for Population Health Research. Med Care 2024; 62:319-325. [PMID: 38546379 PMCID: PMC10997447 DOI: 10.1097/mlr.0000000000001995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Electronic medical record (EMR) data present many opportunities for population health research. The use of EMR data for population risk models can be impeded by the high proportion of missingness in key patient variables. Common approaches like complete case analysis and multiple imputation may not be appropriate for some population health initiatives that require a single, complete analytic data set. In this study, we demonstrate a sequential hot-deck imputation (HDI) procedure to address missingness in a set of cardiometabolic measures in an EMR data set. We assessed the performance of sequential HDI within the individual variables and a commonly used composite risk score. A data set of cardiometabolic measures based on EMR data from 2 large urban hospitals was used to create a benchmark data set with simulated missingness. Sequential HDI was applied, and the resulting data were used to calculate atherosclerotic cardiovascular disease risk scores. The performance of the imputation approach was assessed using a set of metrics to evaluate the distribution and validity of the imputed data. Of the 567,841 patients, 65% had at least 1 missing cardiometabolic measure. Sequential HDI resulted in the distribution of variables and risk scores that reflected those in the simulated data while retaining correlation. When stratified by age and sex, risk scores were plausible and captured patterns expected in the general population. The use of sequential HDI was shown to be a suitable approach to multivariate missingness in EMR data. Sequential HDI could benefit population health research by providing a straightforward, computationally nonintensive approach to missing EMR data that results in a single analytic data set.
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Affiliation(s)
| | | | | | | | - Bjorn C. Westgard
- HealthPartners Institute, Bloomington, MN
- Regions Hospital, St. Paul, MN
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22
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Heianza Y, Xue Q, Rood J, Clish CB, Bray GA, Sacks FM, Qi L. Changes in bile acid subtypes and improvements in lipid metabolism and atherosclerotic cardiovascular disease risk: the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) trial. Am J Clin Nutr 2024; 119:1293-1300. [PMID: 38428740 PMCID: PMC11130658 DOI: 10.1016/j.ajcnut.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/26/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Distinct circulating bile acid (BA) subtypes may play roles in regulating lipid homeostasis and atherosclerosis. OBJECTIVES We investigated whether changes in circulating BA subtypes induced by weight-loss dietary interventions were associated with improved lipid profiles and atherosclerotic cardiovascular disease (ASCVD) risk estimates. METHODS This study included adults with overweight or obesity (n = 536) who participated in a randomized weight-loss dietary intervention trial. Circulating primary and secondary unconjugated BAs and their taurine-/glycine-conjugates were measured at baseline and 6 mo after the weight-loss diet intervention. The ASCVD risk estimates were calculated using the validated equations. RESULTS At baseline, higher concentrations of specific BA subtypes were related to higher concentrations of atherogenic very low-density lipoprotein lipid subtypes and ASCVD risk estimates. Weight-loss diet-induced decreases in primary BAs were related to larger reductions in triglycerides and total cholesterol [every 1 standard deviation (SD) decrease of glycocholate, glycochenodeoxycholate, or taurochenodeoxycholate was related to β (standard error) -3.3 (1.3), -3.4 (1.3), or -3.8 (1.3) mg/dL, respectively; PFDR < 0.05 for all]. Greater decreases in specific secondary BA subtypes were also associated with improved lipid metabolism at 6 mo; there was β -4.0 (1.1) mg/dL per 1-SD decrease of glycoursodeoxycholate (PFDR =0.003) for changes in low-density lipoprotein cholesterol. We found significant interactions (P-interaction < 0.05) between dietary fat intake and changes in BA subtypes on changes in ASCVD risk estimates; decreases in primary and secondary BAs (such as conjugated cholate or deoxycholate) were significantly associated with improved ASCVD risk after consuming a high-fat diet, but not after consuming a low-fat diet. CONCLUSIONS Decreases in distinct BA subtypes were associated with improved lipid profiles and ASCVD risk estimates, highlighting the importance of changes in circulating BA subtypes as significant factors linked to improved lipid metabolism and ASCVD risk estimates in response to weight-loss dietary interventions. Habitual dietary fat intake may modify the associations of changes in BAs with ASCVD risk. This trial was registered at clinicaltrials.gov as NCT00072995.
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Affiliation(s)
- Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States.
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Jennifer Rood
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Clary B Clish
- Metabolomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Frank M Sacks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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23
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Huang X, Mu M, Wang B, Zhang H, Liu Y, Yu L, Zhou M, Ma J, Wang D, Chen W. Associations of coal mine dust exposure with arterial stiffness and atherosclerotic cardiovascular disease risk in chinese coal miners. Int Arch Occup Environ Health 2024; 97:473-484. [PMID: 38530481 DOI: 10.1007/s00420-024-02062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Whether coal mine dust exposure increases cardiovascular diseases (CVDs) risk was rarely explored. Our objective was to examine the association between coal mine dust exposure and cardiovascular risk. METHODS We estimated cumulative coal mine dust exposure (CDE) for 1327 coal miners by combining data on workplace dust concentrations and work history. We used brachial-ankle pulse wave velocity (baPWV, a representative indicator of arterial stiffness) and ten-year atherosclerotic cardiovascular disease (ASCVD) risk to assess potential CVD risk, exploring their associations with CDE. RESULTS Positive dose-response relationships of CDE with baPWV and ten-year ASCVD risk were observed after adjusting for covariates. Specifically, each 1 standard deviation (SD) increase in CDE was related to a 0.27 m/s (95% CI: 0.21, 0.34) increase in baPWV and a 1.29 (95% CI: 1.14, 1.46) elevation in OR (odds ratio) of risk of abnormal baPWV. Moreover, each 1 SD increase in CDE was associated with a 0.74% (95% CI: 0.63%, 0.85%) increase in scores of ten-year ASCVD and a 1.91 (95% CI: 1.62, 2.26) increase in OR of risk of ten-year ASCVD. When compared with groups unexposed to coal mine dust, significant increase in the risk of arterial stiffness and ten-year ASCVD in the highest CDE groups were detected. CONCLUSION The study suggested that cumulative exposure to coal mine dust was associated with elevated arterial stiffness and ten-year ASCVD risk in a dose-response manner. These findings contribute valuable insights for cardiovascular risk associated with coal mine dust.
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Affiliation(s)
- Xuezan Huang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Min Mu
- Key Laboratory of Industrial Dust Control and Occupational Health of the Ministry of Education, Anhui University of Science and Technology, Huainan, 232000, Anhui, China
| | - Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Haozhe Zhang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yang Liu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Linling Yu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Min Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jixuan Ma
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Dongming Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Tremblay JO, Nahodyl L, Mesa RA, Vilchez L, Elfassy T. Low income and education are associated with greater ASCVD risk scores among adults in the US. Prev Med Rep 2024; 41:102720. [PMID: 38623580 PMCID: PMC11017042 DOI: 10.1016/j.pmedr.2024.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction Social determinants of health (SDOH) are fundamental causes of poor cardiovascular health, yet cardiovascular disease (CVD) risk assessment tools exclude SDOH. Our objective was to determine whether SDOH are independently associated with CVD risk in US adults. Methods Utilizing the National Health and Nutrition Examination Survey (NHANES), we combined years 1999-2018 and included participants aged 40-79 without history of CVD and with information to calculate CVD risk (n = 21,694). Ten-year risk of atherosclerotic CVD (ASCVD) was calculated using the American Heart Association/American College of Cardiology (AHA/ACC) pooled cohort equations. We used linear regression models to estimate the association between SDOH and ASCVD risk, after adjusting for demographic factors. All analyses accounted for the complex survey design. Results Mean age was 54.7 years, with 52.7 % female, 73.8 % non-Hispanic White, 9.4 % non-Hispanic Black, and 10.7 % Hispanic. From adjusted models, compared with an income of ≥ $75 K, ASCVD risk was greater by 3.06 (95 % CI: 2.65, 3.47) among those with income < $25 K, by 1.55 (95 % CI: 1.21, 1.89) among those with income $25 K-<$55 K, and by 1.20 (95 % CI: 0.84, 1.56) among those with income $55 K-<$75 K. Compared to college graduates, ASCVD risk was greater by 3.09 (95 % CI: 2.56, 3.62) among those with less than a high school education, by 1.65 (95 % CI: 1.31, 200) among those who were high school graduates, and by 1.41 (95 % CI: 1.11, 1.72) among those with some college education. Conclusion We found strong graded associations between lower income and lower educational attainment with greater CVD risk.
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Affiliation(s)
- Julien O. Tremblay
- Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lauren Nahodyl
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Robert A. Mesa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lilliana Vilchez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tali Elfassy
- Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
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25
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Shi D, Zhou Y, He S, Wagner SK, Huang Y, Keane PA, Ting DS, Zhang L, Zheng Y, He M. Cross-modality Labeling Enables Noninvasive Capillary Quantification as a Sensitive Biomarker for Assessing Cardiovascular Risk. OPHTHALMOLOGY SCIENCE 2024; 4:100441. [PMID: 38420613 PMCID: PMC10899028 DOI: 10.1016/j.xops.2023.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 03/02/2024]
Abstract
Purpose We aim to use fundus fluorescein angiography (FFA) to label the capillaries on color fundus (CF) photographs and train a deep learning model to quantify retinal capillaries noninvasively from CF and apply it to cardiovascular disease (CVD) risk assessment. Design Cross-sectional and longitudinal study. Participants A total of 90732 pairs of CF-FFA images from 3893 participants for segmentation model development, and 49229 participants in the UK Biobank for association analysis. Methods We matched the vessels extracted from FFA and CF, and used vessels from FFA as labels to train a deep learning model (RMHAS-FA) to segment retinal capillaries using CF. We tested the model's accuracy on a manually labeled internal test set (FundusCapi). For external validation, we tested the segmentation model on 7 vessel segmentation datasets, and investigated the clinical value of the segmented vessels in predicting CVD events in the UK Biobank. Main Outcome Measures Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity for segmentation. Hazard ratio (HR; 95% confidence interval [CI]) for Cox regression analysis. Results On the FundusCapi dataset, the segmentation performance was AUC = 0.95, accuracy = 0.94, sensitivity = 0.90, and specificity = 0.93. Smaller vessel skeleton density had a stronger correlation with CVD risk factors and incidence (P < 0.01). Reduced density of small vessel skeletons was strongly associated with an increased risk of CVD incidence and mortality for women (HR [95% CI] = 0.91 [0.84-0.98] and 0.68 [0.54-0.86], respectively). Conclusions Using paired CF-FFA images, we automated the laborious manual labeling process and enabled noninvasive capillary quantification from CF, supporting its potential as a sensitive screening method for identifying individuals at high risk of future CVD events. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Danli Shi
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yukun Zhou
- Centre for Medical Image Computing, University College London, London, UK
| | - Shuang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Siegfried K. Wagner
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Yu Huang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Pearse A. Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Daniel S.W. Ting
- Singapore National Eye Center, Singapore Eye Research Institute, and Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Lei Zhang
- Faculty of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
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26
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Seehusen KE, Remaley AT, Sampson M, Meeusen JW, Larson NB, Decker PA, Killian JM, Takahashi PY, Roger VL, Manemann SM, Lam R, Bielinski SJ. Discordance Between Very Low-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol Increases Cardiovascular Disease Risk in a Geographically Defined Cohort. J Am Heart Assoc 2024; 13:e031878. [PMID: 38591325 DOI: 10.1161/jaha.123.031878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/08/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Clinical risk scores are used to identify those at high risk of atherosclerotic cardiovascular disease (ASCVD). Despite preventative efforts, residual risk remains for many individuals. Very low-density lipoprotein cholesterol (VLDL-C) and lipid discordance could be contributors to the residual risk of ASCVD. METHODS AND RESULTS Cardiovascular disease-free residents, aged ≥40 years, living in Olmsted County, Minnesota, were identified through the Rochester Epidemiology Project. Low-density lipoprotein cholesterol (LDL-C) and VLDL-C were estimated from clinically ordered lipid panels using the Sampson equation. Participants were categorized into concordant and discordant lipid pairings based on clinical cut points. Rates of incident ASCVD, including percutaneous coronary intervention, coronary artery bypass grafting, stroke, or myocardial infarction, were calculated during follow-up. The association of LDL-C and VLDL-C with ASCVD was assessed using Cox proportional hazards regression. Interaction between LDL-C and VLDL-C was assessed. The study population (n=39 098) was primarily White race (94%) and female sex (57%), with a mean age of 54 years. VLDL-C (per 10-mg/dL increase) was significantly associated with an increased risk of incident ASCVD (hazard ratio, 1.07 [95% CI, 1.05-1.09]; P<0.001]) after adjustment for traditional risk factors. The interaction between LDL-C and VLDL-C was not statistically significant (P=0.11). Discordant individuals with high VLDL-C and low LDL-C experienced the highest rate of incident ASCVD events, 16.9 per 1000 person-years, during follow-up. CONCLUSIONS VLDL-C and lipid discordance are associated with a greater risk of ASCVD and can be estimated from clinically ordered lipid panels to improve ASCVD risk assessment.
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Affiliation(s)
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD
| | - Maureen Sampson
- Clinical Center, Department of Laboratory Medicine National Institutes of Health Bethesda MD
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN
| | | | - Paul A Decker
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
| | - Jill M Killian
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
| | - Paul Y Takahashi
- Division of Community Internal Medicine, Department of Medicine National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD
| | - Véronique L Roger
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
- Epidemiology and Community Health Branch National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD
| | | | - Reyna Lam
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
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Heaton J, Alshami A, Imburgio S, Mararenko A, Schoenfeld M, Sealove B, Asif A, Almendral J. Current Trends in Hypertension Identification and Management: Insights from the National Health and Nutrition Examination Survey (NHANES) Following the 2017 ACC/AHA High Blood Pressure Guidelines. J Am Heart Assoc 2024; 13:e034322. [PMID: 38563377 DOI: 10.1161/jaha.123.034322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hypertension is a global health issue associated with increased cardiovascular morbidity and mortality. This study aimed to investigate contemporary hypertension identification and management trends following the 2017 American College of Cardiology/American Heart Association guidelines. METHODS AND RESULTS Data from the National Health and Nutrition Examination Survey conducted from 2017 to 2020 were analyzed. Participants between 20 and 79 years of age were included. Participants were stratified into different treatment groups based on indication and guideline adherence. Descriptive statistics were used to compare medication use, diagnosis rates, and blood pressure control. A total of 265 402 026 people met the inclusion criteria, of which 19.0% (n=50 349 209) were undergoing guideline antihypertensive management. In the guideline antihypertensive management group, a single antihypertensive class was used to treat 45.7% of participants, and 55.2% had uncontrolled blood pressure. Participants not undergoing guideline antihypertensive management qualified for primary prevention in 11.5% (n=24 741 999) of cases and for secondary prevention in 2.4% (n=5 070 044) of cases; of these, 66.3% (n=19 774 007) did not know they may have hypertension and were not on antihypertensive medication. CONCLUSIONS Adherence to guidelines for antihypertensive management is suboptimal. Over half of patients undergoing guideline treatment had uncontrolled blood pressure. One-third of qualifying participants may not be receiving treatment. Education and medical management were missing for 2 in 3 qualifying participants. Addressing these deficiencies is crucial for improving blood pressure control and reducing cardiovascular event outcomes.
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Affiliation(s)
- Joseph Heaton
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Abbas Alshami
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Steven Imburgio
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Anton Mararenko
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Matthew Schoenfeld
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Brett Sealove
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Arif Asif
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Jesus Almendral
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
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Guo J, Zhong L, Ding S, Xiao G, Huang M, Zhang L, Chen Q. Number of Pregnancies and Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women: A Cross-Sectional Study of NHANES from 1999 to 2018. J Womens Health (Larchmt) 2024. [PMID: 38607374 DOI: 10.1089/jwh.2023.0859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) remains the most common cause of death in women. Pregnancy is an exposure unique to women leading to significant changes in maternal cardiovascular function. However, studies of the relationship between the number of pregnancies and ASCVD are rare. We aimed to clarify the association between the number of pregnancies and ASCVD. Methods: In this cross-sectional study, we used publicly available data from the National Health and Nutrition Examination Survey from 1999 to 2018. The number of pregnancies was divided into 0 (reference), 1, 2-3, 4-5, or ≥6, to create more stable estimates. A multiple logistic regression approach was used to examine the correlation between pregnancy and ASCVD in women aged 45 years or older who reported no menstruation in the past 12 months due to menopause, as well as in those aged 55 years or older, encompassing various age groups. We also separately estimated the association between the exposure of pregnancy and individual components of ASCVD. Results: In this study, age-adjusted data showed that women with six or more pregnancies had a doubled risk (odds ratio [OR]: 2.07) of ASCVD. The risk remained elevated at 1.69 times in women with four to five pregnancies and further increased to 1.90 times in women with six or more pregnancies, after adjusting for social factors. Similar patterns were observed when considering reproductive health and cardiovascular risk factors. Across the full population, every model that accounted for these variables consistently indicated that with an increasing number of pregnancies, we observed higher ORs for ASCVD risk (all p values <0.05). Conclusions: A higher number of pregnancies was associated with a higher risk of ASCVD after menopause, especially among women aged 45-64 years. Moreover, this association is particularly significant in the risk of stroke, cardiovascular heart disease, and heart attack.
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Affiliation(s)
- Jie Guo
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Lingli Zhong
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shan Ding
- Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Guitao Xiao
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Minhong Huang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Li Zhang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Qionghua Chen
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
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Mehraj V, Chen J, Routy JP. Effects of statins beyond lipid-lowering agents in ART-treated HIV infection. Front Immunol 2024; 15:1339338. [PMID: 38655259 PMCID: PMC11035727 DOI: 10.3389/fimmu.2024.1339338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Antiretroviral therapies (ART) have reduced human immunodeficiency virus (HIV) infection-associated morbidity and mortality improving the life of people with HIV (PWH). However, ART lead to residual HIV production, which in conjunction with microbial translocation and immune dysfunction contributes to chronic inflammation and immune activation. PWH on ART remain at an increased risk for cardiovascular diseases (CVDs) including myocardial infarction and stroke; which in part is explained by chronic inflammation and immune activation. Lifestyle factors and certain ART are associated with dyslipidemia characterized by an increase of low-density lipoprotein (LDL), which further contributes in the increased risk for CVDs. Lipid-lowering agents like statins are emerging as immune modulators in decreasing inflammation in a variety of conditions including HIV. The international randomized clinical trial REPRIEVE has shed light on the reduction of CVDs with statin therapy among PWH. Such reports indicate a more than expected benefit of statins beyond their lipid-lowering effects. Bempedoic acid, a first-in-class non-statin LDL-lowering drug with immune modulatory effects, may further aid PWH in combination with statins. Herein, we critically reviewed studies aimed at lipid-lowering and immune-modulating roles of statins that may benefit aging PWH.
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Affiliation(s)
- Vikram Mehraj
- Research Centre McGill University Health Centre, Montreal, QC, Canada
| | - Jun Chen
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jean-Pierre Routy
- Research Centre McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service and Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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Gaertner ML, Mintzer S, DeGiorgio CM. Increased cardiovascular risk in epilepsy. Front Neurol 2024; 15:1339276. [PMID: 38633529 PMCID: PMC11021572 DOI: 10.3389/fneur.2024.1339276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Epilepsy is associated with increased mortality. Cardiovascular disease confers a significant portion of this increased risk. Recently there is increased interest in the burden of cardiovascular mortality in people with epilepsy. This review discusses the most common cardiovascular risk factors and their association with epilepsy including obesity, diabetes mellitus, and hyperlipidemia. Hyperlipidemia related to the use of enzyme inducing anti-seizure medications is also discussed as a topic that is of particular importance to prescribers that have patients with comorbid cardiovascular risk and epilepsy. Heart rate variability (HRV) and its association with SUDEP is discussed as well as a contributor to vascular risk. Finally, the authors discuss a potential role for neurologists who treat epilepsy to engage closer with their patient's cardiovascular risk factors using available tools such as a the ASCVD score calculator to determine the overall risk of mortality, as well as acting upon this information to guide treatment approaches integrating the information provided in this review.
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Affiliation(s)
- Mark L. Gaertner
- Department of Neurology, David Geffen-UCLA School of Medicine, Los Angeles, CA, United States
- Olive View-UCLA Medical Center, Los Angeles, CA, United States
| | - Scott Mintzer
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Christopher M. DeGiorgio
- Department of Neurology, David Geffen-UCLA School of Medicine, Los Angeles, CA, United States
- Olive View-UCLA Medical Center, Los Angeles, CA, United States
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Zou RS, Ruan Y, Truong B, Bhattacharya R, Lu MT, Karády J, Bernardo R, Finneran P, Hornsby W, Fitch KV, Ribaudo HJ, Zanni MV, Douglas PS, Grinspoon SK, Patel AP, Natarajan P. Polygenic Scores and Preclinical Cardiovascular Disease in Individuals With HIV: Insights From the REPRIEVE Trial. J Am Heart Assoc 2024; 13:e033413. [PMID: 38533953 DOI: 10.1161/jaha.123.033413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/23/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of death among the 38.4 million people with HIV globally. The extent to which cardiovascular polygenic risk scores (PRSs) derived in non-HIV populations generalize to people with HIV is not well understood. METHODS AND RESULTS PRSs for CAD (GPSMult) and lipid traits were calculated in a global cohort of people with HIV treated with antiretroviral therapy with low-to-moderate atherosclerotic cardiovascular disease risk enrolled in REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV). The PRSs were associated with baseline lipid traits in 4495 genotyped participants, and with subclinical CAD in a subset of 662 who underwent coronary computed tomography angiography. Among participants who underwent coronary computed tomography angiography (mean age, 50.9 [SD, 5.8] years; 16.1% women; 41.8% African, 57.3% European, 1.1% Asian), GPSMult was associated with plaque presence with odds ratio (OR) per SD in GPSMult of 1.42 (95% CI, 1.20-1.68; P=3.8×10-5), stenosis >50% (OR, 2.39 [95% CI, 1.48-3.85]; P=3.4×10-4), and noncalcified/vulnerable plaque (OR, 1.45 [95% CI, 1.23-1.72]; P=9.6×10-6). Effects were consistent in subgroups of age, sex, 10-year atherosclerotic cardiovascular disease risk, ancestry, and CD4 count. Adding GPSMult to established risk factors increased the C-statistic for predicting plaque presence from 0.718 to 0.734 (P=0.02). Furthermore, a PRS for low-density lipoprotein cholesterol was associated with plaque presence with OR of 1.21 (95% CI, 1.01-1.44; P=0.04), and partially calcified plaque with OR of 1.21 (95% CI, 1.01-1.45; P=0.04) per SD. CONCLUSIONS Among people with HIV treated with antiretroviral therapy without documented atherosclerotic cardiovascular disease and at low-to-moderate calculated risk in REPRIEVE, an externally developed CAD PRS was predictive of subclinical atherosclerosis. PRS for low-density lipoprotein cholesterol was also associated with subclinical atherosclerosis, supporting a role for low-density lipoprotein cholesterol in HIV-associated CAD. REGISTRATION URL: https://www.reprievetrial.org; Unique identifier: NCT02344290.
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Affiliation(s)
- Roger S Zou
- Department of Medicine Massachusetts General Hospital Boston MA USA
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard Cambridge MA USA
- Harvard Medical School Boston MA USA
| | - Yunfeng Ruan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard Cambridge MA USA
| | - Buu Truong
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard Cambridge MA USA
| | - Romit Bhattacharya
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard Cambridge MA USA
- Harvard Medical School Boston MA USA
- Division of Cardiology, Department of Medicine, Center for Genomic Medicine Massachusetts General Hospital Boston MA USA
| | - Michael T Lu
- Harvard Medical School Boston MA USA
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Júlia Karády
- Harvard Medical School Boston MA USA
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Rachel Bernardo
- Division of Cardiology, Department of Medicine, Center for Genomic Medicine Massachusetts General Hospital Boston MA USA
| | - Phoebe Finneran
- Division of Cardiology, Department of Medicine, Center for Genomic Medicine Massachusetts General Hospital Boston MA USA
| | - Whitney Hornsby
- Division of Cardiology, Department of Medicine, Center for Genomic Medicine Massachusetts General Hospital Boston MA USA
| | - Kathleen V Fitch
- Harvard Medical School Boston MA USA
- Metabolism Unit Massachusetts General Hospital Boston MS USA
| | - Heather J Ribaudo
- Department of Biostatistics, Center for Biostatistics in AIDS Research Harvard TH Chan School of Public Health Boston MA USA
| | - Markella V Zanni
- Harvard Medical School Boston MA USA
- Metabolism Unit Massachusetts General Hospital Boston MS USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine Durham NC USA
| | - Steven K Grinspoon
- Harvard Medical School Boston MA USA
- Metabolism Unit Massachusetts General Hospital Boston MS USA
| | - Aniruddh P Patel
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard Cambridge MA USA
- Harvard Medical School Boston MA USA
- Division of Cardiology, Department of Medicine, Center for Genomic Medicine Massachusetts General Hospital Boston MA USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard Cambridge MA USA
- Harvard Medical School Boston MA USA
- Division of Cardiology, Department of Medicine, Center for Genomic Medicine Massachusetts General Hospital Boston MA USA
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Mesa RA, Damas OM, Schneiderman N, Palacio AM, Gallo LC, Talavera GA, Sotres-Alvarez D, Daviglus ML, Pirzada A, Llabre MM, Elfassy T. Association Between High-Sensitivity C-Reactive Protein and Metabolic Syndrome Among Hispanic/Latino Participants of the Hispanic Community Health Study/Study of Latinos. Metab Syndr Relat Disord 2024. [PMID: 38563777 DOI: 10.1089/met.2023.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Purpose: To determine whether high-sensitivity C-reactive protein (hsCRP) is associated with incident Metabolic Syndrome (MetS) among U.S. Hispanic/Latino adults. Patients and Methods: The Hispanic Community Health Study/Study of Latinos is a longitudinal observational cohort assessing cardiovascular health among diverse U.S. Hispanic/Latino adults. hsCRP was measured at visit 1 (2008-2011) and classified as low, moderate, or high, based on the Centers for Disease Control and Prevention and American Heart Association (CDC/AHA) guidelines. All MetS components [abdominal obesity, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and fasting glucose] were measured at visit 1 and visit 2 (2014-2017). MetS was defined as the presence of three or more components based on the 2005 definition from the modified Third Report of the National Cholesterol Education Program Adult Treatment Panel (modified NCEP ATP III). Participants free of MetS at visit 1 and with complete data on hsCRP and all MetS components were included (n = 6121 participants). We used Poisson regression analysis to determine whether hsCRP was associated with incident MetS after adjusting for demographic, behavioral, and clinical factors. All analyses accounted for the complex survey design of the study. Results: In fully adjusted models, moderate versus low hsCRP was associated with a 33% increased risk of MetS [incidence rate ratio (IRR): 1.33, 95% confidence interval (CI): 1.10-1.61], while high versus low hsCRP was associated with a 89% increased risk of MetS (IRR: 1.89, 95% CI: 1.58-2.25). Conclusions: Greater levels of hsCRP were associated with new onset of MetS in a diverse sample of U.S. Hispanic/Latino adults. Results suggest that hsCRP may be an independent risk factor for MetS.
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Affiliation(s)
- Robert A Mesa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Oriana M Damas
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Ana M Palacio
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Gregory A Talavera
- Department of Psychology, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Tali Elfassy
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Razavi AC, Kohli P, McGuire DK, Martin SS, Polonsky TS, McEvoy JW, Whelton SP, Blumenthal RS. PREVENT Equations: A New Era in Cardiovascular Disease Risk Assessment. Circ Cardiovasc Qual Outcomes 2024; 17:e010763. [PMID: 38506044 DOI: 10.1161/circoutcomes.123.010763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Alexander C Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.C.R.)
| | - Payal Kohli
- Department of Cardiology, University of Colorado Anschutz, Aurora (P.K.)
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC (P.K.)
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Tamar S Polonsky
- Section of Cardiology, Division of Medicine, University of Chicago Pritzker School of Medicine, IL (T.S.P.)
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
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Mitro SD, Wise LA, Waetjen LE, Lee C, Zaritsky E, Harlow SD, Solomon DH, Thurston RC, El Khoudary SR, Santoro N, Hedderson MM. Hypertension, Cardiovascular Risk Factors, and Uterine Fibroid Diagnosis in Midlife. JAMA Netw Open 2024; 7:e246832. [PMID: 38625699 PMCID: PMC11022113 DOI: 10.1001/jamanetworkopen.2024.6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/18/2024] [Indexed: 04/17/2024] Open
Abstract
Importance Fibroids are benign neoplasms associated with severe gynecologic morbidity. There are no strategies to prevent fibroid development. Objective To examine associations of hypertension, antihypertensive treatment, anthropometry, and blood biomarkers with incidence of reported fibroid diagnosis in midlife. Design, Setting, and Participants The Study of Women's Health Across the Nation is a prospective, multisite cohort study in the US. Participants were followed-up from enrollment (1996-1997) through 13 semiannual visits (1998-2013). Participants had a menstrual period in the last 3 months, were not pregnant or lactating, were aged 42 to 52 years, were not using hormones, and had a uterus and at least 1 ovary. Participants with prior fibroid diagnoses were excluded. Data analysis was performed from November 2022 to February 2024. Exposures Blood pressure, anthropometry, biomarkers (cholesterol, triglycerides, and C-reactive protein), and self-reported antihypertensive treatment at baseline and follow-up visits were measured. Hypertension status (new-onset, preexisting, or never [reference]) and hypertension treatment (untreated, treated, or no hypertension [reference]) were categorized. Main Outcomes and Measures Participants reported fibroid diagnosis at each visit. Discrete-time survival models estimated hazard ratios (HRs) and 95% CIs for associations of time-varying hypertension status, antihypertensive treatment, anthropometry, and biomarkers with incident reported fibroid diagnoses. Results Among 2570 participants without a history of diagnosed fibroids (median [IQR] age at screening, 45 [43-48] years; 1079 [42.1%] college educated), 526 (20%) reported a new fibroid diagnosis during follow-up. Risk varied by category of hypertension treatment: compared with those with no hypertension, participants with untreated hypertension had a 19% greater risk of newly diagnosed fibroids (HR, 1.19; 95% CI, 0.91-1.57), whereas those with treated hypertension had a 20% lower risk (HR, 0.80; 95% CI, 0.56-1.15). Among eligible participants with hypertension, those taking antihypertensive treatment had a 37% lower risk of newly diagnosed fibroids (HR, 0.63; 95% CI, 0.38-1.05). Risk also varied by hypertension status: compared with never-hypertensive participants, participants with new-onset hypertension had 45% greater risk of newly diagnosed fibroids (HR, 1.45; 95% CI, 0.96-2.20). Anthropometric factors and blood biomarkers were not associated with fibroid risk. Conclusions and Relevance Participants with untreated and new-onset hypertension had increased risk of newly diagnosed fibroids, whereas those taking antihypertensive treatment had lower risk, suggesting that blood pressure control may provide new strategies for fibroid prevention.
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Affiliation(s)
- Susanna D. Mitro
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - L. Elaine Waetjen
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Davis
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Eve Zaritsky
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland
| | - Siobán D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | - Rebecca C. Thurston
- Department of Psychology and Psychiatry, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Samar R. El Khoudary
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
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Vaghefi E, Squirrell D, Yang S, An S, Xie L, Durbin MK, Hou H, Marshall J, Shreibati J, McConnell MV, Budoff M. Development and validation of a deep-learning model to predict 10-year atherosclerotic cardiovascular disease risk from retinal images using the UK Biobank and EyePACS 10K datasets. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:59-69. [PMID: 38765618 PMCID: PMC11096659 DOI: 10.1016/j.cvdhj.2023.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death globally, and early detection of high-risk individuals is essential for initiating timely interventions. The authors aimed to develop and validate a deep learning (DL) model to predict an individual's elevated 10-year ASCVD risk score based on retinal images and limited demographic data. Methods The study used 89,894 retinal fundus images from 44,176 UK Biobank participants (96% non-Hispanic White, 5% diabetic) to train and test the DL model. The DL model was developed using retinal images plus age, race/ethnicity, and sex at birth to predict an individual's 10-year ASCVD risk score using the pooled cohort equation (PCE) as the ground truth. This model was then tested on the US EyePACS 10K dataset (5.8% non-Hispanic White, 99.9% diabetic), composed of 18,900 images from 8969 diabetic individuals. Elevated ASCVD risk was defined as a PCE score of ≥7.5%. Results In the UK Biobank internal validation dataset, the DL model achieved an area under the receiver operating characteristic curve of 0.89, sensitivity 84%, and specificity 90%, for detecting individuals with elevated ASCVD risk scores. In the EyePACS 10K and with the addition of a regression-derived diabetes modifier, it achieved sensitivity 94%, specificity 72%, mean error -0.2%, and mean absolute error 3.1%. Conclusion This study demonstrates that DL models using retinal images can provide an additional approach to estimating ASCVD risk, as well as the value of applying DL models to different external datasets and opportunities about ASCVD risk assessment in patients living with diabetes.
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Affiliation(s)
| | | | | | | | - Li Xie
- Toku Eyes, Auckland, New Zealand
| | | | | | - John Marshall
- Institute of Ophthalmology, University College of London, London, United Kingdom
| | | | - Michael V. McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
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Alkis T, Luo X, Wall K, Brody J, Bartz T, Chang PP, Norby FL, Hoogeveen RC, Morrison AC, Ballantyne CM, Coresh J, Boerwinkle E, Psaty BM, Shah AM, Yu B. A polygenic risk score of atrial fibrillation improves prediction of lifetime risk for heart failure. ESC Heart Fail 2024; 11:1086-1096. [PMID: 38258344 PMCID: PMC10966276 DOI: 10.1002/ehf2.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/01/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
AIMS Heart failure (HF) has shared genetic architecture with its risk factors: atrial fibrillation (AF), body mass index (BMI), coronary heart disease (CHD), systolic blood pressure (SBP), and type 2 diabetes (T2D). We aim to assess the association and risk prediction performance of risk-factor polygenic risk scores (PRSs) for incident HF and its subtypes in bi-racial populations. METHODS AND RESULTS Five PRSs were constructed for AF, BMI, CHD, SBP, and T2D in White participants of the Atherosclerosis Risk in Communities (ARIC) study. The associations between PRSs and incident HF and its subtypes were assessed using Cox models, and the risk prediction performance of PRSs was assessed using C statistics. Replication was performed in the ARIC study Black and Cardiovascular Health Study (CHS) White participants. In 8624 ARIC study Whites, 1922 (31% cumulative incidence) HF cases developed over 30 years of follow-up. PRSs of AF, BMI, and CHD were associated with incident HF (P < 0.001), where PRSAF showed the strongest association [hazard ratio (HR): 1.47, 95% confidence interval (CI): 1.41-1.53]. Only the addition of PRSAF to the ARIC study HF risk equation improved C statistics for 10 year risk prediction from 0.812 to 0.829 (∆C: 0.017, 95% CI: 0.009-0.026). The PRSAF was associated with both incident HF with reduced ejection fraction (HR: 1.43, 95% CI: 1.27-1.60) and incident HF with preserved ejection fraction (HR: 1.46, 95% CI: 1.33-1.62). The associations between PRSAF and incident HF and its subtypes, as well as the improved risk prediction, were replicated in the ARIC study Blacks and the CHS Whites (P < 0.050). Protein analyses revealed that N-terminal pro-brain natriuretic peptide and other 98 proteins were associated with PRSAF. CONCLUSIONS The PRSAF was associated with incident HF and its subtypes and had significant incremental value over an established HF risk prediction equation.
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Affiliation(s)
- Taryn Alkis
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTXUSA
| | - Xi Luo
- Department of Biostatistics and Data Science, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTXUSA
| | - Katherine Wall
- Department of Biostatistics and Data Science, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTXUSA
| | - Jennifer Brody
- Cardiovascular Health Research UnitUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Traci Bartz
- Cardiovascular Health Research Unit, Departments of Medicine and BiostatisticsUniversity of WashingtonSeattleWAUSA
| | - Patricia P. Chang
- Division of CardiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - Faye L. Norby
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMNUSA
| | | | - Alanna C. Morrison
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTXUSA
| | | | - Josef Coresh
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTXUSA
- Human Genome Sequencing CenterBaylor College of MedicineHoustonTXUSA
| | - Bruce M. Psaty
- Cardiovascular Health Research UnitUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Health Systems and Population HealthUniversity of WashingtonSeattleWAUSA
| | - Amil M. Shah
- Department of Internal MedicineUT Southwestern Medical CenterDallasTXUSA
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTXUSA
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Beaudoin JR, Curran J, Alexander GC. Impact of Race on Classification of Atherosclerotic Risk Using a National Cardiovascular Risk Prediction Tool. AJPM FOCUS 2024; 3:100200. [PMID: 38440670 PMCID: PMC10910235 DOI: 10.1016/j.focus.2024.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Introduction The use of race in clinical risk prediction tools may exacerbate racial disparities in healthcare access and outcomes. This study quantified the number of individuals reclassified for primary prevention of cardiovascular disease owing to a change in their race alone on the basis of a commonly used risk prediction tool. Methods This is a cross-sectional analysis of individuals aged 40-75 years without a history of cardiovascular events, diabetes, or other high-risk features using the 2005-2018 National Health and Nutritional Examination Survey. Authors compared atherosclerotic cardiovascular disease risk scores using the American Heart Association/American College of Cardiology equation recommended for White individuals or individuals of other races with that recommended for Black individuals. Results A total of 2,946 White individuals; 1,361 Black individuals; and 2,495 individuals of other races were included in the analysis. Using the American Heart Association/American College of Cardiology equation, the mean 10-year atherosclerotic cardiovascular disease risk was 5.80% (95% CI=5.54, 6.06) for White individuals, 7.04% (956% CI=6.69, 7.39) for Black individuals, and 4.93% (95% CI=4.61, 5.24) for individuals of other races. When using the American Heart Association/American College of Cardiology equation designated for the opposite race (White/other race versus Black), the mean atherosclerotic cardiovascular disease risk score increased by 1.02% (95% CI=0.90, 1.13) for White individuals, decreased by 1.82% (95% CI= -1.67, -1.96) for Black individuals, and increased by 0.98% (95% CI=0.85, 1.10) for individuals of other races. When using clinical atherosclerotic cardiovascular disease categories of <7.5%, 7.5%-10%, and >10%, 16.93% of all individuals were reclassified when using the American Heart Association/American College of Cardiology's equation designated for the opposite race. Conclusions Changing race within a commonly used cardiovascular risk prediction tool results in significant changes in risk classification among eligible White and Black individuals in the U.S.
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Affiliation(s)
- Jarett R. Beaudoin
- Department of Family and Community Medicine, University of California, Davis, California
| | - Jill Curran
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Tangjitgamol S, Udayachalerm W, Panyarachun S, Wanishsawad C, Kaewwanna W, Manusirivithaya S. The 10-year cardiovascular risk of physicians estimated by the Thai CV risk score and its association with current coronary artery disease: A retrospective study. Health Sci Rep 2024; 7:e2009. [PMID: 38629110 PMCID: PMC11019138 DOI: 10.1002/hsr2.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/04/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Background and Aims To assess the 10-year cardiovascular disease (CVD) risk among Thai physicians. The risk compared to the general population and their relationship with the current coronary artery disease (CAD) were also examined. Methods This retrospective study collected data of Thai physicians who underwent cardiovascular assessments between February 14, 2022, and October 31, 2022. The CVD risk was calculated using the Thai CVD risk (TCVR) score, which incorporated variables of age, gender, smoking, diabetes mellitus, blood pressure, and total cholesterol. Additional collected data included family history of CAD, weekly work hours, fiber diet, exercise, body mass index, coronary artery calcium (CAC) score, and presence of CAD. The association between the risk levels with presence of CAD and clinical features including CAC score were analyzed. Results Of 1225 physicians, the risk for CVD development was categorized as low in 80.0%, moderate in 11.2%, high in 4.9%, and very high in 3.9%. Among these, 33.6% were found to have higher relative risk compared to the general population of the same age and gender. The overall prevalence of CAD was 11.2%. This prevalence was escalated by risk or relative risk groups: 4.9% in low-, 33.8% in moderate-, 35.1% in high-, and 46.8% in very high-risk groups or 7.2% in lower risk, 8.0% the same risk, and 18.4% higher relative risk groups. Conclusions Approximately, 20% of Thai physicians in the study exhibited a moderate to very high 10-year risk of CVD. Furthermore, 33.6% of the physicians had higher risk than individuals of the same age and gender in the general population. The prevalence of CAD increased with higher CVD risk and higher relative risk.
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Xia M, An J, Safford MM, Colantonio LD, Sims M, Reynolds K, Moran AE, Zhang Y. Cardiovascular Risk Associated With Social Determinants of Health at Individual and Area Levels. JAMA Netw Open 2024; 7:e248584. [PMID: 38669015 PMCID: PMC11053380 DOI: 10.1001/jamanetworkopen.2024.8584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance The benefit of adding social determinants of health (SDOH) when estimating atherosclerotic cardiovascular disease (ASCVD) risk is unclear. Objective To examine the association of SDOH at both individual and area levels with ASCVD risks, and to assess if adding individual- and area-level SDOH to the pooled cohort equations (PCEs) or the Predicting Risk of CVD Events (PREVENT) equations improves the accuracy of risk estimates. Design, Setting, and Participants This cohort study included participants data from 4 large US cohort studies. Eligible participants were aged 40 to 79 years without a history of ASCVD. Baseline data were collected from 1995 to 2007; median (IQR) follow-up was 13.0 (9.3-15.0) years. Data were analyzed from September 2023 to February 2024. Exposures Individual- and area-level education, income, and employment status. Main outcomes and measures ASCVD was defined as the composite outcome of nonfatal myocardial infarction, death from coronary heart disease, and fatal or nonfatal stroke. Results A total of 26 316 participants were included (mean [SD] age, 61.0 [9.1] years; 15 494 women [58.9%]; 11 365 Black [43.2%], 703 Chinese American [2.7%], 1278 Hispanic [4.9%], and 12 970 White [49.3%]); 11 764 individuals (44.7%) had at least 1 adverse individual-level SDOH and 10 908 (41.5%) had at least 1 adverse area-level SDOH. A total of 2673 ASCVD events occurred during follow-up. SDOH were associated with increased risk of ASCVD at both the individual and area levels, including for low education (individual: hazard ratio [HR], 1.39 [95% CI, 1.25-1.55]; area: HR, 1.31 [95% CI, 1.20-1.42]), low income (individual: 1.35 [95% CI, 1.25-1.47]; area: HR, 1.28 [95% CI, 1.17-1.40]), and unemployment (individual: HR, 1.61 [95% CI, 1.24-2.10]; area: HR, 1.25 [95% CI, 1.14-1.37]). Adding area-level SDOH alone to the PCEs did not change model discrimination but modestly improved calibration. Furthermore, adding both individual- and area-level SDOH to the PCEs led to a modest improvement in both discrimination and calibration in non-Hispanic Black individuals (change in C index, 0.0051 [95% CI, 0.0011 to 0.0126]; change in scaled integrated Brier score [IBS], 0.396% [95% CI, 0.221% to 0.802%]), and improvement in calibration in White individuals (change in scaled IBS, 0.274% [95% CI, 0.095% to 0.665%]). Adding individual-level SDOH to the PREVENT plus area-level social deprivation index (SDI) equations did not improve discrimination but modestly improved calibration in White participants (change in scaled IBS, 0.182% [95% CI, 0.040% to 0.496%]), Black participants (0.187% [95% CI, 0.039% to 0.501%]), and women (0.289% [95% CI, 0.115% to 0.574%]). Conclusions and Relevance In this cohort study, both individual- and area-level SDOH were associated with ASCVD risk; adding both individual- and area-level SDOH to the PCEs modestly improved discrimination and calibration for estimating ASCVD risk for Black individuals, and adding individual-level SDOH to PREVENT plus SDI also modestly improved calibration. These findings suggest that both individual- and area-level SDOH may be considered in future development of ASCVD risk assessment tools, particularly among Black individuals.
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Affiliation(s)
- Mengying Xia
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jaejin An
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Mario Sims
- Department of Social Medicine, Population, and Public Health, University of California, Riverside
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Andrew E. Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yiyi Zhang
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
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Park YS, Jang HM, Park JH, Kim BJ, Park HY, Kim YJ. Evaluating cardiovascular disease risk stratification using multiple-polygenic risk scores and pooled cohort equations: insights from a 17-year longitudinal Korean cohort study. Front Genet 2024; 15:1364993. [PMID: 38606355 PMCID: PMC11007088 DOI: 10.3389/fgene.2024.1364993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, caused by a complex interplay of genetic and environmental factors. This study aimed to evaluate the combined efficacy of multi-polygenic risk scores and pooled cohort equations (PCE) for predicting future CVD risks in the Korean population. In this longitudinal study, 7,612 individuals from the Ansan and Ansung cohorts were analyzed over a 17-year follow-up period. The participants were genotyped using the Korea Biobank Array, and quality-controlled genetic data were subjected to imputation analysis. The weighted sum of the PRSs (wPRSsum) was calculated using PRS-CS with summary statistics from myocardial infarction, ischemic stroke, coronary artery disease, and hypertension genome-wide association studies. The recalibrated PCE was used to assess clinical risk, and the participants were stratified into risk groups based on the wPRSsum and PCE. Associations between these risk scores and incident CVD were evaluated using Cox proportional hazards models and Kaplan-Meier analysis. The wPRSsum approach showed a significant association with incident CVD (HR = 1.15, p = 7.49 × 10-5), and the top 20% high-risk genetic group had an HR of 1.50 (p = 5.04 × 10-4). The recalibrated PCE effectively differentiated between the low and high 10-year CVD risk groups, with a marked difference in survival rates. The predictive models constructed using the wPRSsum and PCE demonstrated a slight improvement in prediction accuracy, particularly among males aged <55 years (C-index = 0.640). We demonstrated that while the integration of wPRSsum with PCE did not significantly outperform the PCE-only model (C-index: 0.703 for combined and 0.704 for PCE-only), it provided enhanced stratification of CVD risk. The highest risk group, identified through the combination of high wPRSsum and PCE scores, exhibited an HR of 4.99 for incident CVD (p = 1.45 × 10-15). These findings highlight the potential of integrating genetic risk assessments with traditional clinical tools for effective CVD risk stratification. Although the addition of wPRSsum to the PCE provided a marginal predictive improvement, it proved valuable in identifying high-risk individuals and supporting personalized treatment strategies. This study reinforces the utility of multi-PRS in conjunction with clinical risk assessment tools, paving the way for more tailored approaches for CVD prevention and management in diverse populations.
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Affiliation(s)
- Yi Seul Park
- Division of Genome Science, Department of Precision Medicine, National Institute of Health, Cheongju-si, Republic of Korea
| | - Hye-Mi Jang
- Division of Genome Science, Department of Precision Medicine, National Institute of Health, Cheongju-si, Republic of Korea
| | - Ji Hye Park
- Division of Genome Science, Department of Precision Medicine, National Institute of Health, Cheongju-si, Republic of Korea
| | - Bong-Jo Kim
- Division of Genome Science, Department of Precision Medicine, National Institute of Health, Cheongju-si, Republic of Korea
| | - Hyun-Young Park
- National Institute of Health, Cheongju-si, Republic of Korea
| | - Young Jin Kim
- Division of Genome Science, Department of Precision Medicine, National Institute of Health, Cheongju-si, Republic of Korea
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Leucker TM, Harb T, Gerstenblith G, Celentano DD, Ziogos E, Treisman G, Mandler RN, Khalsa J, Charurat M, Lai S, Lai H. Homocysteine modifies the association of coronary stenosis and HIV infection in an inner city African American population. Int J STD AIDS 2024:9564624241242171. [PMID: 38531830 DOI: 10.1177/09564624241242171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND AIMS People with HIV (PWH) whose disease is controlled on anti-retroviral regimens remain at an increased risk for coronary artery disease (CAD). Traditional cardiovascular risk factors do not fully explain the residual risk in PWH suggesting contributions from nontraditional factors. Homocysteine (Hcy) may be one of these as prior work in adults without HIV demonstrate that Hcy may impair endothelial function by decreasing the availability of nitric oxide, promoting the development of atherosclerosis. In addition, plasma Hcy levels are higher in PWH than in individuals living without HIV. The aim of this study was to investigate whether Hcy levels influence the association between HIV and coronary stenosis in an inner city African American population. METHODS African Americans from the Heart Study in Baltimore, with and without HIV, recruited from inner-city Baltimore between June 2004 and February 2015, were included in this analysis. Participants underwent coronary CT angiography to evaluate the presence of coronary stenosis, defined as luminal stenosis >10%. Hcy was measured from stored serum samples. RESULTS In this analysis, the median [IQR] age of the 664 participants was 56 [50-66] years; 68.1% were living with HIV and 43.1% were women. Elevated Hcy (>15 µmol/L) was more prevalent in those with coronary stenosis (23.3%, 95% CI: 18.4%-28.2%) than in those without coronary stenosis (13.1%, 95% CI: 9.7%-16.5%) (p = 0.0007), and HIV was associated with coronary stenosis in those participants with an elevated Hcy (Prevalence Ratio: 1.94, 95% CI: 1.04-3.64, p = 0.0038) and not in those with a Hcy ≤15 µmol/L (Prevalence Ratio: 1.02, 95% CI: 0.83-1.25, p = 0.87). CONCLUSIONS Our data suggest an association between elevated Hcy levels (>15 µmol/L) and the prevalence of coronary stenosis in PWH from this inner city African American population.
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Affiliation(s)
- Thorsten M Leucker
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tarek Harb
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Efthymios Ziogos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Glenn Treisman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Jag Khalsa
- Department of Microbiology, Immunology and Tropical Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shenghan Lai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hong Lai
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Barnado A, Moore RP, Domenico HJ, Green S, Camai A, Suh A, Han B, Walker K, Anderson A, Caruth L, Katta A, McCoy AB, Byrne DW. Identifying antinuclear antibody positive individuals at risk for developing systemic autoimmune disease: development and validation of a real-time risk model. Front Immunol 2024; 15:1384229. [PMID: 38571954 PMCID: PMC10987951 DOI: 10.3389/fimmu.2024.1384229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Objective Positive antinuclear antibodies (ANAs) cause diagnostic dilemmas for clinicians. Currently, no tools exist to help clinicians interpret the significance of a positive ANA in individuals without diagnosed autoimmune diseases. We developed and validated a risk model to predict risk of developing autoimmune disease in positive ANA individuals. Methods Using a de-identified electronic health record (EHR), we randomly chart reviewed 2,000 positive ANA individuals to determine if a systemic autoimmune disease was diagnosed by a rheumatologist. A priori, we considered demographics, billing codes for autoimmune disease-related symptoms, and laboratory values as variables for the risk model. We performed logistic regression and machine learning models using training and validation samples. Results We assembled training (n = 1030) and validation (n = 449) sets. Positive ANA individuals who were younger, female, had a higher titer ANA, higher platelet count, disease-specific autoantibodies, and more billing codes related to symptoms of autoimmune diseases were all more likely to develop autoimmune diseases. The most important variables included having a disease-specific autoantibody, number of billing codes for autoimmune disease-related symptoms, and platelet count. In the logistic regression model, AUC was 0.83 (95% CI 0.79-0.86) in the training set and 0.75 (95% CI 0.68-0.81) in the validation set. Conclusion We developed and validated a risk model that predicts risk for developing systemic autoimmune diseases and can be deployed easily within the EHR. The model can risk stratify positive ANA individuals to ensure high-risk individuals receive urgent rheumatology referrals while reassuring low-risk individuals and reducing unnecessary referrals.
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Affiliation(s)
- April Barnado
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ryan P. Moore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Henry J. Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah Green
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Alex Camai
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ashley Suh
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bryan Han
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Katherine Walker
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Audrey Anderson
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lannawill Caruth
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anish Katta
- Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Allison B. McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel W. Byrne
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
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Wang Z, Yang X, Li L, Zhang X, Zhou W, Chen S. Comparative Analysis of Three Atherosclerotic Cardiovascular Disease Risk Prediction Models in Individuals Aged 75 and Older. Clin Interv Aging 2024; 19:529-538. [PMID: 38525315 PMCID: PMC10961081 DOI: 10.2147/cia.s454060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To evaluate the performance of the Framingham cardiovascular risk score (FRS)/pooled cohort equations (PCE)/China prediction for atherosclerotic cardiovascular disease (ASCVD) risk (China-PAR model) in a prospective cohort of Chinese older adults. Patients and Methods We assessed 717 older adults aged 75-85 years without ASCVD at the baseline from the Sichuan province of China. The participants were followed annually from 2011 to 2021. We obtained the participants' information through the medical records of physical examination and evaluated their 10-year ASCVD risk using FRS, PCE, and China-PAR. We further evaluated the predictive abilities of three assessment models. Results During the 10-year follow-up, 206 participants developed ASCVD, with an incidence rate of 28.73%. The FRS and China-PAR moderately underestimated the risk of ASCVD (22.1% and 12.4%, respectively), but while PCE overestimated the risk (36.1%). FRS and China-PAR were found to underestimate the risk of ASCVD (26% and 63%, respectively) for men, while PCE overestimated the risk by 8%; For women, FRS and China-PAR were found to underestimate the risk of ASCVD (14% and 35%, respectively), while PCE overestimated the risk by 88%. Conclusion The 10-year ASCVD risk was found to be overestimated by PCE. China-PAR had the most accurate predictions in women, while FRS was particularly well-calibrated in males. All three risk models have good discrimination, with FRS and PCE being well-calibrated in men and all three being well-calibrated in women. Therefore, accurate risk models are warranted to facilitate the prevention of ASCVD at the baseline among Chinese older adults.
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Affiliation(s)
- Zhang Wang
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Xue Yang
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Longxin Li
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Xiaobo Zhang
- The Third People’s Hospital of Beichuan Qiang Autonomous County, Mianyang, People’s Republic of China
| | - Wenlin Zhou
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Sixue Chen
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
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A M, L V, G M, M M, A B, G F, B M, A C, G CM, S C, C P, A U, F G, M M, P DA, G S, A Z, C C, F D. Fitness age outperforms body mass index in differentiating aging patterns and health risk profiles of healthy adults aged 51-80 years. GeroScience 2024:10.1007/s11357-024-01125-z. [PMID: 38499955 DOI: 10.1007/s11357-024-01125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
Physical fitness has been extensively shown to strongly associate with general health status and major health risks. Here we tested the ability of a novel estimate of fitness age (FitAge) to differentiate aging trajectories.This study aimed at (1) testing the ability of FitAge to differentiate aging patterns among decelerated, normal, and accelerated agers in selected health domains, (2) estimating the risk for developing major health issues depending on the aging trajectory, and (3) comparing FitAge to body mass index (BMI) categorization in differentiating healthy from unhealthy aging patterns.A total of 176 volunteers participated in this cross-sectional study. Participants underwent clinical screening and a comprehensive assessment of body composition, nutritional and health-related status, cognitive functioning, and haematochemical analyses with routine tests, oxidative stress, and inflammation markers. Scores for major health risks were also computed.FitAge outperformed BMI in estimating major health risk scores and was able to differentiate decelerated from normal and accelerated agers for health risk profile and several physiological domains. Body composition, immune system activation, and inflammation markers emerged as those variables flagging the largest differences between decelerated and accelerated aging patterns.The novel estimate of biological aging can accurately differentiate both in women and men decelerated from accelerated agers in almost all the domains scrutinized. Overall, decelerated aging is linked to positively oriented features which associate with reduced risk of developing major health issues.The present findings have potential relevance and practical implications to identify individuals at higher risk of accelerated aging according to their FitAge estimated via simple and cost-effective motor tests.
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Affiliation(s)
- Manca A
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Ventura L
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Martinez G
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Morrone M
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Boi A
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Fiorito G
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
- IRCCS Ospedale Pediatrico Giannina Gaslini, Genoa, Italy
| | - Mercante B
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Cano A
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Catte M G
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Cruciani S
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Pozzati C
- Department of History, Human Sciences and Education, University of Sassari, Sassari, Italy
| | - Uccula A
- Department of History, Human Sciences and Education, University of Sassari, Sassari, Italy
| | - Ginatempo F
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Maioli M
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Delitala A P
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Solinas G
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Zinellu A
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Carru C
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Deriu F
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy.
- Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy.
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Goldberg JF, Hyun G, Ness KK, Dixon SB, Towbin JA, Rhea IB, Ehrhardt MJ, Srivastava DK, Mulrooney DA, Hudson MM, Robison LL, Jefferies JL, Rohatgi A, Armstrong GT. Dyslipidemia and cardiovascular disease among childhood cancer survivors: a St. Jude Lifetime Cohort report. J Natl Cancer Inst 2024; 116:408-420. [PMID: 37952244 PMCID: PMC10919333 DOI: 10.1093/jnci/djad222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Childhood cancer survivors have increased risk of dyslipidemia and atherosclerotic cardiovascular disease (CVD). The aim of this study was to evaluate the prevalence and associated cardiovascular risks of specific lipid abnormalities among childhood cancer survivors. METHODS Comprehensive lipid panel measurements were obtained from 4115 5-year survivors, with 3406 (mean age at evaluation = 35.2 years, SD = 10.4 years) not having previous dyslipidemia diagnosis, as well as 624 age, sex, and race and ethnicity matched community controls. RESULTS Previously undiagnosed dyslipidemia with abnormal low-density lipoprotein (LDL) cholesterol (>160 mg/dL), non-high density lipoprotein (HDL) cholesterol (>190 mg/dL), HDL cholesterol (<40 mg/dL for men, <50 mg/dL for women), and triglycerides (>150 mg/dL) were identified in 4%, 6%, 30%, and 17%, respectively. Survivors without previous dyslipidemia diagnosis had higher LDL cholesterol and non-HDL cholesterol and lower HDL cholesterol than community controls. Cranial radiotherapy (relative risk [RR] = 2.2, 95% confidence interval [CI] = 1.6 to 3.0 for non-HDL cholesterol) and total body irradiation for hematopoietic cell transplantation (RR = 6.7, 95% CI = 3.5 to 13.0 for non-HDL cholesterol; RR = 9.9, 95% CI = 6.0 to 16.3 for triglycerides) were associated with greater risk of dyslipidemia. Diagnoses of low HDL cholesterol (hazard ratio [HR] = 2.9, 95% CI = 1.8 to 4.7) and elevated triglycerides (HR = 3.1, 95% CI = 1.9 to 5.1) were associated with increased risk for myocardial infarction, and diagnoses of high LDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), high non-HDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), low HDL cholesterol (HR = 3.9, 95% CI = 2.8 to 5.4), and elevated triglycerides (HR = 3.8, 95% CI = 2.7 to 5.5) were associated with increased risk for cardiomyopathy. CONCLUSIONS Previously undiagnosed dyslipidemia among childhood cancer survivors was associated with increased risk for myocardial infarction and cardiomyopathy. Comprehensive dyslipidemia evaluation and treatment are needed to reduce cardiovascular morbidity in this population.
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Affiliation(s)
- Jason F Goldberg
- Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Geehong Hyun
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Stephanie B Dixon
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jeffrey A Towbin
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Isaac B Rhea
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - John L Jefferies
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anand Rohatgi
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Zheutlin AR, Sharareh N, Guadamuz JS, Berchie RO, Derington CG, Jacobs JA, Mondesir FL, Alexander GC, Levitan EB, Safford M, Vos RO, Qato DM, Bress AP. Association Between Pharmacy Proximity With Cardiovascular Medication Use and Risk Factor Control in the United States. J Am Heart Assoc 2024; 13:e031717. [PMID: 38390820 PMCID: PMC10944071 DOI: 10.1161/jaha.123.031717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Poor neighborhood-level access to health care, including community pharmacies, contributes to cardiovascular disparities in the United States. The authors quantified the association between pharmacy proximity, antihypertensive and statin use, and blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) among a large, diverse US cohort. METHODS AND RESULTS A cross-sectional analysis of Black and White participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study during 2013 to 2016 was conducted. The authors designated pharmacy proximity by census tract using road network analysis with population-weighted centroids within a 10-minute drive time, with 5- and 20-minute sensitivity analyses. Pill bottle review measured medication use, and BP and LDL-C were assessed using standard methods. Poisson regression was used to quantify the association between pharmacy proximity with medication use and BP control, and linear regression for LDL-C. Among 16 150 REGARDS participants between 2013 and 2016, 8319 (51.5%) and 8569 (53.1%) had an indication for antihypertensive and statin medication, respectively, and pharmacy proximity data. The authors did not find a consistent association between living in a census tract with higher pharmacy proximity and antihypertensive medication use, BP control, or statin medication use and LDL-C levels, regardless of whether the area was rural, suburban, or urban. Results were similar among the 5- and 20-minute drive-time analyses. CONCLUSIONS Living in a low pharmacy proximity census tract may be associated with antihypertensive and statin medication use, or with BP control and LDL-C levels. Although, in this US cohort, outcomes were similar for adults living in high or low pharmacy proximity census tracts.
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Affiliation(s)
- Alexander R. Zheutlin
- Division of Cardiology, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Nasser Sharareh
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Jenny S. Guadamuz
- Division of Health Policy and ManagementUniversity of California, Berkeley, School of Public HealthBerkeleyCAUSA
| | - Ransmond O. Berchie
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Catherine G. Derington
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Joshua A. Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Favel L. Mondesir
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - G. Caleb Alexander
- Department of EpidemiologyCenter for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of MedicineJohns Hopkins MedicineBaltimoreMDUSA
| | - Emily B. Levitan
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical CollegeCornell UniversityNew YorkNYUSA
| | - Robert O. Vos
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Dima M. Qato
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern CaliforniaLos AngelesCAUSA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Alfred Mann School of Pharmacy and Pharmaceutical SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Adam P. Bress
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
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Lim KK, Koleva‐Kolarova R, Kamaruzaman HF, Kamil AA, Chowienczyk P, Wolfe CDA, Fox‐Rushby J. Genetic-Guided Pharmacotherapy for Coronary Artery Disease: A Systematic and Critical Review of Economic Evaluations. J Am Heart Assoc 2024; 13:e030058. [PMID: 38390792 PMCID: PMC10944053 DOI: 10.1161/jaha.123.030058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/15/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Genetic-guided pharmacotherapy (PGx) is not recommended in clinical guidelines for coronary artery disease (CAD). We aimed to examine the extent and quality of evidence from economic evaluations of PGx in CAD and to identify variables influential in changing conclusions on cost-effectiveness. METHODS AND RESULTS From systematic searches across 6 databases, 2 independent reviewers screened, included, and rated the methodological quality of economic evaluations of PGx testing to guide pharmacotherapy for patients with CAD. Of 35 economic evaluations included, most were model-based cost-utility analyses alone, or alongside cost-effectiveness analyses of PGx testing to stratify patients into antiplatelets (25/35), statins (2/35), pain killers (1/35), or angiotensin-converting enzyme inhibitors (1/35) to predict CAD risk (8/35) or to determine the coumadin doses (1/35). To stratify patients into antiplatelets (96/151 comparisons with complete findings of PGx versus non-PGx), PGx was more effective and more costly than non-PGx clopidogrel (28/43) but less costly than non-PGx prasugrel (10/15) and less costly and less effective than non-PGx ticagrelor (22/25). To predict CAD risk (51/151 comparisons), PGx using genetic risk scores was more effective and less costly than clinical risk score (13/17) but more costly than no risk score (16/19) or no treatment (9/9). The remaining comparisons were too few to observe any trend. Mortality risk was the most common variable (47/294) changing conclusions. CONCLUSIONS Economic evaluations to date found PGx to stratify patients with CAD into antiplatelets or to predict CAD risk to be cost-effective, but findings varied based on the non-PGx comparators, underscoring the importance of considering local practice in deciding whether to adopt PGx.
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Affiliation(s)
- Ka Keat Lim
- School of Life Course & Population SciencesFaculty of Life Sciences & Medicine, King’s College LondonLondonUnited Kingdom
| | - Rositsa Koleva‐Kolarova
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Hanin Farhana Kamaruzaman
- Health Economics and Health Technology Assessment (HEHTA), School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
- Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of HealthPutrajayaMalaysia
| | - Ahmad Amir Kamil
- School of Life Course & Population SciencesFaculty of Life Sciences & Medicine, King’s College LondonLondonUnited Kingdom
| | - Phil Chowienczyk
- School of Life Course & Population SciencesFaculty of Life Sciences & Medicine, King’s College LondonLondonUnited Kingdom
- King’s College London British Heart Foundation CentreSt. Thomas’ Hospital, Westminster BridgeLondonUnited Kingdom
| | - Charles D. A. Wolfe
- School of Life Course & Population SciencesFaculty of Life Sciences & Medicine, King’s College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South LondonLondonUnited Kingdom
| | - Julia Fox‐Rushby
- School of Life Course & Population SciencesFaculty of Life Sciences & Medicine, King’s College LondonLondonUnited Kingdom
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Longenecker CT, Jones KA, Hileman CO, Okeke NL, Gripshover BM, Aifah A, Bloomfield GS, Muiruri C, Smith VA, Vedanthan R, Webel AR, Bosworth HB. Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2356445. [PMID: 38441897 PMCID: PMC10915684 DOI: 10.1001/jamanetworkopen.2023.56445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 03/07/2024] Open
Abstract
Importance Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of HIV primary care. Objective To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non-high-density lipoprotein (HDL) cholesterol level in a diverse population of PWH receiving antiretroviral therapy (ART). Design, Setting, and Participants This randomized clinical trial enrolled PWH at 3 academic HIV clinics in the US from September 2019 to January 2022 and conducted follow-up for 12 months until January 2023. Included patients were 18 years or older and had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. Participants were stratified by trial site and randomized 1:1 to either the multicomponent EXTRA-CVD (A Nurse-Led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention) intervention group or the control group. Primary analyses were conducted according to the intention-to-treat principle. Intervention The EXTRA-CVD group received home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse at 4 in-person visits (baseline and 4, 8, and 12 months) and frequent telephone check-ins up to every 2 weeks as needed. The control group received general prevention education sessions from the prevention nurse at each of the 4 in-person visits. Main Outcomes and Measures Study-measured SBP was the primary outcome, and non-HDL cholesterol level was the secondary outcome. Measurements were taken over 12 months and assessed by linear mixed models. Prespecified moderators tested were sex at birth, baseline ASCVD risk, and trial site. Results A total of 297 PWH were randomized to the EXTRA-CVD arm (n = 149) or control arm (n = 148). Participants had a median (IQR) age of 59.0 (53.0-65.0) years and included 234 males (78.8%). Baseline mean (SD) SBP was 135.0 (18.8) mm Hg and non-HDL cholesterol level was 139.9 (44.6) mg/dL. At 12 months, participants in the EXTRA-CVD arm had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P < .001) lower non-HDL cholesterol level compared with participants in the control arm. There was a clinically meaningful but not statistically significant difference in SBP effect in females compared with males (11.8-mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06). Conclusions and Relevance Results of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for PWH. Trial Registration ClinicalTrials.gov Identifier: NCT03643705.
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Affiliation(s)
| | | | - Corrilynn O. Hileman
- MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Barbara M. Gripshover
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Angela Aifah
- New York University Grossman School of Medicine, New York
| | | | | | - Valerie A. Smith
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | | | - Hayden B. Bosworth
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
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Xue Q, Heianza Y, Li X, Wang X, Ma H, Rood J, Dorans KS, Mills KT, Liu X, Bray GA, Sacks FM, Qi L. Circulating MicroRNA-19 and cardiovascular risk reduction in response to weight-loss diets. Clin Nutr 2024; 43:892-899. [PMID: 38382419 DOI: 10.1016/j.clnu.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE MicroRNA-19 (miR-19) plays a critical role in cardiac development and cardiovascular disease (CVD). We examined whether change in circulating miR-19 was associated with change in CVD risk during weight loss. METHODS This study included 509 participants with overweight or obesity from the 24-month weight-loss diet intervention study (the POUNDS Lost trial) and with available data on circulating miR-19a-3p and miR-19b-3p at baseline and 6 months. The primary outcome for this analysis was the change in atherosclerotic CVD (ASCVD) risk at 6 and 24 months, which estimates the 10-year probability of hard ASCVD events. Secondary outcomes were the changes in ASCVD risk score components. RESULTS Circulating miR-19a-3p and miR-19b-3p levels significantly decreased during the initial 6-month dietary intervention period (P = 0.008, 0.0004, respectively). We found that a greater decrease in miR-19a-3p or miR-19b-3p was related to a greater reduction in ASCVD risk (β[SE] = 0.33 [0.13], P = 0.01 for miR-19a-3p; β[SE] = 0.3 [0.12], P = 0.017 for miR-19b-3p) over 6 months, independent of concurrent weight loss. Moreover, we found significant interactions between change in miR-19 and sleep disturbance on change in ASCVD risk over 24 months of intervention (P interaction = 0.01 and 0.008 for miR-19a-3p and miR-19b-3p, respectively). Participants with a greater decrease in miR-19 without sleep disturbance had a greater reduction of ASCVD risk than those with slight/moderate/great amounts of sleep disturbance. In addition, change in physical activity significantly modified the associations between change in miR-19 and change in ASCVD risk over 24 months (P interaction = 0.006 and 0.004 for miR-19a-3p and miR-19b-3p, respectively). A greater decrease in miR-19 was significantly associated with a greater reduction in ASCVD risk among participants with an increase in physical activity, while non-significant inverse associations were observed among those without an increase in physical activity. CONCLUSIONS In conclusion, decreased circulating miR-19 levels during dietary weight-loss interventions were related to a significant reduction in ASCVD risk, and these associations were more evident in people with no sleep disturbance or increase in physical activity. TRIAL REGISTRATION ClinicalTrials.gov NCT00072995.
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Affiliation(s)
- Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jennifer Rood
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Kirsten S Dorans
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Katherine T Mills
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Xiaowen Liu
- Tulane Center of Biomedical Informatics and Genomics, Deming Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, USA
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Frank M Sacks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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50
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Maiti R, Mohanty RR, Dey A, Maji S, Padhan M, Mishra A. Effect of Virgin Coconut Oil (VCO) on Cardiometabolic Parameters in Patients with Dyslipidemia: A Randomized, Add-on Placebo-Controlled Clinical Trial. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:244-251. [PMID: 37708389 DOI: 10.1080/27697061.2023.2256816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Statin monotherapy for dyslipidemia is limited by adverse effects and limited effectiveness in certain subgroups like metabolic syndrome. Add-on therapy with an agent with a known safety profile may improve clinical outcomes, and virgin coconut oil (VCO) may be the candidate agent for improving the cardiometabolic profile. The present study was conducted to evaluate the effect of add-on VCO with atorvastatin in dyslipidemia in adults. METHODS A randomized, double-blind clinical trial was conducted on 150 patients with dyslipidemia who were randomized into control and test groups. The control group received atorvastatin monotherapy, whereas the test group received add-on VCO with atorvastatin for 8 weeks. At baseline, demographic, clinical, and biochemical parameters were assessed and repeated after 8 weeks of therapy. The main outcome measures were lipid profile, cardiovascular risk indices, 10-year cardiovascular risk, body fat compositions, and thiobarbituric acid reactive substances (TBARS). RESULTS The increase in HDL in the test group was significantly greater than in the control group (MD: 2.76; 95%CI: 2.43-3.08; p < 0.001). The changes in the atherogenic index (p = 0.003), coronary risk index (p < 0.001), cardiovascular risk index (p = 0.001), and TBARS (p < 0.001) were significantly greater in the test group. The decrease in LDL, total cholesterol and lipoprotein(a), were significantly higher in the control group. There were no significant differences between the groups with respect to the changes in triglyceride, VLDL, and 10-year cardiovascular risk. CONCLUSIONS Add-on VCO (1000 mg/day) with atorvastatin (10 mg/day) can achieve a better clinical outcome in patients with dyslipidemia by increasing HDL and improving oxidative stress cardiovascular risk indices.
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Affiliation(s)
- Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Rashmi Ranjan Mohanty
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Shampa Maji
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Milan Padhan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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