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Liu L, Gracely EJ, Zhao X, Gliebus GP, May NS, Volpe SL, Shi J, DiMaria-Ghalili RA, Eisen HJ. Association of multiple metabolic and cardiovascular markers with the risk of cognitive decline and mortality in adults with Alzheimer's disease and AD-related dementia or cognitive decline: a prospective cohort study. Front Aging Neurosci 2024; 16:1361772. [PMID: 38628973 PMCID: PMC11020085 DOI: 10.3389/fnagi.2024.1361772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Background and objectives There is a scarcity of data stemming from large-scale epidemiological longitudinal studies focusing on potentially preventable and controllable risk factors for Alzheimer's disease (AD) and AD-related dementia (ADRD). This study aimed to examine the effect of multiple metabolic factors and cardiovascular disorders on the risk of cognitive decline and AD/ADRD. Methods We analyzed a cohort of 6,440 participants aged 45-84 years at baseline. Multiple metabolic and cardiovascular disorder factors included the five components of the metabolic syndrome [waist circumference, high blood pressure (HBP), elevated glucose and triglyceride (TG) concentrations, and reduced high-density lipoprotein cholesterol (HDL-C) concentrations], C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), factor VIII, D-dimer, and homocysteine concentrations, carotid intimal-medial thickness (CIMT), and urine albumin-to-creatinine ratio (ACR). Cognitive decline was defined using the Cognitive Abilities Screening Instrument (CASI) score, and AD/ADRD cases were classified using clinical diagnoses. Results Over an average follow-up period of 13 years, HBP and elevated glucose, CRP, homocysteine, IL-6, and ACR concentrations were significantly associated with the risk of mortality in the individuals with incident AD/ADRD or cognitive decline. Elevated D-dimer and homocysteine concentrations, as well as elevated ACR were significantly associated with incident AD/ADRD. Elevated homocysteine and ACR were significantly associated with cognitive decline. A dose-response association was observed, indicating that an increased number of exposures to multiple risk factors corresponded to a higher risk of mortality in individuals with cognitive decline or with AD/ADRD. Conclusion Findings from our study reaffirm the significance of preventable and controllable factors, including HBP, hyperglycemia, elevated CRP, D-dimer, and homocysteine concentrations, as well as, ACR, as potential risk factors for cognitive decline and AD/ADRD.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Edward J. Gracely
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Department of Family, Community & Preventive Medicine, College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Xiaopeng Zhao
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Gediminas P. Gliebus
- Department of Neurology, College of Medicine, Drexel University Philadelphia, Philadelphia, PA, United States
| | - Nathalie S. May
- Department of Medicine, College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Stella L. Volpe
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Jingyi Shi
- Department of Mathematics and Statistics, Mississippi State University, Starkville, MS, United States
| | - Rose Ann DiMaria-Ghalili
- Doctoral Nursing Department, Nutrition Science Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Howard J. Eisen
- Clinical Research for the Advanced Cardiac and Pulmonary Vascular Disease Program, Thomas Jefferson University Hospital, Philadelphia, PA, United States
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de Boer EC, Dinis Fernandes C, van Neerven D, Pennings C, Joshi R, Manzari S, Shulepov S, van Knippenberg L, van Rooij J, Bouwman RA, Mischi M. Quantitative assessment of carotid ultrasound diameter measurements in the operating room: a comparable analysis of long-axis versus rotated and tilted orientation. Physiol Meas 2024; 45:035006. [PMID: 38422517 DOI: 10.1088/1361-6579/ad2eb4] [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: 06/29/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
Objective. Carotid ultrasound (US) has been studied as a non-invasive alternative for hemodynamic monitoring. A long-axis (LA) view is traditionally employed but is difficult to maintain and operator experience may impact the diameter estimates, making it unsuitable for monitoring. Preliminary results show that a new, i.e. rotated and tilted (RT) view is more robust to motion and less operator-dependent. This study aimed to quantitatively assess common carotid diameter estimates obtained in a clinical setting from an RT view and compare those to corresponding estimates obtained using other views.Approach. Carotid US measurements were performed in 30 adult cardiac-surgery patients (26 males, 4 females) with short-axis (SA), LA, and RT probe orientations, the first being used as a reference for measuring the true vessel diameter. Per 30 s acquisition, the median and spread in diameter values were computed, the latter representing a measure of robustness, and were statistically compared between views.Main results. The median (IQR) over all the patients of the median diameter per 30 s acquisition was 7.15 (1.15) mm for the SA view, 7.03 (1.51) mm for the LA view, and 6.99 (1.72) mm for the RT view. The median spread in diameter values was 0.18 mm for the SA view, 0.16 mm for the LA view, and 0.18 mm for the RT view. There were no statistically significant differences between views in the median diameter values (p= 0.088) or spread (p= 0.122).Significance. The RT view results in comparable and equally robust median carotid diameter values compared to the reference. These findings open the path for future studies investigating the use of the RT view in new applications, such as in wearable ultrasound devices.
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Affiliation(s)
- Esmée C de Boer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Catarina Dinis Fernandes
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Danihel van Neerven
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Christoph Pennings
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rohan Joshi
- Philips Research, Eindhoven, The Netherlands
| | | | | | - Luuk van Knippenberg
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
| | | | - R Arthur Bouwman
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Anesthesiology and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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3
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Durda P, Raffield LM, Lange EM, Olson NC, Jenny NS, Cushman M, Deichgraeber P, Grarup N, Jonsson A, Hansen T, Mychaleckyj JC, Psaty BM, Reiner AP, Tracy RP, Lange LA. Circulating Soluble CD163, Associations With Cardiovascular Outcomes and Mortality, and Identification of Genetic Variants in Older Individuals: The Cardiovascular Health Study. J Am Heart Assoc 2022; 11:e024374. [PMID: 36314488 PMCID: PMC9673628 DOI: 10.1161/jaha.121.024374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Monocytes/macrophages participate in cardiovascular disease. CD163 (cluster of differentiation 163) is a monocyte/macrophage receptor, and the shed sCD163 (soluble CD163) reflects monocyte/macrophage activation. We examined the association of sCD163 with incident cardiovascular disease events and performed a genome-wide association study to identify sCD163-associated variants. Methods and Results We measured plasma sCD163 in 5214 adults (aged ≥65 years, 58.7% women, 16.2% Black) of the CHS (Cardiovascular Health Study). We used Cox regression models (associations of sCD163 with incident events and mortality); median follow-up was 26 years. Genome-wide association study analyses were stratified on race. Adjusted for age, sex, and race and ethnicity, sCD163 levels were associated with all-cause mortality (hazard ratio [HR], 1.08 [95% CI, 1.04-1.12] per SD increase), cardiovascular disease mortality (HR, 1.15 [95% CI, 1.09-1.21]), incident coronary heart disease (HR, 1.10 [95% CI, 1.04-1.16]), and incident heart failure (HR, 1.18 [95% CI, 1.12-1.25]). When further adjusted (eg, cardiovascular disease risk factors), only incident coronary heart disease lost significance. In European American individuals, genome-wide association studies identified 38 variants on chromosome 2 near MGAT5 (top result rs62165726, P=3.3×10-18),19 variants near chromosome 17 gene ASGR1 (rs55714927, P=1.5×10-14), and 18 variants near chromosome 11 gene ST3GAL4. These regions replicated in the European ancestry ADDITION-PRO cohort, a longitudinal cohort study nested in the Danish arm of the Anglo-Danish-Dutch study of Intensive Treatment Intensive Treatment In peOple with screeNdetcted Diabetes in Primary Care. In Black individuals, we identified 9 variants on chromosome 6 (rs3129781 P=7.1×10-9) in the HLA region, and 3 variants (rs115391969 P=4.3×10-8) near the chromosome 16 gene MYLK3. Conclusions Monocyte function, as measured by sCD163, may be predictive of overall and cardiovascular-specific mortality and incident heart failure.
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Affiliation(s)
- Peter Durda
- Department of Pathology and Laboratory MedicineLarner College of Medicine, University of VermontBurlingtonVT
| | | | - Ethan M. Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Nels C. Olson
- Department of Pathology and Laboratory MedicineLarner College of Medicine, University of VermontBurlingtonVT
| | - Nancy Swords Jenny
- Department of Pathology and Laboratory MedicineLarner College of Medicine, University of VermontBurlingtonVT
| | - Mary Cushman
- Department of Pathology and Laboratory MedicineLarner College of Medicine, University of VermontBurlingtonVT,Department of MedicineLarner College of Medicine, University of VermontBurlingtonVT
| | - Pia Deichgraeber
- Steno Diabetes CenterAarhus University HospitalAarhusDenmark,Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic ResearchCopenhagenDenmark
| | - Anna Jonsson
- Novo Nordisk Foundation Center for Basic Metabolic ResearchCopenhagenDenmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic ResearchCopenhagenDenmark
| | | | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health ServicesUniversity of WashingtonSeattleWA
| | - Alex P. Reiner
- Department of EpidemiologyUniversity of WashingtonSeattleWA
| | - Russell P. Tracy
- Department of Pathology and Laboratory MedicineLarner College of Medicine, University of VermontBurlingtonVT,Department of BiochemistryLarner College of Medicine, University of VermontBurlingtonVT
| | - Leslie A. Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
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Kabłak-Ziembicka A, Przewłocki T. Clinical Significance of Carotid Intima-Media Complex and Carotid Plaque Assessment by Ultrasound for the Prediction of Adverse Cardiovascular Events in Primary and Secondary Care Patients. J Clin Med 2021; 10:4628. [PMID: 34682751 PMCID: PMC8538659 DOI: 10.3390/jcm10204628] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Recently published recommendations from the American Society of Echocardiography on 'Carotid Arterial Plaque Assessment by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk' provoked discussion once more on the potential clinical applications of carotid intima-media complex thickness (CIMT) and carotid plaque assessment in the context of cardiovascular risk in both primary and secondary care patients. This review paper addresses key issues and milestones regarding indications, assessment, technical aspects, recommendations, and interpretations of CIMT and carotid plaque findings. We discuss lacks of evidence, limitations, and possible future directions.
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Affiliation(s)
- Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland;
- Department of Interventional Cardiology, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
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Autoimmune Rheumatic Diseases and Vascular Function: The Concept of Autoimmune Atherosclerosis. J Clin Med 2021; 10:jcm10194427. [PMID: 34640445 PMCID: PMC8509415 DOI: 10.3390/jcm10194427] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022] Open
Abstract
Autoimmune rheumatic diseases (AIRDs) with unknown etiology are increasing in incidence and prevalence. Up to 5% of the population is affected. AIRDs include rheumatoid arthritis, system lupus erythematosus, systemic sclerosis, and Sjögren's syndrome. In patients with autoimmune diseases, the immune system attacks structures of its own body, leading to widespread tissue and organ damage, which, in turn, is associated with increased morbidity and mortality. One third of the mortality associated with autoimmune diseases is due to cardiovascular diseases. Atherosclerosis is considered the main underlying cause of cardiovascular diseases. Currently, because of finding macrophages and lymphocytes at the atheroma, atherosclerosis is considered a chronic immune-inflammatory disease. In active inflammation, the liberation of inflammatory mediators such as tumor necrotic factor alpha (TNFa), interleukine-6 (IL-6), IL-1 and other factors like T and B cells, play a major role in the atheroma formation. In addition, antioxidized, low-density lipoprotein (LDL) antibodies, antinuclear antibodies (ANA), and rheumatoid factor (RF) are higher in the atherosclerotic patients. Traditional risk factors like gender, age, hypercholesterolemia, smoking, diabetes mellitus, and hypertension, however, do not alone explain the risk of atherosclerosis present in autoimmune diseases. This review examines the role of chronic inflammation in the etiology-and progression-of atherosclerosis in autoimmune rheumatic diseases. In addition, discussed here in detail are the possible effects of autoimmune rheumatic diseases that can affect vascular function. We present here the current findings from studies that assessed vascular function changes using state-of-the-art techniques and innovative endothelial function biomarkers.
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6
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Huang NK, Bůžková P, Matthan NR, Djoussé L, Kizer JR, Mukamal KJ, Polak JF, Lichtenstein AH. Serum Non-Esterified Fatty Acids, Carotid Artery Intima-Media Thickness and Flow-Mediated Dilation in Older Adults: The Cardiovascular Health Study (CHS). Nutrients 2021; 13:nu13093052. [PMID: 34578930 PMCID: PMC8465602 DOI: 10.3390/nu13093052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 12/24/2022] Open
Abstract
Backgrounds and aims: Elevated common carotid artery intima-media thickness (carotid IMT) and diminished flow-mediated dilation (FMD) are early subclinical indicators of atherosclerosis. Serum total non-esterified fatty acid (NEFA) concentrations have been positively associated with subclinical atherosclerosis. The relations between individual NEFA, carotid IMT and FMD have as yet to be assessed. Methods: We investigated the associations between fasting serum individual NEFA, carotid IMT and FMD among Cardiovascular Health Study (CHS) participants with (n = 255 for carotid IMT, 301 for FMD) or without (n = 1314 for carotid IMT, 1462 for FMD) known atherosclerotic cardiovascular disease (ASCVD). Using archived samples (fasting) collected from 1996-1997 (baseline), 35 individual NEFAs were measured using gas chromatography. Carotid IMT and estimated plaque thickness (mean of maximum internal carotid IMT) were determined in 1998-1999. FMD was measured in 1997-1998. Linear regression adjusted by the Holm-Bonferroni method was used to assess relations between individual NEFA, carotid IMT and FMD. Results: In multivariable adjusted linear regression models per SD increment, the non-esterified trans fatty acid conjugated linoleic acid (trans-18:2 CLA) was positively associated with carotid IMT [β (95% CI): 44.8 (19.2, 70.4), p = 0.025] among participants with, but not without, ASCVD [2.16 (-6.74, 11.5), p = 1.000]. Non-esterified cis-palmitoleic acid (16:1n-7c) was positively associated with FMD [19.7 (8.34, 31.0), p = 0.024] among participants without, but not with ASCVD. No significant associations between NEFAs and estimated plaque thickness were observed. Conclusions: In older adults, serum non-esterified CLA and palmitoleic acid were positively associated with carotid IMT and FMD, respectively, suggesting potential modifiable biomarkers for arteriopathy.
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Grants
- HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grants U01HL080295 and U01HL130114 NHLBI NIH HHS
- R01AG023629, R01AG053325, and K24AG065525 NIA NIH HHS
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Affiliation(s)
- Neil K. Huang
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA; (N.K.H.); (N.R.M.)
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA 98115, USA;
| | - Nirupa R. Matthan
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA; (N.K.H.); (N.R.M.)
| | - Luc Djoussé
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Jorge R. Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA;
- Department of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Kenneth J. Mukamal
- Beth Israel Deaconess Medical Center, Division of General Medicine, Boston, MA 02215, USA;
| | - Joseph F. Polak
- Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA;
| | - Alice H. Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA; (N.K.H.); (N.R.M.)
- Correspondence: ; Tel.: +1-(617)-556-3127
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Impact of Plasma Xanthine Oxidoreductase Activity on the Mechanisms of Distal Symmetric Polyneuropathy Development in Patients with Type 2 Diabetes. Biomedicines 2021; 9:biomedicines9081052. [PMID: 34440256 PMCID: PMC8391363 DOI: 10.3390/biomedicines9081052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022] Open
Abstract
To unravel associations between plasma xanthine oxidoreductase (XOR) and diabetic vascular complications, especially distal symmetric polyneuropathy (DSP), we investigated plasma XOR activities using a novel assay. Patients with type 2 diabetes mellitus (T2DM) with available nerve conduction study (NCS) data were analyzed. None were currently taking XOR inhibitors. XOR activity of fasting blood samples was assayed using a stable isotope-labeled substrate and LC-TQMS. JMP Clinical version 5.0. was used for analysis. We analyzed 54 patients. Mean age was 64.7 years, mean body mass index was 26.0 kg/m2, and mean glycated hemoglobin was 9.4%. The logarithmically transformed plasma XOR activity (ln-XOR) correlated positively with hypoxanthine, xanthine, visceral fatty area, and liver dysfunction but negatively with HDL cholesterol. ln-XOR correlated negatively with diabetes duration and maximum intima-media thickness. Stepwise multiple regression analysis revealed ln-XOR to be among selected explanatory factors for various NCS parameters. Receiver operating characteristic curves showed the discriminatory power of ln-XOR. Principal component analysis revealed a negative relationship of ln-XOR with F-waves as well as positive relationships of ln-XOR with hepatic steatosis and obesity-related disorders. Taken together, our results show plasma XOR activity to be among potential disease status predictors in T2DM patients. Plasma XOR activity measurements might reliably detect pre-symptomatic DSP.
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8
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Aladin AI, Soliman EZ, Kitzman DW, Dardari Z, Rasool SH, Yeboah J, Budoff MJ, Psaty BM, Ouyang P, Polak JF, Blumenthal RS, McEvoy JW, Gandhi SK, Herrington DM. Comparison of the Relation of Carotid Intima-Media Thickness With Incident Heart Failure With Reduced Versus Preserved Ejection Fraction (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2021; 148:102-109. [PMID: 33667446 DOI: 10.1016/j.amjcard.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
Increased carotid intima-media thickness (cIMT) is associated with heart failure (HF) in previous studies, but it is not known whether the association of cIMT differs between HF with reduced (HFrEF) versus preserved ejection fraction (HFpEF). We studied 6699 participants (mean age 62 ± 10 years, 47% male, and 38% white) from the Multi-Ethnic Study of Atherosclerosis (MESA) with baseline cIMT measurements. We classified HF events as HFrEF (EF <50%) or HFpEF (EF ≥ 50%) at the time of diagnosis. Cox proportional hazard regression was used to compute hazard ratios (HR), and 95% confidence intervals (CI) for the association between the IMT Z-score (measured maximum IMT of Internal Carotid (IC) and Common Carotid (CC) sites as the mean of the maximum IMT of the near and far walls of right and left sides), and incident HFrEF or HFpEF. Models were adjusted for covariates and interim coronary artery disease (CAD) events. A total of 191 HFrEF and 167 HFpEF events occurred during follow-up. In multivariable analysis, each 1 standard deviation increase in the measured maximum IMT (Z-score) was associated with both HFrEF and HFpEF in the unadjusted and demographically adjusted models [HR, 95% CI 1.57 (1.43 to 1.73)] and [HR, 95% CI 1.61 (1.47 to 1.77)] but not in the fully adjusted models [HR, 95% CI 1.11 (0.96 to 1.28)] and [HR, 95% CI 1.13 (0.98 to 1.30)]. In conclusion, cIMT was significantly associated with incident HF, but the association is partially attenuated with adjustment for demographic factors and becomes non-significant after adjustment for other traditional heart failure risk factors and interim CAD events. There was no difference in the association of IMT measures with HFrEF versus HFpEF.
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Affiliation(s)
- Amer I Aladin
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland.
| | - Elsayed Z Soliman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Dalane W Kitzman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Zeina Dardari
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Shereen H Rasool
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Joseph Yeboah
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Matthew J Budoff
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Bruce M Psaty
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Pamela Ouyang
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Joseph F Polak
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Roger S Blumenthal
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - John W McEvoy
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Sanjay K Gandhi
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - David M Herrington
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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9
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Cho DH, Choi JI, Choi J, Kim YG, Oh SK, Kook H, Lee KN, Shim J, Park SM, Shim WJ, Kim YH. Impact of carotid atherosclerosis in CHA2DS2-VASc-based risk score on predicting ischemic stroke in patients with atrial fibrillation. Korean J Intern Med 2021; 36:342-351. [PMID: 32088940 PMCID: PMC7969068 DOI: 10.3904/kjim.2019.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Vascular disease is an established risk factor for stroke in patients with atrial fibrillation (AF), which is included in CHA2DS2-VASc score. However, the role of carotid atherosclerosis remains to be determined. METHODS Three hundred-ten patients with AF who underwent carotid sonography were enrolled. RESULTS During a median follow-up of 31 months, 18 events (5.8%) of stroke were identified. Patients with stroke had higher carotid intima-media thickness (CIMT) (1.16 ± 0.33 mm vs. 0.98 ± 0.25 mm, p = 0.017). CIMT was significantly increased according to the CHA2DS2-VASc score (p < 0.001) and it was correlated with left ventricular mass index and early diastolic mitral annular velocity (e'), a ratio of early transmitral flow velocity to e' (E/e') and pulmonary artery systolic pressure (all p < 0.05). Cox regression using multivariate models showed that carotid plaque was associated with the risk of stroke (hazard ratio, 3.748; 95% confidence interval [CI], 1.107 to 12.688; p = 0.034). C-statistics increased from 0.648 (95% CI, 0.538 to 0.757) to 0.716 (95% CI, 0.628 to 0.804) in the CHA2DS2-VASc score model after the addition of CIMT and carotid plaque as a vascular component (p = 0.013). CONCLUSION Increased CIMT and presence of carotid plaque are associated with a high risk of ischemic stroke, and CIMT is related to myocardial remodeling and diastolic dysfunction, suggesting that carotid atherosclerosis can improve risk prediction of stroke in patients with AF, when included under vascular disease in the CHA2DS2-VASc scoring system.
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Affiliation(s)
- Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
- Correspondence to Jong-Il Choi, M.D. Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5445 Fax: +82-2-927-1478 E-mail:
| | - Jimi Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Hyungdon Kook
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Kwang No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Wan Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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10
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Zaid M, Fujiyoshi A, Hisamatsu T, Kadota A, Kadowaki S, Satoh A, Sekikawa A, Barinas-Mitchell E, Horie M, Miura K, Ueshima H. A Comparison of Segment-Specific and Composite Measures of Carotid Intima-Media Thickness and their Relationships with Coronary Calcium. J Atheroscler Thromb 2021; 29:282-295. [PMID: 33551394 PMCID: PMC8803560 DOI: 10.5551/jat.61283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims:
The utility of carotid intima-media thickness (cIMT) as a marker for coronary heart disease is under heavy debate. This is predominantly due to the lack of a standard definition of cIMT, leading to inconsistent results. We investigated and compared the relationships of five different measures of cIMT with coronary calcium.
Methods:
Japanese men aged 40-79y (
n
=869) from Shiga Epidemiological Study of Subclinical Atherosclerosis were examined. Mean cIMT was measured in three segments of the carotid arteries: common carotid artery (CCA
mean
), internal carotid artery (ICA
mean
) and bifurcation (Bif
mean
). Mean cIMT of average values (Mean cIMT) and mean cIMT of maximum values (Mean-Max cIMT) of all segments combined were assessed. Coronary calcium was assessed as coronary artery calcification (CAC). Ordinal logistic regression was used to determine the odds ratio (OR) of higher CAC per 1 standard deviation higher cIMT measure. Analyses were adjusted for cardiovascular covariates and stratified by age quartiles.
Results:
All cIMT measures had positive associations with CAC (
p
<0.001): [OR, 95% Confidence Interval]: ICA
mean
[1.23, 1.07-1.42], CCA
mean
[1.27, 1.08-1.49], Bif
mean
[1.33, 1.15-1.53], Mean cIMT [1.42, 1.22-1.66], and Mean-Max [1.50, 1.28-1.75]. In age-stratified analyses, only Mean-Max cIMT maintained a significant relationship with CAC in every age quartile (
p
<0.05), while CCA
mean
had some of the weakest associations among age quartiles.
Conclusions:
Mean-Max cIMT had consistently stronger associations with coronary calcium, independent of important confounders, such as age. The most oft-used measure, CCA
mean
, was no longer associated with coronary calcium after age-adjustment and stratification.
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Affiliation(s)
- Maryam Zaid
- Department of Epidemiology, School of Public Health, Fudan University.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science.,Department of Hygiene, Wakayama Medical University
| | - Takashi Hisamatsu
- Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science
| | - Atsushi Satoh
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh.,Clinical Translational Science Institute, University of Pittsburgh
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
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11
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Rohmann JL, Longstreth WT, Cushman M, Fitzpatrick AL, Heckbert SR, Rice K, Rosendaal FR, Sitlani CM, Psaty BM, Siegerink B. Coagulation factor VIII, white matter hyperintensities and cognitive function: Results from the Cardiovascular Health Study. PLoS One 2020; 15:e0242062. [PMID: 33196677 PMCID: PMC7668572 DOI: 10.1371/journal.pone.0242062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the relationship between high FVIII clotting activity (FVIII:C), MRI-defined white matter hyperintensities (WMH) and cognitive function over time. METHODS Data from the population-based Cardiovascular Health Study (n = 5,888, aged ≥65) were used. FVIII:C was measured in blood samples taken at baseline. WMH burden was assessed on two cranial MRI scans taken roughly 5 years apart. Cognitive function was assessed annually using the Modified Mini-Mental State Examination (3MSE) and Digit Symbol Substitution Test (DSST). We used ordinal logistic regression models adjusted for demographic and cardiovascular factors in cross-sectional and longitudinal WMH analyses, and adjusted linear regression and linear mixed models in the analyses of cognitive function. RESULTS After adjustment for confounding, higher levels of FVIII:C were not strongly associated with the burden of WMH on the initial MRI scan (OR>p75 = 1.20, 95% CI 0.99-1.45; N = 2,735) nor with WMH burden worsening over time (OR>p75 = 1.18, 95% CI 0.87-1.59; N = 1,527). High FVIII:C showed no strong association with cognitive scores cross-sectionally (3MSE>p75 β = -0.06, 95%CI -0.45 to 0.32, N = 4,005; DSST>p75 β = -0.69, 95%CI -1.52 to 0.13, N = 3,954) or over time (3MSE>p75 β = -0.07,95% CI -0.58 to 0.44, N = 2,764; DSST>p75 β = -0.22, 95% CI -0.97 to 0.53, N = 2,306) after confounding adjustment. INTERPRETATION The results from this cohort study of older adult participants indicate no strong relationships between higher FVIII:C levels and WMH burden or cognitive function in cross-sectional and longitudinal analyses.
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Affiliation(s)
- Jessica L. Rohmann
- Charité –Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - W. T. Longstreth
- Department of Neurology, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
| | - Annette L. Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, United States of America
| | - Kenneth Rice
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Colleen M. Sitlani
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, United States of America
| | - Bruce M. Psaty
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Health Services, University of Washington, Seattle, WA, United States of America
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Bob Siegerink
- Charité –Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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12
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Shimoda S, Kitamura A, Imano H, Cui R, Muraki I, Yamagishi K, Umesawa M, Sankai T, Hayama-Terada M, Kubota Y, Shimizu Y, Okada T, Kiyama M, Iso H. Associations of Carotid Intima-Media Thickness and Plaque Heterogeneity With the Risks of Stroke Subtypes and Coronary Artery Disease in the Japanese General Population: The Circulatory Risk in Communities Study. J Am Heart Assoc 2020; 9:e017020. [PMID: 32990124 PMCID: PMC7792402 DOI: 10.1161/jaha.120.017020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Evidence on the associations of carotid intima-media thickness and carotid plaque characteristics with stroke subtypes and coronary artery disease risks in Asians is limited. This study investigated these associations in the Japanese general population. Methods and Results Maximum intima-media thicknesses of both the common carotid artery and internal carotid artery and carotid plaque characteristics were evaluated in 2943 Japanese subjects aged 40 to 75 years without history of cardiovascular disease. Subjects were followed up for a median of 15.1 years. Using a multivariate Cox proportional hazard model, we found that hazard ratios (HRs) and 95% CIs for the highest (≥1.07 mm) versus lowest (≤0.77 mm) quartiles of maximum intima-media thicknesses of the common carotid artery were 1.97 (1.26-3.06) for total stroke, 1.52 (0.67-3.41) for hemorrhagic stroke, 2.45 (1.41-4.27) for ischemic stroke, 3.60 (1.64-7.91) for lacunar infarction, 1.53 (0.69-3.41) for nonlacunar cerebral infarction, 2.68 (1.24-5.76) for coronary artery disease, and 2.11 (1.44-3.12) for cardiovascular disease (similar results were found for maximum intima-media thicknesses of the internal carotid artery). HRs(95% CIs) for heterogeneous plaque versus no plaque were 1.58 (1.09-2.30) for total stroke, 1.25 (0.58-2.70) for hemorrhagic stroke, 1.74 (1.13-2.67) for ischemic stroke, 1.84 (1.03-3.19) for lacunar infarction, 1.58 (0.80-3.11) for nonlacunar cerebral infarction, 2.11 (1.20-3.70) for coronary artery disease, and 1.71 (1.25-2.35) for cardiovascular disease. Conclusions Maximum intima-media thicknesses of the common carotid artery, maximum intima-media thicknesses of the internal carotid artery, and heterogeneous plaque were associated with the risks of stroke, lacunar infarction, coronary artery disease, and cardiovascular disease in Asians.
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Affiliation(s)
- Saeko Shimoda
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Akihiko Kitamura
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan.,Research Team for Social Participation and Community Health Tokyo Metropolitan Institute of Gerontology Tokyo Japan.,Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan.,Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Renzhe Cui
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kazumasa Yamagishi
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan.,Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center University of Tsukuba Ibaraki Japan.,Ibaraki Western Medical Center Ibaraki Japan
| | - Mitsumasa Umesawa
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center University of Tsukuba Ibaraki Japan.,Department of Public Health Dokkyo Medical University Tochigi Japan
| | - Tomoko Sankai
- Department of Public Health and Nursing, Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Mina Hayama-Terada
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan.,Yao Public Health Center, Yao City Office Osaka Japan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Yuji Shimizu
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
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13
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Mukamal KJ, Siscovick DS, de Boer IH, Ix JH, Kizer JR, Djoussé L, Fitzpatrick AL, Tracy RP, Boyko EJ, Kahn SE, Arnold AM. Metabolic Clusters and Outcomes in Older Adults: The Cardiovascular Health Study. J Am Geriatr Soc 2019; 66:289-296. [PMID: 29431855 DOI: 10.1111/jgs.15205] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Few studies have the requisite phenotypic information to define metabolic patterns that may inform our understanding of the pathophysiology and consequences of diabetes in older adults. We sought to characterize clusters of older adults on the basis of shared metabolic features. DESIGN Population-based prospective cohort study. SETTING Four U.S. Cardiovascular Health Study field centers. PARTICIPANTS Individuals aged 65 and older taking no glucose-lowering agents (N = 2,231). MEASUREMENTS K-means cluster analysis of 11 metabolic parameters (fasting and postload serum glucose and plasma insulin, fasting C-peptide, body mass index, C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), albuminuria, carboxymethyl lysine (an advanced glycation end-product), procollagen III N-terminal propeptide (a fibrotic marker)) and their associations with incident cardiovascular disease, diabetes, disability, and mortality over 8 to 14.5 years of follow-up and with measures of subclinical cardiovascular disease. RESULTS A 6-cluster solution provided robust differentiation into distinct, identifiable clusters. Cluster A (n = 739) had the lowest glucose and insulin and highest eGFR and the lowest rates of all outcomes. Cluster B (n = 419) had high glucose and insulin and intermediate rates of most outcomes. Cluster C (n = 118) had the highest insulin. Cluster D (n = 129) had the highest glucose with much lower insulin. Cluster E (n = 314) had the lowest eGFR and highest albuminuria. Cluster F (n = 512) had the highest CRP. Rates of CVD, mortality, and subclinical atherosclerosis were highest in clusters C, D, and E and were similar to rates in participants with treated diabetes. Incidence of disability was highest in Cluster C. CONCLUSION Clustering according to metabolic parameters identifies distinct phenotypes that are strongly associated with clinical and functional outcomes, even at advanced age.
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Affiliation(s)
- Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David S Siscovick
- Department of Medicine, University of Washington, Seattle, Washington.,New York Academy of Medicine, New York, New York
| | - Ian H de Boer
- Department of Medicine, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
| | - Joachim H Ix
- Veterans Affairs San Diego Healthcare System, San Diego, California.,School of Medicine, University of California, San Diego, California
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, New York, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York
| | - Luc Djoussé
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston Veterans Affairs Healthcare System, Boston, Massachusetts
| | - Annette L Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, Washington.,Department of Global Health, University of Washington, Seattle, Washington
| | - Russell P Tracy
- Department of Pathology, College of Medicine, University of Vermont, Burlington, Vermont.,Department of Biochemistry, College of Medicine, University of Vermont, Burlington, Vermont
| | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Steven E Kahn
- Department of Medicine, University of Washington, Seattle, Washington.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington
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14
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Polak JF, Herrington D, O'Leary DH. Associations of edge-detected and manual-traced common carotid artery intima-media thickness with incident peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis. Vasc Med 2019; 24:306-312. [PMID: 31023166 DOI: 10.1177/1358863x19835925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Common carotid artery (CCA) intima-media thickness (IMT) is associated with coronary heart disease and can be measured on ultrasound images either by hand or with an automated edge detector. The association of CCA IMT with incident peripheral artery disease (PAD) is poorly studied. We studied 5467 participants of the Multi-Ethnic Study of Atherosclerosis composed of non-Hispanic white, Chinese, Hispanic, and African American participants with a mean age of 61.9 years (47.8% men). Framingham Risk Factors, manual-traced IMT (mt-IMT), and edge-detected IMT (ed-IMT) were entered into multivariable Cox proportional hazards models with incident PAD as the outcome. There were 87 events during a median follow-up of 12.2 years. In fully adjusted models and expressing the hazard ratios (HR) as an increment in SD values, both mt-IMT and ed-IMT were significantly associated with incident PAD: HR 1.36 (95% CI: 1.15, 1.61) and 1.29 (95% CI: 1.04, 1.60), respectively. We conclude that ed- and mt-CCA IMT measurements are associated with incident PAD. ClinicalTrials.gov Identifier: NCT00063440.
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Affiliation(s)
- Joseph F Polak
- 1 Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.,2 Ultrasound Reading Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - David Herrington
- 3 Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Daniel H O'Leary
- 2 Ultrasound Reading Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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15
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Dugandžić V, Drikermann D, Ryabchykov O, Undisz A, Vilotijević I, Lorkowski S, Bocklitz TW, Matthäus C, Weber K, Cialla-May D, Popp J. Surface enhanced Raman spectroscopy-detection of the uptake of mannose-modified nanoparticles by macrophages in vitro: A model for detection of vulnerable atherosclerotic plaques. JOURNAL OF BIOPHOTONICS 2018; 11:e201800013. [PMID: 29799670 DOI: 10.1002/jbio.201800013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
Atherosclerosis is a process of thickening and stiffening of the arterial walls through the accumulation of lipids and fibrotic material, as a consequence of aging and unhealthy life style. However, not all arterial plaques lead to complications, which can lead to life-threatening events such as stroke and myocardial infarction. Diagnosis of the disease in early stages and identification of unstable atherosclerotic plaques are still challenging. It has been shown that the development of atherosclerotic plaques is an inflammatory process, where the accumulation of macrophages in the arterial walls is immanent in the early as well as late stages of the disease. We present a novel surface enhanced Raman spectroscopy (SERS)-based strategy for the detection of early stage atherosclerosis, based on the uptake of tagged gold nanoparticles by macrophages and subsequent detection by means of SERS. The results presented here provide a basis for future in vivo studies in animal models.The workflow of tracing the SERS-active nanoparticle uptake by macrophages employing confocal Raman imaging.
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Affiliation(s)
- Vera Dugandžić
- Institute of Physical Chemistry, Friedrich-Schiller University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Jena, Germany
- Abbe Center of Photonics, Friedrich Schiller University Jena, Jena, Germany
| | - Denis Drikermann
- Institute for Organic Chemistry and Macromolecular Chemistry, Friedrich Schiller University Jena, Jena, Germany
| | - Oleg Ryabchykov
- Institute of Physical Chemistry, Friedrich-Schiller University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Jena, Germany
- Abbe Center of Photonics, Friedrich Schiller University Jena, Jena, Germany
| | - Andreas Undisz
- Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Jena, Germany
| | - Ivan Vilotijević
- Institute for Organic Chemistry and Macromolecular Chemistry, Friedrich Schiller University Jena, Jena, Germany
| | - Stefan Lorkowski
- Abbe Center of Photonics, Friedrich Schiller University Jena, Jena, Germany
- Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany
- Jena Centre for Soft Matter, (JCSM), Friedrich Schiller University Jena, Jena, Germany
| | - Thomas W Bocklitz
- Institute of Physical Chemistry, Friedrich-Schiller University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Jena, Germany
- Abbe Center of Photonics, Friedrich Schiller University Jena, Jena, Germany
| | - Christian Matthäus
- Institute of Physical Chemistry, Friedrich-Schiller University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Jena, Germany
- Abbe Center of Photonics, Friedrich Schiller University Jena, Jena, Germany
| | - Karina Weber
- Institute of Physical Chemistry, Friedrich-Schiller University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Jena, Germany
- Jena Centre for Soft Matter, (JCSM), Friedrich Schiller University Jena, Jena, Germany
| | - Dana Cialla-May
- Institute of Physical Chemistry, Friedrich-Schiller University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Jena, Germany
- Abbe Center of Photonics, Friedrich Schiller University Jena, Jena, Germany
| | - Jürgen Popp
- Institute of Physical Chemistry, Friedrich-Schiller University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Jena, Germany
- Abbe Center of Photonics, Friedrich Schiller University Jena, Jena, Germany
- Jena Centre for Soft Matter, (JCSM), Friedrich Schiller University Jena, Jena, Germany
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Olson NC, Raffield LM, Lange LA, Lange EM, Longstreth WT, Chauhan G, Debette S, Seshadri S, Reiner AP, Tracy RP. Associations of activated coagulation factor VII and factor VIIa-antithrombin levels with genome-wide polymorphisms and cardiovascular disease risk. J Thromb Haemost 2018; 16:19-30. [PMID: 29112333 PMCID: PMC5760305 DOI: 10.1111/jth.13899] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 11/26/2022]
Abstract
ESSENTIALS Essentials A fraction of coagulation factor VII circulates in blood as an activated protease (FVIIa). We evaluated FVIIa and FVIIa-antithrombin (FVIIa-AT) levels in the Cardiovascular Health Study. Polymorphisms in the F7 and PROCR loci were associated with FVIIa and FVIIa-AT levels. FVIIa may be an ischemic stroke risk factor in older adults and FVIIa-AT may assess mortality risk. SUMMARY Background A fraction of coagulation factor (F) VII circulates as an active protease (FVIIa). FVIIa also circulates as an inactivated complex with antithrombin (FVIIa-AT). Objective Evaluate associations of FVIIa and FVIIa-AT with genome-wide single nucleotide polymorphisms (SNPs) and incident coronary heart disease, ischemic stroke and mortality. Patients/Methods We measured FVIIa and FVIIa-AT in 3486 Cardiovascular Health Study (CHS) participants. We performed a genome-wide association scan for FVIIa and FVIIa-AT in European-Americans (n = 2410) and examined associations of FVII phenotypes with incident cardiovascular disease. Results In European-Americans, the most significant SNP for FVIIa and FVIIa-AT was rs1755685 in the F7 promoter region on chromosome 13 (FVIIa, β = -25.9 mU mL-1 per minor allele; FVIIa-AT, β = -26.6 pm per minor allele). Phenotypes were also associated with rs867186 located in PROCR on chromosome 20 (FVIIa, β = 7.8 mU mL-1 per minor allele; FVIIa-AT, β = 9.9 per minor allele). Adjusted for risk factors, a one standard deviation higher FVIIa was associated with increased risk of ischemic stroke (hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.01, 1.23). Higher FVIIa-AT was associated with mortality from all causes (HR, 1.08; 95% CI, 1.03, 1.12). Among European-American CHS participants the rs1755685 minor allele was associated with lower ischemic stroke (HR, 0.69; 95% CI, 0.54, 0.88), but this association was not replicated in a larger multi-cohort analysis. Conclusions The results support the importance of the F7 and PROCR loci in variation in circulating FVIIa and FVIIa-AT. The findings suggest FVIIa is a risk factor for ischemic stroke in older adults, whereas higher FVIIa-AT may reflect mortality risk.
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Affiliation(s)
- N C Olson
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
- Cardiovascular Research Institute of Vermont, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - L M Raffield
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - L A Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - E M Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - G Chauhan
- INSERM U1219 Neuroepidemiology, Bordeaux, France
- University of Bordeaux, Bordeaux, France
- Centre for Brain Research, Indian Institute of Science, Bangalore, India
| | - S Debette
- INSERM U1219 Neuroepidemiology, Bordeaux, France
- University of Bordeaux, Bordeaux, France
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA, USA
| | - S Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA, USA
| | - A P Reiner
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - R P Tracy
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
- Cardiovascular Research Institute of Vermont, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Biochemistry, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
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17
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Presence of coronary artery disease in diabetic and non diabetic South Asian immigrants. Indian Heart J 2017; 70:50-55. [PMID: 29455788 PMCID: PMC5902822 DOI: 10.1016/j.ihj.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 05/28/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction South Asian Immigrants (SAIs) are the second fastest growing Asian immigrant population in the US, and at a higher risk of type 2 diabetes (diabetes) and coronary artery disease (CAD) than the general US population. Objectives: We sought to determine in SAIs the; 1) the prevalence of CAD risk factors in diabetics and non-diabetics; and b) the high possibility of CAD in diabetic SAIs. We also assessed the prevalence of sub-clinical CAD in both diabetics and non-diabetics SAIs using common carotid artery Intima-media thickness (CIMT) as a surrogate marker for atherosclerosis. Methods In a cross-sectional study design, 213 first generation SAIs were recruited and based on the history, and fasting glucose levels were divided into two subgroups; 35 diabetics and 178 non-diabetics. 12-hour fasting blood samples were collected for glucose and total cholesterol levels. Exercise Tolerance Test (ETT) was performed to determine the possibility of CAD. Results Both diabetics and non-diabetics SAIs in general, share a significant burden of CAD risk factors. The prevalence of hypertension (p = 0.003), total cholesterol ≥ 200 mg/dl (p < 0.0001) and family history of diabetes (p < 0.0001) was significantly was significantly higher in diabetics compared to non-diabetics. Of the 22/29 diabetic participants without known history of CAD, 45% had positive ETT (p < 0.001). Similarly, 63.1% of diabetics and 51.8 % of non-diabetics were positive for sub-clinical CAD using CIMT as a marker. Conclusion The susceptibility to diabetes amongst SAIs promotes an adverse CAD risk, as evident by this small study. Further research, including larger longitudinal prospective studies, is required to validate the current small study findings with investigation of the temporal association.
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18
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Sanders JL, Arnold AM, Hirsch CH, Thielke SM, Kim D, Mukamal KJ, Kizer JR, Ix JH, Kaplan RC, Kritchevsky SB, Newman AB. Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults. J Am Geriatr Soc 2017; 64:1242-9. [PMID: 27321602 DOI: 10.1111/jgs.14163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity). DESIGN Prospective, community-based cohort study in four U.S. cities. SETTING Cardiovascular Health Study. PARTICIPANTS Individuals aged 65 and older. MEASUREMENTS Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty-reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self-reported healthy life (YHL), and mortality using multivariable regression and survival analysis. RESULTS After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60-1.33) more YAL and 0.54 (95% CI = 0.19-0.90) more YHL than expected agers, and those who were prematurely frail had -0.99 (95% CI = -1.36 to -0.62) fewer YAL and -0.53 (95% CI = -0.89 to -0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001). CONCLUSION Despite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.
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Affiliation(s)
- Jason L Sanders
- Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Calvin H Hirsch
- Department of Medicine, University of California Davis, Sacramento, California
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
| | - Dae Kim
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jorge R Kizer
- Department of Medicine, Yeshiva University, Bronx, New York
| | - Joachim H Ix
- Department of Medicine, University of California San Diego, San Diego, California
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Yeshiva University, Bronx, New York
| | - Stephen B Kritchevsky
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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19
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Maggi P, Bellacosa C, Leone A, Volpe A, Ricci ED, Ladisa N, Cicalini S, Grilli E, Viglietti R, Chirianni A, Bellazzi LI, Maserati R, Martinelli C, Corsi P, Celesia BM, Sozio F, Angarano G. Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy: Comparison of three different regimens - PREVALEAT II cohort. Atherosclerosis 2017; 263:398-404. [PMID: 28522147 DOI: 10.1016/j.atherosclerosis.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/29/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS PREVALEAT (PREmature VAscular LEsions and Antiretroviral Therapy) II is a multicenter, longitudinal cohort study aimed at the evaluation of cardiovascular risk among advanced HIV-positive, treatment-naïve patients starting their first therapy. We hypothesized that these patients, present a higher cardiovascular (CV) risk. METHODS The study included all consecutive naïve patients with less than 200 CD4 cells/ml starting antiretroviral therapy. Our primary objective was to evaluate changes in carotid intima- media thickness (IMT). Secondary endpoints included changes in flow mediated vasodilation (FMD), inflammatory markers, triglycerides and cholesterol. Patients were evaluated at time 0, and after 3, 6 and 12 months. RESULTS We enrolled 119 patients, stratified into three different groups: patients receiving atazanavir/ritonavir boosted (ATV/r) based regimens, efavirenz (EFV) based regimens and darunavir/ritonavir boosted (DRV/r) based regimens. At baseline, advanced naïve patients showed a relevant deterioration of CV conditions in terms of traditional CV risk factors, endothelial dysfunction and serum biomarkers. During the 12-month follow up period, mean blood lipids significantly increased: total cholesterol from 159 to 190 mg/dL, HDL-C from 31 to 41 mg/dL, and LDL-C from 99 to 117 mg/dL. D-dimers steadily decreased (median level 624 at baseline and 214 at T3), whereas ICAM and VCAM consistently raised. DRV/r and ATV/r determined a more marked decrease of D-dimers as compared to EFV. Regarding the epi-aortic changes (IMT >1 mm or presence of atherosclerotic plaques), patients in the DRV/r group were at risk of developing pathological IMT during the study (OR 6.0, 95% CI 0.9-36.9), as compared to EFV ones. CONCLUSIONS CV risk was elevated in advanced naïve patients and tended to remain high in the first year of therapy.
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Affiliation(s)
- Paolo Maggi
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy.
| | - Chiara Bellacosa
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | - Armando Leone
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | - Anna Volpe
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | - Elena Delfina Ricci
- CISAI (Coordinamento Italiano per lo Studio dell'Allergia in Infezione da HIV), Italy
| | - Nicoletta Ladisa
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | | | | | - Rosaria Viglietti
- Department of Infectious Diseases, Ospedale Cotugno Napoli3, Napoli, Italy
| | - Antonio Chirianni
- Department of Infectious Diseases, Ospedale Cotugno Napoli3, Napoli, Italy
| | | | - Renato Maserati
- Institute of Infectious Diseases, Policlinico San Matteo, Pavia, Italy
| | - Canio Martinelli
- Institute of Infectious Diseases, Ospedale Careggi, Firenze, Italy
| | - Paola Corsi
- Institute of Infectious Diseases, Ospedale Careggi, Firenze, Italy
| | | | - Federica Sozio
- Department of Infectious Diseases, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Gioacchino Angarano
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
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20
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Shendre A, Wiener H, Irvin MR, Zhi D, Limdi NA, Overton ET, Wassel CL, Divers J, Rotter JI, Post WS, Shrestha S. Admixture Mapping of Subclinical Atherosclerosis and Subsequent Clinical Events Among African Americans in 2 Large Cohort Studies. CIRCULATION. CARDIOVASCULAR GENETICS 2017; 10:e001569. [PMID: 28408707 PMCID: PMC5396391 DOI: 10.1161/circgenetics.116.001569] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/03/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Local ancestry may contribute to the disproportionate burden of subclinical and clinical cardiovascular disease among admixed African Americans compared with other populations, suggesting a rationale for admixture mapping. METHODS AND RESULTS We estimated local European ancestry (LEA) using Local Ancestry inference in adMixed Populations using Linkage Disequilibrium method (LAMP-LD) and evaluated the association with common carotid artery intima-media thickness (cCIMT) using multivariable linear regression analysis among 1554 African Americans from MESA (Multi-Ethnic Study of Atherosclerosis). We conducted secondary analysis to examine the significant cCIMT-LEA associations with clinical cardiovascular disease events. We observed genome-wide significance in relation to cCIMT association with the SERGEF gene (secretion-regulating guanine nucleotide exchange factor; β=0.0137; P=2.98×10-4), also associated with higher odds of stroke (odds ratio=1.71; P=0.02). Several regions, in particular CADPS gene (Ca2+-dependent secretion activator 1) region identified in MESA, were also replicated in the ARIC cohort (Atherosclerosis Risk in Communities). We observed other cCIMT-LEA regions associated with other clinical events, most notably the regions harboring CKMT2 gene (creatine kinase, mitochondrial 2) and RASGRF2 gene (Ras protein-specific guanine nucleotide-releasing factor 2) with all clinical events except stroke, the LRRC3B gene (leucine-rich repeat containing 3B) with myocardial infarction, the PRMT3 gene (protein arginine methyltransferase 3) with stroke, and the LHFPL2 gene (lipoma high mobility group protein I-C fusion partner-like 2) with hard and all coronary heart disease. CONCLUSIONS We identified several novel LEA regions, in addition to previously identified genetic variations, associated with cCIMT and cardiovascular disease events among African Americans.
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Affiliation(s)
- Aditi Shendre
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
- Currently: Richard M. Fairbanks School of Public Health, Indianapolis University Purdue University Indianapolis, IN
| | - Howard Wiener
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
- Currently: Richard M. Fairbanks School of Public Health, Indianapolis University Purdue University Indianapolis, IN
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
- Currently: Richard M. Fairbanks School of Public Health, Indianapolis University Purdue University Indianapolis, IN
| | - Degui Zhi
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
- Currently, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX
| | - Nita A. Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Edgar T. Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Christina L. Wassel
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT
| | - Jasmin Divers
- Biostatistical Sciences, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Jerome I. Rotter
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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21
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Polonsky TS, Ning H, Daviglus ML, Liu K, Burke GL, Cushman M, Eng J, Folsom AR, Lutsey PL, Nettleton JA, Post WS, Sacco RL, Szklo M, Lloyd-Jones DM. Association of Cardiovascular Health With Subclinical Disease and Incident Events: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.116.004894. [PMID: 28320747 PMCID: PMC5524019 DOI: 10.1161/jaha.116.004894] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few adults have ideal cardiovascular health (CVH). We studied associations of an overall CVH score with subclinical cardiovascular disease and events. We assessed whether associations varied by race/ethnicity. Methods and Results Among 5961 participants in the Multi‐Ethnic Study of Atherosclerosis, components of CVH were measured at baseline, 2000‐2002: systolic blood pressure, total cholesterol, fasting glucose, smoking, physical activity, diet, and body mass index. Levels were classified as ideal (2 points), intermediate (1 point), and poor (0 points) according to American Heart Association definitions. Points were summed to produce a CVH score (0‐7 low, 8‐11 moderate, 12‐14 high). Coronary artery calcium, carotid intima‐media thickness, and left ventricular mass were measured at baseline. Cardiovascular disease was defined as myocardial infarction, coronary heart disease death, resuscitated cardiac arrest, stroke, heart failure, or peripheral artery disease. Follow‐up was 10.3 years. Regression models were used to examine associations of the CVH score with subclinical disease and events, adjusting for age, sex, and education. Analyses were stratified by race/ethnicity. Adults with high or moderate CVH scores had significantly lower odds of coronary artery calcium and lower carotid intima‐media thickness and left ventricular mass than adults with low CVH scores. Adults with high or moderate CVH scores were 67% (95%CI 41% to 82%) and 37% (95%CI 22% to 49%) less likely, respectively, to experience a cardiovascular disease event than adults with low scores. There was no interaction with race/ethnicity. Conclusions There is a graded inverse association between CVH scores and measures of subclinical and overt cardiovascular disease that is similar across race/ethnic groups.
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Affiliation(s)
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, IL
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Gregory L Burke
- Department of Public Health Sciences, Wake Forest University, Winston Salem, NC
| | - Mary Cushman
- Departments of Medicine and Pathology & Laboratory Medicine, University of Vermont, Colchester, VT
| | - John Eng
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron R Folsom
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Jennifer A Nettleton
- Health Science Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas, Houston, TX
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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22
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Bots ML, Evans GW, Tegeler CH, Meijer R. Carotid Intima-media Thickness Measurements: Relations with Atherosclerosis, Risk of Cardiovascular Disease and Application in Randomized Controlled Trials. Chin Med J (Engl) 2017; 129:215-26. [PMID: 26830994 PMCID: PMC4799550 DOI: 10.4103/0366-6999.173500] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Advances in the field of carotid ultrasound have been incremental, resulting in a steady decrease in measurement variability. Improvements in edge detection algorithms point toward increasing automation of CIMT measurements. The major advantage of CIMT is that it is completely noninvasive and can be repeated as often as required. It provides a continuous measure since all subjects have a measurable carotid wall. It is also relatively inexpensive to perform, and the technology is widely available. A graded relation between raising LDL cholesterol and increased CIMT is apparent. Increased CIMT has been shown consistently to relate the atherosclerotic abnormalities elsewhere in the arterial system. Moreover, increased CIMT predicts future vascular events in both populations from Caucasian ancestry and those from Asian ancestry. Furthermore, lipid‑lowering therapy has been shown to affect CIMT progression within 12–18 months in properly designed trials with results congruent with clinical events trials. In conclusion, when one wants to evaluate the effect of a pharmaceutical intervention that is to be expected to beneficially affect atherosclerosis progression and to reduce CV event risk, the use of CIMT measurements over time is a valid, suitable, and evidence‑based choice.
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Affiliation(s)
- Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Jeong IK, Kim SG, Cho DH, Kim CH, Kim CS, Lee WY, Won KC, Kim DM. Impact of carotid atherosclerosis detection on physician and patient behavior in the management of type 2 diabetes mellitus: a prospective, observational, multicenter study. BMC Cardiovasc Disord 2016; 16:220. [PMID: 27842497 PMCID: PMC5109726 DOI: 10.1186/s12872-016-0401-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 11/08/2016] [Indexed: 11/23/2022] Open
Abstract
Background This study compared carotid ultrasound (CUS) and traditional risk calculations in determining cardiovascular disease (CVD) risk in patients with type 2 diabetes mellitus (DM) and investigated whether awareness of CVD affects patient and/or physician behavior. Methods In this prospective, observational, multicenter study, 797 participants with type 2 diabetes were assessed using CUS, the United Kingdom Prospective Diabetes Study Risk Engine (UKPDSRE) calculator, and the Framingham Risk Score (FRS) algorithm. Health-related behaviors and physician treatments were compared at baseline and at 6 months after assessment. Results According to CUS, 43.5 % of the participants were at high risk (compared to 10.6 % and 4.3 % using the UKPDSRE and FRS approaches, respectively). Interestingly, 31.5 % of the patients with low risk scores according to the UKPDSRE calculator and 35.8 % of the patients with low risk scores according to the FRS algorithm were found to be at high risk according to CUS. The proportion of patients who achieved target LDL-C levels significantly increased after CUS. Moreover, increased awareness of atherosclerosis through CUS findings significantly altered physician treatment patterns and patient health-related behaviors. Conclusions Carotid atherosclerosis was detected in more than 30 % of all participants with low or intermediate risk stratification scores. Improved awareness of atherosclerosis through CUS findings had a positive impact on both patient and physician behavior, resulting in improved CV risk management. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0401-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- In-Kyung Jeong
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Sin-Gon Kim
- Korea University Anam Hospital, Seoul, South Korea
| | - Dong Hyeok Cho
- Chonnam National University Hospital, Gwangju, South Korea
| | | | - Chul Sik Kim
- Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea
| | | | - Kyu-Chang Won
- Yeungnam University Medical Center, Daegu, South Korea
| | - Doo-Man Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Gil-Dong, Gangdong-Gu, Seoul, South Korea.
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Poredos P. Intima-media thickness: indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med 2016; 9:46-54. [PMID: 15230488 DOI: 10.1191/1358863x04vm514ra] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The measurement of intima-media thickness (IMT) of large superficial arteries, especially the carotid, using high-resolution B-mode ultrasonography has emerged as one of the methods of choice for determining the anatomic extent of atherosclerosis and for assessing cardiovascular risk. IMT measurement obtained by ultrasonography correlates very well with pathohistologic measurements and the reproducibility of this technique is good. Population studies have shown a strong correlation between carotid IMT and several cardiovascular risk factors, and it has also been found to be associated with the extent of atherosclerosis and end-organ damage of high-risk patients. Therefore, increased carotid IMT is a measure of athero-sclerotic burden and a predictor of subsequent events. Because of its quantitative value, carotid IMT measurement is more and more frequently used in clinical trials to test the effects of different preventive measures, including drugs. More recently, there has been interest in the clinical use of this technique for detecting preclinical (asymptomatic) atherosclerosis and for identifying subjects at high risk. Measurement of carotid IMT could influence a clinician to intervene with medication and to use more aggressive treatment of risk factors in primary prevention, and in patients with atherosclerotic disease in whom there is evidence of progression and extension of atherosclerotic disease. For more extensive use of this method in clinical practice a consensus concerning the standardization of methods of measurement and precise definition of threshold between normal and pathologic IMT value is urgently needed.
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Affiliation(s)
- Pavel Poredos
- Department for Vascular Disease, University Medical Centre, Ljubljana, Slovenia.
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25
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Cheng HG, Patel BS, Martin SS, Blaha M, Doneen A, Bale B, Jones SR. Effect of comprehensive cardiovascular disease risk management on longitudinal changes in carotid artery intima-media thickness in a community-based prevention clinic. Arch Med Sci 2016; 12:728-35. [PMID: 27478452 PMCID: PMC4947619 DOI: 10.5114/aoms.2016.60955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 05/11/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The aim of the study was to examine changes in carotid intima-media thickness (CIMT) and carotid plaque morphology in patients receiving multifactorial cardiovascular disease (CVD) risk factor management in a community-based prevention clinic. Quantitative changes in CIMT and qualitative changes in carotid plaque morphology may be measured non-invasively by ultrasound. MATERIAL AND METHODS This is a retrospective study on a cohort of 324 patients who received multifactorial cardiovascular risk reduction treatment at a community prevention clinic. All patients received lipid-lowering medications (statin, niacin, and/or ezetimibe) and lifestyle modification. All patients underwent at least one follow-up CIMT measurement after starting their regimen. Annual biomarker, CIMT, and plaque measurements were analyzed for associations with CVD risk reduction treatment. RESULTS Median time to last CIMT was 3.0 years. Compared to baseline, follow-up analysis of all treatment groups at 2 years showed a 52.7% decrease in max CIMT, a 3.0% decrease in mean CIMT, and an 87.0% decrease in the difference between max and mean CIMT (p < 0.001). Plaque composition changes occurred, including a decrease in lipid-rich plaques of 78.4% within the first 2 years (p < 0.001). After the first 2 years, CIMT and lipid-rich plaques continued to decline at reduced rates. CONCLUSION In a cohort of patients receiving comprehensive CVD risk reduction therapy, delipidation of subclinical carotid plaque and reductions in CIMT predominantly occurred within 2 years, and correlated with changes in traditional biomarkers. These observations, generated from existing clinical data, provide unique insight into the longitudinal on-treatment changes in carotid plaque.
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Affiliation(s)
- Henry G. Cheng
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Birju S. Patel
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Seth S. Martin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Michael Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Amy Doneen
- Heart Attack and Stroke Prevention Center, Spokane, USA
| | - Brad Bale
- Heart Attack and Stroke Prevention Center, Spokane, USA
| | - Steven R. Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
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Dormanesh B, Vosoughi K, Akhoundi FH, Mehrpour M, Fereshtehnejad SM, Esmaeili S, Sabet AS. Carotid duplex ultrasound and transcranial Doppler findings in commercial divers and pilots. Neurol Sci 2016; 37:1911-1916. [PMID: 27461112 DOI: 10.1007/s10072-016-2674-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/15/2016] [Indexed: 11/28/2022]
Abstract
The risky working environments of divers and pilots, and the possible role of extreme ambient pressure in carotid stenosis, make ischemic stroke an important occupational concern among these professionals. In this study, we aimed to evaluate the association of being exposed to hyperbaric or hypobaric conditions with carotid artery stenosis by comparing common carotid intima-media thickness (CCIMT) and blood flow velocities of cerebral arteries in divers and pilots using carotid duplex ultrasound (CDUS) and transcranial Doppler (TCD). CDUS and transtemporal TCD were performed in 29 divers, 36 pilots and 30 control participants. Medical history, blood pressure, lipid profile and blood sugar were recorded to control the previously well-known risk factors of atherosclerosis. Findings of the CDUS and TCD [including: CCIMT and blood flow velocities of internal carotid artery (ICA), common carotid artery (CCA), and middle cerebral artery (MCA)] of divers and pilots were compared with those of the control group using regression analysis models. Both right and left side CCIMT were significantly higher in divers (P < 0.05) and pilots (P < 0.05) in comparison with the control group. Carotid index [peak systolic velocity (PSV) of ICA/PSV of CCA) of divers and pilots were also higher than the control group. TCD findings were not significantly different between divers, pilots, and the control group. Increased CCIMT and carotid index in diver and pilot groups appear to be suggestive of accelerated atherosclerosis of carotid artery in these occupational groups.
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Affiliation(s)
| | - Kia Vosoughi
- Iran University of Medical Sciences and Health Services, Tehran, Iran. .,Neurology Department, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran. .,Medical Students Research Committee, Iran University of Medical Sciences, Tehran, Iran.
| | - Fahimeh H Akhoundi
- Neurology Department, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Neurology Department, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Setareh Esmaeili
- Medical Students Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Shafiee Sabet
- Medical Students Research Committee, Iran University of Medical Sciences, Tehran, Iran
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27
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Roman MJ, Naqvi TZ, Gardin JM, Gerhard-Herman M, Jaff M, Mohler E. American Society of Echocardiography Report. Vasc Med 2016; 11:201-11. [PMID: 17288128 DOI: 10.1177/1358863x06070511] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Noninvasive measures of atherosclerosis have emerged as adjuncts to standard cardiovascular disease (CVD) risk factors in an attempt to refine risk stratification and the need for more aggressive preventive strategies. Two such approaches, carotid artery imaging and brachial artery reactivity testing (BART), are ultrasound based. Numerous carotid artery imaging protocols have been used, and methodologic aspects are described in detail in this review. The panel recommends that protocols: (1) use end-diastolic (minimum dimension) images for intimal-medial thickness (IMT) measurements; (2) provide separate categorization of plaque presence and IMT; (3) avoid use of a single upper limit of normal for IMT because the measure varies with age, sex, and race; and (4) incorporate lumen measurement, particularly when serial measurements are performed to account for changes in distending pressure. Protocols may vary in the number of segments wherein IMT is measured, whether near wall is measured in addition to far wall, and whether IMT measurements are derived from B-mode or M-mode images, depending on the application. BART is a technique that requires meticulous attention to patient preparation and methodologic detail. Its application is substantially more challenging than is carotid imaging and remains largely a research technique that is not readily translated into routine clinical practice.
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Affiliation(s)
- Mary J Roman
- Weill Medical College of Cornell University, New York, NY, USA.
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28
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Lee S, Ahuja V, Masaki K, Evans RW, Barinas-Mitchell EJM, Ueshima H, Shin C, Choo J, Hassen L, Edmundowicz D, Kuller LH, Willcox B, Sekikawa A. A Significant Positive Association of Vitamin D Deficiency with Coronary Artery Calcification among Middle-aged Men: For the ERA JUMP Study. J Am Coll Nutr 2016; 35:614-620. [PMID: 27315115 DOI: 10.1080/07315724.2015.1118651] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Although a significant positive association of vitamin D deficiency with coronary heart disease has been demonstrated in cross-sectional as well as prospective studies, only a few studies have examined the association of vitamin D deficiency with subclinical atherosclerosis. We examined whether vitamin D deficiency is associated with subclinical atherosclerosis, as measured by coronary artery calcification (CAC) in asymptomatic adults. METHODS In a population-based cross-sectional study, 195 men aged 40 to 49 years without cardiovascular disease were randomly selected (98 Caucasian and 97 Japanese American men). Liquid chromatography-tandem mass spectrometry was utilized to measure serum vitamin D. CAC was examined by electron beam computed tomography using standardized protocols and read centrally at the University of Pittsburgh using Agatston's methods. To investigate an association between vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL) and CAC (defined as Agatston score ≥ 10), we utilized multivariable logistic regression models. RESULTS Prevalence of CAC and vitamin D deficiency was 27.2% and 10.3%, respectively. Participants with CAC were significantly older, had significantly higher body mass index (BMI), and had higher rates of smoking. Those with CAC were 3.31 times likely to be vitamin D deficient, after adjusting for traditional cardiovascular risk factors (odds ratio [OR] = 3.31, 95% confidence interval [CI], 1.12-9.77). CONCLUSIONS In this population-based study of healthy middle-aged men, vitamin D deficiency had a significant positive association with the presence of CAC.
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Affiliation(s)
- Sunghee Lee
- a Institute of Human Genomic Study, Korea University Ansan Hospital , Ansan , SOUTH KOREA
| | - Vasudha Ahuja
- c Department of Epidemiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Kamal Masaki
- d Department of Geriatric Medicine , the John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii
| | - Rhobert W Evans
- c Department of Epidemiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Emma J M Barinas-Mitchell
- c Department of Epidemiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Hirotsugu Ueshima
- e Department of Health Science , Shiga University of Medical Science , Otsu , Shiga , JAPAN
| | - Chol Shin
- b Department of Internal Medicine , Korea University Ansan Hospital , Ansan , SOUTH KOREA
| | - Jina Choo
- g Korea University College of Nursing , Seoul , SOUTH KOREA
| | - Lauren Hassen
- c Department of Epidemiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Daniel Edmundowicz
- f Cardiovascular Institute, University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania
| | - Lewis H Kuller
- c Department of Epidemiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Bradley Willcox
- d Department of Geriatric Medicine , the John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii
| | - Akira Sekikawa
- c Department of Epidemiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , Pennsylvania.,e Department of Health Science , Shiga University of Medical Science , Otsu , Shiga , JAPAN
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29
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Khazai B, Golden SH, Colangelo LA, Swerdloff R, Wang C, Honoris L, Gapstur SM, Ouyang P, Cushman M, Li D, Kopp P, Vaidya D, Liu K, Dobs A, Budoff M. Association of endogenous testosterone with subclinical atherosclerosis in men: the multi-ethnic study of atherosclerosis. Clin Endocrinol (Oxf) 2016; 84:700-7. [PMID: 26663365 DOI: 10.1111/cen.12997] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 09/14/2015] [Accepted: 11/25/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Whether endogenous sex hormones play a role in cardiovascular disease (CVD) risk in men is unclear. Few studies have examined associations of sex hormones with atherosclerosis measured by coronary artery calcium score (CACS) and carotid intima-media thickness (cIMT). We evaluated the association of testosterone (T) and other sex hormones with CACS and cIMT. METHODS Using the large multi-ethnic cohort of 3164 men without known CVD in the Multi-Ethnic Study of Atherosclerosis (MESA), cross-sectional associations of tertiles of endogenous sex hormones with CACS and cIMT were analysed. RESULTS In regard to CAC, there was a significant negative trend (P-trend = 0·02) for CACS>0 over tertiles of free T (FT) with RRs (95% CI) for the lowest to highest tertiles. There was also a marginally significant positive trend (P-trend = 0·06) for CACS>0 over tertiles of sex hormone-binding globulin (SHBG) with RRs for the lowest to highest tertiles. There were no significant associations with CACS >0 for tertiles of TT (Total T), bioavailable T (BT), oestradiol (E2) and dehydroepiandrosterone (DHEA). There was significantly higher log CACS after adjustment for CVD risk factors for lower TT levels, compared to higher levels, using 9·54 and 10·4 nmol/l as cut-off points. In regard to cIMT, there was a significant positive trend (P = 0·003) in mean cIMT over the tertiles of BT, but not for TT, FT, E2, DHEA and SHBG. There was significantly lower cIMT after adjustment for CVD risk factors for lower TT levels compared to higher levels. CONCLUSION In a population of male subjects with no known CVD, lower FT is associated with higher RR of CACS>0 and lower TT is associated with higher log CACS. Lower BT and TT are associated with lower cIMT. While these findings support the positive correlation between low T and coronary atherosclerosis, the opposite findings on cIMT warrant further evaluation.
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Affiliation(s)
- Bahram Khazai
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | | | - Laura A Colangelo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald Swerdloff
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | - Christina Wang
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | - Lily Honoris
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | | | - Pamela Ouyang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Dong Li
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | - Peter Kopp
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Kiang Liu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adrian Dobs
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
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30
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Wang H, Gauthier M, Kelly JR, Miller RJ, Xu M, O'Brien WD, Cheng J. Targeted Ultrasound-Assisted Cancer-Selective Chemical Labeling and Subsequent Cancer Imaging using Click Chemistry. Angew Chem Int Ed Engl 2016; 55:5452-6. [PMID: 27010510 PMCID: PMC4918225 DOI: 10.1002/anie.201509601] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/29/2016] [Indexed: 01/01/2023]
Abstract
Metabolic sugar labeling followed by the use of reagent-free click chemistry is an established technique for in vitro cell targeting. However, selective metabolic labeling of the target tissues in vivo remains a challenge to overcome, which has prohibited the use of this technique for targeted in vivo applications. Herein, we report the use of targeted ultrasound pulses to induce the release of tetraacetyl N-azidoacetylmannosamine (Ac4 ManAz) from microbubbles (MBs) and its metabolic expression in the cancer area. Ac4 ManAz-loaded MBs showed great stability under physiological conditions, but rapidly collapsed in the presence of tumor-localized ultrasound pulses. The released Ac4 ManAz from MBs was able to label 4T1 tumor cells with azido groups and significantly improved the tumor accumulation of dibenzocyclooctyne (DBCO)-Cy5 by subsequent click chemistry. We demonstrated for the first time that Ac4 ManAz-loaded MBs coupled with the use of targeted ultrasound could be a simple but powerful tool for in vivo cancer-selective labeling and targeted cancer therapies.
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Affiliation(s)
- Hua Wang
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, USA
| | - Marianne Gauthier
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Jamie R Kelly
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Rita J Miller
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Ming Xu
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, USA
| | - William D O'Brien
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Jianjun Cheng
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, USA.
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31
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Pflederer MC, Long CS, Beaty B, Havranek EP, Mehler PS, Keniston A, Krantz MJ. Longitudinal Changes in Vascular Risk Markers and Mortality Rates among a Latino Population with Hypertension. Tex Heart Inst J 2016; 43:131-6. [PMID: 27127427 DOI: 10.14503/thij-15-5053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Vascular markers such as pulse-wave velocity and carotid intima-media thickness (CIMT) might improve the prediction of incident cardiovascular disease beyond traditional risk factors. These vascular markers have not been well characterized in minority populations and might be more useful than inflammatory biomarkers. We conducted a prospective, longitudinal cohort study among hypertensive patients in an urban safety-net hospital. We evaluated inflammatory biomarkers, arterial pulse-wave velocity, and carotid intima-media thickness at baseline, 1 year, and 2 years. The primary outcome variable was CIMT. Generalized linear mixed-effects models were used to evaluate associations between CIMT and predictive variables accounting for the correlation of multiple measurements within subjects over time. For our secondary outcome, we used administrative and National Death Index data to determine all-cause death, and univariate relationships were evaluated. Among 175 subjects, 117 were Latino (67%) and 117 were female (67%). Pulse-wave velocity and CIMT regressed over time (both P <0.001) and were highly correlated (P <0.001). Only pulse-wave velocity (P=0.002) and total cholesterol (P=0.03) were associated with CIMT in time-varying covariate analysis. At a median follow-up period of 80 months, 17 of 175 subjects had died (10%). Higher baseline CIMT and pulse-wave velocity were associated with increased mortality rates (both P <0.01). No serum inflammatory marker was significantly correlated with longitudinal changes in CIMT or death. In conclusion, both arterial stiffness and preclinical carotid atherosclerosis were associated with increased mortality rates and might be useful risk-stratification markers among this minority population.
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32
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Wang H, Gauthier M, Kelly JR, Miller RJ, Xu M, O'Brien WD, Cheng J. Targeted Ultrasound‐Assisted Cancer‐Selective Chemical Labeling and Subsequent Cancer Imaging using Click Chemistry. Angew Chem Int Ed Engl 2016. [DOI: 10.1002/ange.201509601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hua Wang
- Department of Materials Science and Engineering University of Illinois at Urbana-Champaign USA
| | - Marianne Gauthier
- Department of Electrical and Computer Engineering University of Illinois at Urbana-Champaign Urbana IL 61801 USA
| | - Jamie R. Kelly
- Department of Electrical and Computer Engineering University of Illinois at Urbana-Champaign Urbana IL 61801 USA
| | - Rita J. Miller
- Department of Electrical and Computer Engineering University of Illinois at Urbana-Champaign Urbana IL 61801 USA
| | - Ming Xu
- Department of Materials Science and Engineering University of Illinois at Urbana-Champaign USA
| | - William D. O'Brien
- Department of Electrical and Computer Engineering University of Illinois at Urbana-Champaign Urbana IL 61801 USA
| | - Jianjun Cheng
- Department of Materials Science and Engineering University of Illinois at Urbana-Champaign USA
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Shah AS, Dabelea D, Fino NF, Dolan LM, Wadwa RP, D'Agostino R, Hamman R, Marcovina S, Daniels SR, Urbina EM. Predictors of Increased Carotid Intima-Media Thickness in Youth With Type 1 Diabetes: The SEARCH CVD Study. Diabetes Care 2016; 39:418-25. [PMID: 26721813 PMCID: PMC4764035 DOI: 10.2337/dc15-1963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/03/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Youth with type 1 diabetes have worse cardiovascular (CV) risk factors and higher carotid intima-media thickness (IMT) than their peers without diabetes. Whether the burden of CV risk factors over time is associated with carotid IMT at follow-up in youth with type 1 diabetes is not known. RESEARCH DESIGN AND METHODS Two hundred ninety-eight youth with type 1 diabetes (mean age 13.3 ± 2.9 years, 87.6% non-Hispanic white, 53.7% male) had two study visits 5 years apart. CV risk factors, including BMI, lipids, blood pressure, hemoglobin A(1c), and smoking status, were assessed at both visits, and carotid IMT was measured at follow-up using B-mode ultrasonography. Linear regression models with an area under the curve measurement that incorporated the baseline and follow-up CV risk factors were used to evaluate the relationship with carotid IMT at follow-up. RESULTS All CV risk factors worsened significantly over time (except LDL cholesterol) (P < 0.05). From baseline to follow-up, the number of abnormal CV risk factors also increased (P < 0.05). Predictors of carotid IMT were older age, male sex, and higher BMI z score area under the curve (all P < 0.05). CONCLUSIONS The CV risk factor burden increases over time in youth with type 1 diabetes. BMI z score was the only modifiable CV risk factor that predicted carotid IMT. This study highlights the critical need to better understand the risk factors that influence carotid IMT early in the course of type 1 diabetes.
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Affiliation(s)
- Amy S Shah
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Nora F Fino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Lawrence M Dolan
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - R Paul Wadwa
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Richard Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Elaine M Urbina
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
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Vargas JD, Manichaikul A, Wang XQ, Rich SS, Rotter JI, Post WS, Polak JF, Budoff MJ, Bluemke DA. Detailed analysis of association between common single nucleotide polymorphisms and subclinical atherosclerosis: The Multi-ethnic Study of Atherosclerosis. Data Brief 2016; 7:229-42. [PMID: 26958643 PMCID: PMC4773483 DOI: 10.1016/j.dib.2016.01.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 01/19/2023] Open
Abstract
Previously identified single nucleotide polymorphisms (SNPs) in genome wide association studies (GWAS) of cardiovascular disease (CVD) in participants of mostly European descent were tested for association with subclinical cardiovascular disease (sCVD), coronary artery calcium score (CAC) and carotid intima media thickness (CIMT) in the Multi-Ethnic Study of Atherosclerosis (MESA). The data in this data in brief article correspond to the article Common Genetic Variants and Subclinical Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis [1]. This article includes the demographic information of the participants analyzed in the article as well as graphical displays and data tables of the association of the selected SNPs with CAC and of the meta-analysis across ethnicities of the association of CIMT-c (common carotid), CIMT-I (internal carotid), CAC-d (CAC as dichotomous variable with CAC>0) and CAC-c (CAC as continuous variable, the log of the raw CAC score plus one) and CVD. The data tables corresponding to the 9p21 fine mapping experiment as well as the power calculations referenced in the article are also included.
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Affiliation(s)
- Jose D. Vargas
- MedStar Health Research Institute, Georgetown University Hospital, Washington, District of Columbia, USA
- National Institutes of Health, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Ani Manichaikul
- Biostatistics Section, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Center for Public Health and Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Xin-Qun Wang
- Biostatistics Section, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Stephen S. Rich
- Center for Public Health and Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jerome I. Rotter
- Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Institute for Translational Genomics and Population Sciences, Torrance, CA, USA
| | - Wendy S. Post
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph F. Polak
- Department of Radiology, Tufts University School of Medicine, Boston, MA, USA
| | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David A. Bluemke
- National Institutes of Health, Radiology and Imaging Sciences, Bethesda, MD, USA
- Corresponding author: Radiology and Imaging Sciences, NIH Clinical Center, 10 Center Drive, Building 10/1c351, Bethesda, 20892, MD, USA.Radiology and Imaging SciencesNIH Clinical Center10 Center DriveBuilding 10/1c351BethesdaMD20892USA
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35
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Vargas JD, Manichaikul A, Wang XQ, Rich SS, Rotter JI, Post WS, Polak JF, Budoff MJ, Bluemke DA. Common genetic variants and subclinical atherosclerosis: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2016; 245:230-6. [PMID: 26789557 PMCID: PMC4738145 DOI: 10.1016/j.atherosclerosis.2015.11.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/27/2015] [Accepted: 11/29/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Subclinical atherosclerosis (sCVD), measured by coronary artery calcium (CAC) and carotid intima media thickness (CIMT) is associated with cardiovascular disease (CVD). Genome-Wide Association Studies (GWAS) of sCVD and CVD have focused primarily on Caucasian populations. We hypothesized that these associations may differ in populations from distinct genetic backgrounds. METHODS The associations between sCVD and 66 single nucleotide polymorphisms (SNPs) from published GWAS of sCVD and CVD were tested in 8224 Multi-Ethnic Study of Atherosclerosis (MESA) and MESA Family participants [2329 Caucasians (EUA), 691 Chinese (CHN), 2482 African Americans (AFA), and 2012 Hispanic (HIS)] using an additive model adjusting for CVD risk factors, with SNP significance defined by a Bonferroni-corrected p < 7.6 × 10(-4) (0.05/66). RESULTS In EUA there were significant associations for CAC with SNPs in 9p21 (rs1333049, P = 2 × 10(-9); rs4977574, P = 4 × 10(-9)), COL4A1 (rs9515203, P = 9 × 10(-6)), and PHACTR1 (rs9349379, P = 4 × 10(-4)). In HIS, CAC was associated with SNPs in 9p21 (rs1333049, P = 8 × 10(-5); rs4977574, P = 5 × 10(-5)), APOA5 (rs964184, P = 2 × 10(-4)), and ADAMTS7 (rs7173743, P = 4 × 10(-4)). There were no associations between CAC and 9p21 SNPs for AFA and CHN. Fine mapping of the 9p21 region revealed SNPs with robust associations with CAC in EUA and HIS but no significant associations in AFA and CHN. CONCLUSION Our results suggest some shared genetic architecture for sCVD across ethnic groups, while also underscoring the possibility of novel variants and/or pathways in risk of CVD in ethnically diverse populations.
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Affiliation(s)
- Jose D Vargas
- MedStar Health Research Institute, Georgetown University Hospital, Washington, DC, USA; National Institutes of Health, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Ani Manichaikul
- Center for Public Health and Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA; Biostatistics Section, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Xin-Qun Wang
- Biostatistics Section, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Stephen S Rich
- Center for Public Health and Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jerome I Rotter
- Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Institute for Translational Genomics and Population Sciences, Torrance, CA, USA
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph F Polak
- Department of Radiology, Tufts University School of Medicine, Boston, MA, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David A Bluemke
- National Institutes of Health, Radiology and Imaging Sciences, Bethesda, MD, USA.
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Stiglic G, Pajnkihar M. Evaluation of Major Online Diabetes Risk Calculators and Computerized Predictive Models. PLoS One 2015; 10:e0142827. [PMID: 26560153 PMCID: PMC4641713 DOI: 10.1371/journal.pone.0142827] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/27/2015] [Indexed: 12/29/2022] Open
Abstract
Classical paper-and-pencil based risk assessment questionnaires are often accompanied by the online versions of the questionnaire to reach a wider population. This study focuses on the loss, especially in risk estimation performance, that can be inflicted by direct transformation from the paper to online versions of risk estimation calculators by ignoring the possibilities of more complex and accurate calculations that can be performed using the online calculators. We empirically compare the risk estimation performance between four major diabetes risk calculators and two, more advanced, predictive models. National Health and Nutrition Examination Survey (NHANES) data from 1999-2012 was used to evaluate the performance of detecting diabetes and pre-diabetes. American Diabetes Association risk test achieved the best predictive performance in category of classical paper-and-pencil based tests with an Area Under the ROC Curve (AUC) of 0.699 for undiagnosed diabetes (0.662 for pre-diabetes) and 47% (47% for pre-diabetes) persons selected for screening. Our results demonstrate a significant difference in performance with additional benefits for a lower number of persons selected for screening when statistical methods are used. The best AUC overall was obtained in diabetes risk prediction using logistic regression with AUC of 0.775 (0.734) and an average 34% (48%) persons selected for screening. However, generalized boosted regression models might be a better option from the economical point of view as the number of selected persons for screening of 30% (47%) lies significantly lower for diabetes risk assessment in comparison to logistic regression (p < 0.001), with a significantly higher AUC (p < 0.001) of 0.774 (0.740) for the pre-diabetes group. Our results demonstrate a serious lack of predictive performance in four major online diabetes risk calculators. Therefore, one should take great care and consider optimizing the online versions of questionnaires that were primarily developed as classical paper questionnaires.
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Affiliation(s)
- Gregor Stiglic
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
- * E-mail:
| | - Majda Pajnkihar
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Laugsand LE, Ix JH, Bartz TM, Djousse L, Kizer JR, Tracy RP, Dehghan A, Rexrode K, Lopez OL, Rimm EB, Siscovick DS, O'Donnell CJ, Newman A, Mukamal KJ, Jensen MK. Fetuin-A and risk of coronary heart disease: A Mendelian randomization analysis and a pooled analysis of AHSG genetic variants in 7 prospective studies. Atherosclerosis 2015; 243:44-52. [PMID: 26343871 PMCID: PMC4609621 DOI: 10.1016/j.atherosclerosis.2015.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/13/2015] [Accepted: 08/23/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Fetuin-A has a plausible role in the inhibition of arterial calcification, but its association with risk of coronary heart disease (CHD) in the general population is unclear. We used two common genetic variants in the fetuin-A gene (AHSG) that are strongly associated with circulating fetuin-A levels to investigate the associations with risk of CHD and subclinical cardiovascular measures (intima-media thickness, ankle-arm index, and coronary artery calcification). METHODS Genetic variation and fetuin-A levels were assessed in 3299 community-living individuals (2733 Caucasians and 566 African Americans) 65 years of age or older, free of previous cardiovascular disease, who participated in the Cardiovascular Health Study (CHS) in 1992-1993. RESULTS Among Caucasians, both rs2248690 and rs4917 were associated with 12% lower fetuin-A concentrations per minor allele (P < 0.0001). The hazard ratios (HRs) per minor allele for incident CHD were 1.12 (95% CI: 1.00-1.26) for rs2248690 and 1.02 (0.91-1.14) for rs4917. Using both genotypes as an instrumental variable for measured fetuin-A, the HRs for one standard deviation increase in genetically determined fetuin-A levels on CHD risk were 0.84 (95% CI: 0.70-1.00) for rs2248690 and 0.97 (95% CI: 0.82-1.14) for rs4917, respectively. However, in CHS neither of the genotypes were associated with subclinical cardiovascular measures and when CHS data were meta-analyzed with data from six other prospective studies (totaling 26,702 Caucasian participants and 3295 CHD cases), the meta-analyzed HRs for incident CHD were 1.12 (0.93-1.34) and 1.06 (0.93-1.20) for rs2248690 and rs4917, respectively (p heterogeneity 0.005 and 0.0048). CONCLUSION Common variants in the AHSG gene are strongly associated with fetuin-A levels, but their concurrent association with CHD risk in current prospective studies is inconsistent. Further investigation in studies with measured fetuin-A and AHSG variants is needed to clarify the potential causal association of fetuin-A with CHD risk.
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Affiliation(s)
- Lars E Laugsand
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Divisions of Nephrology and Preventive Medicine, University of California San Diego, San Diego, CA, USA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Luc Djousse
- Boston Veterans Affairs Healthcare System, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Jorge R Kizer
- Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russell P Tracy
- Department of Pathology and Biochemistry, University of Vermont College of Medicine, Burlington, USA
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kathryn Rexrode
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David S Siscovick
- Cardiovascular Health Research Unit, Department of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA; Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Christopher J O'Donnell
- National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA; Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anne Newman
- UPMC/University of Pittsburgh Schools of the Health Sciences, Pittsburgh, PA, USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Olson NC, Butenas S, Lange LA, Lange EM, Cushman M, Jenny NS, Walston J, Souto JC, Soria JM, Chauhan G, Debette S, Longstreth WT, Seshadri S, Reiner AP, Tracy RP. Coagulation factor XII genetic variation, ex vivo thrombin generation, and stroke risk in the elderly: results from the Cardiovascular Health Study. J Thromb Haemost 2015; 13:1867-77. [PMID: 26286125 PMCID: PMC4946166 DOI: 10.1111/jth.13111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/12/2015] [Accepted: 08/02/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The relationships of thrombin generation (TG) with cardiovascular disease risk are underevaluated in population-based cohorts. OBJECTIVES To evaluate the relationships of TG influenced by the contact and tissue factor coagulation pathways ex vivo with common single-nucleotide polymorphisms (SNPs) and incident cardiovascular disease and stroke. PATIENTS/METHODS We measured peak TG (pTG) in baseline plasma samples of Cardiovascular Health Study participants (n = 5411), both with and without inhibitory anti-factor XIa antibody (pTG/FXIa(-) ). We evaluated their associations with ~ 50 000 SNPs by using the IBCv2 genotyping array, and with incident cardiovascular disease and stroke events over a median follow-up of 13.2 years. RESULTS The minor allele for an SNP in the FXII gene (F12), rs1801020, was associated with lower pTG in European-Americans (β = - 34.2 ± 3.5 nm; P = 3.3 × 10(-22) ; minor allele frequency [MAF] = 0.23) and African-Americans (β = - 31.1 ± 7.9 nm; P = 9.0 × 10(-5) ; MAF = 0.42). Lower FXIa-independent pTG (pTG/FXIa(-) ) was associated with the F12 rs1801020 minor allele, and higher pTG/FXIa(-) was associated with the ABO SNP rs657152 minor allele (β = 16.3 nm; P = 4.3 × 10(-9) ; MAF = 0.37). The risk factor-adjusted ischemic stroke hazard ratios were 1.09 (95% confidence interval CI 1.01-1.17; P = 0.03) for pTG, 1.06 (95% CI 0.98-1.15; P = 0.17) for pTG/FXIa(-) , and 1.11 (95% CI 1.02-1.21; P = 0.02) for FXIa-dependent pTG (pTG/FXIa(+) ), per one standard deviation increment (n = 834 ischemic strokes). In a multicohort candidate gene analysis, rs1801020 was not associated with incident ischemic stroke (β = - 0.02; standard error = 0.08; P = 0.81). CONCLUSIONS These results support the importance of contact activation pathway-dependent TG as a risk factor for ischemic stroke, and indicate the importance of F12 SNPs for TG ex vivo and in vivo.
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Affiliation(s)
- N C Olson
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - S Butenas
- Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA
| | - L A Lange
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - E M Lange
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - M Cushman
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - N S Jenny
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - J Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J C Souto
- Department of Hematology, Institute of Biomedical Research (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J M Soria
- Unit of Genomics of Complex Diseases, Institute of Biomedical Research (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - G Chauhan
- INSERM U897, University of Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - S Debette
- INSERM U897, University of Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
- Bordeaux University Hospital, Bordeaux, France
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - S Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - A P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - R P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
- Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA
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Kim DH, Grodstein F, Newman AB, Chaves PHM, Odden MC, Klein R, Sarnak MJ, Lipsitz LA. Microvascular and Macrovascular Abnormalities and Cognitive and Physical Function in Older Adults: Cardiovascular Health Study. J Am Geriatr Soc 2015; 63:1886-93. [PMID: 26338279 DOI: 10.1111/jgs.13594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function DESIGN Cross-sectional analysis of the Cardiovascular Health Study (1998-1999). SETTING Community. PARTICIPANTS Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5). MEASUREMENTS Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test (TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand) RESULTS Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = -0.30, 95% confidence interval (CI) = -0.37 to -0.24) and physical (mean score difference = -0.32, 95% CI = -0.38 to -0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: -0.16, 95% CI = -0.24 to -0.08 vs -0.13, 95% CI = -0.20 to -0.06; physical function: -0.15, 95% CI = -0.22 to -0.08 vs -0.12, 95% CI = -0.18 to -0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function. CONCLUSION Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication.
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Affiliation(s)
- Dae Hyun Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
| | - Francine Grodstein
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Michelle C Odden
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Lewis A Lipsitz
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
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40
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Fijacko N, Brzan PP, Stiglic G. Mobile Applications for Type 2 Diabetes Risk Estimation: a Systematic Review. J Med Syst 2015; 39:124. [PMID: 26303152 DOI: 10.1007/s10916-015-0319-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
Screening for chronical diseases like type 2 diabetes can be done using different methods and various risk tests. This study present a review of type 2 diabetes risk estimation mobile applications focusing on their functionality and availability of information on the underlying risk calculators. Only 9 out of 31 reviewed mobile applications, featured in three major mobile application stores, disclosed the name of risk calculator used for assessing the risk of type 2 diabetes. Even more concerning, none of the reviewed applications mentioned that they are collecting the data from users to improve the performance of their risk estimation calculators or offer users the descriptive statistics of the results from users that already used the application. For that purpose the questionnaires used for calculation of risk should be upgraded by including the information on the most recent blood sugar level measurements from users. Although mobile applications represent a great future potential for health applications, developers still do not put enough emphasis on informing the user of the underlying methods used to estimate the risk for a specific clinical condition.
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Affiliation(s)
- Nino Fijacko
- Faculty of Health Sciences, University of Maribor, Zitna ulica 15, 2000, Maribor, Slovenia,
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41
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Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cífková R, Cosentino F, De Carlo M, Gallino A, Landmesser U, Laurent S, Lekakis J, Mikhailidis DP, Naka KK, Protogerou AD, Rizzoni D, Schmidt-Trucksäss A, Van Bortel L, Weber T, Yamashina A, Zimlichman R, Boutouyrie P, Cockcroft J, O'Rourke M, Park JB, Schillaci G, Sillesen H, Townsend RR. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation. Atherosclerosis 2015; 241:507-32. [DOI: 10.1016/j.atherosclerosis.2015.05.007] [Citation(s) in RCA: 476] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/29/2015] [Accepted: 05/14/2015] [Indexed: 02/07/2023]
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Patel J, Al Rifai M, Blaha MJ, Budoff MJ, Post WS, Polak JF, Bluemke DA, Scheuner MT, Kronmal RA, Blumenthal RS, Nasir K, McEvoy JW. Coronary Artery Calcium Improves Risk Assessment in Adults With a Family History of Premature Coronary Heart Disease: Results From Multiethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2015; 8:e003186. [PMID: 26047825 DOI: 10.1161/circimaging.115.003186] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prognostic value of coronary artery calcium (CAC) or carotid intima-media thickness (CIMT) among asymptomatic adults with a family history (FH) of premature coronary heart disease is unclear. METHODS AND RESULTS Multiethnic Study of Atherosclerosis enrolled 6814 adults without known atherosclerotic cardiovascular disease (ASCVD). Hard ASCVD events were ascertained over a median follow-up of 10.2 years. We estimated adjusted-hazard ratios for CAC and CIMT categories using Cox regression, both within and across FH status groups. Improvement in discrimination with CAC or CIMT added to variables from the ASCVD pooled cohort equation was also evaluated using receiver-operating characteristic curve and likelihood ratio analysis. Of 6125 individuals (62±10 years; 47% men) who reported information on FH, 1262 (21%) had an FH of premature coronary heart disease. Among these, 104 hard ASCVD events occurred. Crude incidence rates (per 1000 person-years) for hard ASCVD were 4.4 for CAC, 0 (n=574; 46% of the sample); 8.8 for CAC, 1 to 99 (n=368); 14.9 for CAC, 100 to 399 (n=178); and 20.8 for CAC, ≥400 (n=142). Relative to CAC=0, adjusted hard ASCVD hazard ratios for each CAC category among persons with an FH were 1.64 (95% confidence interval, 0.94-2.87), 2.45 (1.31-4.58), and 2.80 (1.44-5.43), respectively. However, there was no increased adjusted hazard for hard ASCVD in high versus low CIMT categories. In participants with an FH of premature coronary heart disease, CAC improved discrimination of hard ASCVD events (P<0.001). However, CIMT did not discriminate ASCVD (P=0.70). CONCLUSIONS Nearly half of individuals reporting FH have zero CAC and may receive less net benefit from aspirin or statin therapy. Among persons with an FH, CAC is a robust marker of absolute and relative risk of ASCVD, whereas CIMT is not.
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Affiliation(s)
- Jaideep Patel
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Mahmoud Al Rifai
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Michael J Blaha
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Matthew J Budoff
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Wendy S Post
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Joseph F Polak
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - David A Bluemke
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Maren T Scheuner
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Richard A Kronmal
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Roger S Blumenthal
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Khurram Nasir
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - John W McEvoy
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.).
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Garg PK, McClelland RL, Jenny NS, Criqui MH, Greenland P, Rosenson RS, Siscovick DS, Jorgensen N, Cushman M. Lipoprotein-associated phospholipase A2 and risk of incident cardiovascular disease in a multi-ethnic cohort: The multi ethnic study of atherosclerosis. Atherosclerosis 2015; 241:176-82. [PMID: 26004387 PMCID: PMC4504012 DOI: 10.1016/j.atherosclerosis.2015.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/10/2015] [Accepted: 05/13/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Prospective studies reporting a positive association of lipoprotein-associated phospholipase A2 (Lp-PLA2) mass and activity with incident cardiovascular disease (CVD) have included primarily white individuals. We evaluated associations of Lp-PLA2 and first-time cardiovascular events in a healthy multi-ethnic cohort characterized by presence or absence of baseline subclinical atherosclerosis. METHODS Lp-PLA2 mass and activity were measured at baseline in 5456 participants in the Multi-Ethnic Study of Atherosclerosis. Individuals were characterized for presence of baseline subclinical disease (coronary artery calcium score > 0 or carotid intima-media thickness value > 80th percentile) and followed prospectively for development of CVD events (coronary heart disease, ischemic stroke, and cardiovascular death). RESULTS 516 incident CVD events occurred over median follow-up of 10.2 years. In adjusted Cox proportional hazards models, each higher standard deviation of both Lp-PLA2 activity and mass was associated with an increased risk of cardiovascular events; hazard ratios (HR; 95% confidence intervals (CI)) 1.12 (1.01-1.26) for Lp-PLA2 activity and 1.10 (1.01-1.21) for mass. Associations did not differ by subclinical disease status (p-value for interaction 0.99 for Lp-PLA2 activity and 0.32 for Lp-PLA2 mass) and there was no confounding by subclinical atherosclerosis measures. Associations of Lp-PLA2 activity but not mass were weaker in Chinese participants but there were relatively few events among Chinese in race-stratified analysis. CONCLUSION In this multi-ethnic cohort, Lp-PLA2 was positively associated with CVD risk, regardless of the presence of coronary artery calcium or a thickened carotid-intimal media.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Nancy S Jenny
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Michael H Criqui
- Department of Family & Preventive Medicine, University of California in San Diego, La Jolla, CA, USA
| | - Philip Greenland
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Neal Jorgensen
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA; Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
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Hunt KJ, Baker NL, Cleary PA, Klein R, Virella G, Lopes-Virella MF. Longitudinal Association Between Endothelial Dysfunction, Inflammation, and Clotting Biomarkers With Subclinical Atherosclerosis in Type 1 Diabetes: An Evaluation of the DCCT/EDIC Cohort. Diabetes Care 2015; 38:1281-9. [PMID: 25852210 PMCID: PMC4477339 DOI: 10.2337/dc14-2877] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/15/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is considerable interest in identifying biomarkers that predict high risk for the development of macrovascular complications in patients with diabetes. Therefore, the longitudinal association between subclinical atherosclerosis as measured by internal carotid artery intima-media thickness (IMT) and acute-phase reactants, cytokines/adipokines, thrombosis, and adhesion molecules was examined. RESEARCH DESIGN AND METHODS Biomarkers were measured at four time points over 20 years in 886 DCCT/EDIC participants with type 1 diabetes. Four composite scores were created by combining z scores generated from within the data set of individual biomarkers: acute-phase reactants (fibrinogen, C-reactive protein), thrombosis (fibrinogen, active and total plasminogen activator inhibitor [PAI]-1), cytokines/adipokines (tumor necrosis factor receptor-1 and -2, active and total PAI-1, IL-6), and endothelial dysfunction (soluble intracellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, and soluble E-selectin). Internal carotid IMT was measured at EDIC years 1, 6, and 12, with elevated IMT defined at each time point as being in the upper quintile of its distribution. RESULTS Logistic regression models indicate that while individual biomarkers were not predictive of or associated with subclinical atherosclerosis, composite scores of acute-phase reactants (odds ratio [OR] 2.78 [95% CI 1.42, 5.42]), thrombolytic factors (OR 2.83 [95% CI 1.45, 5.52]), and cytokines/adipokines (OR 2.83 [95% CI 1.48, 5.41]) measured at our final time point EDIC years 8-11 were associated with higher levels of atherosclerosis at EDIC year 12, but findings were not consistent at early time points. The endothelial dysfunction score was not appreciably predictive of or associated with subclinical atherosclerosis at any of the time points measured. CONCLUSIONS The pathophysiologic relationship between higher biomarker levels and progression of subclinical atherosclerosis remains unclear.
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Affiliation(s)
- Kelly J Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Patricia A Cleary
- The Biostatistics Center, The George Washington University, Washington, DC
| | - Richard Klein
- Ralph H. Johnson VA Medical Center, Charleston, SC Department of Medicine and Laboratory Services, Medical University of South Carolina, Charleston, SC
| | - Gabriel Virella
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Maria F Lopes-Virella
- Ralph H. Johnson VA Medical Center, Charleston, SC Department of Medicine and Laboratory Services, Medical University of South Carolina, Charleston, SC
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Cengiz M, Yavuzer S, Kılıçkıran Avcı B, Yürüyen M, Yavuzer H, Dikici SA, Karataş ÖF, Özen M, Uzun H, Öngen Z. Circulating miR-21 and eNOS in subclinical atherosclerosis in patients with hypertension. Clin Exp Hypertens 2015; 37:643-9. [PMID: 26114349 DOI: 10.3109/10641963.2015.1036064] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the relationship of miR-21, nitric oxide (NOx) and endothelial nitric oxide synthase (eNOS) with subclinical atherosclerosis in carotid arteries by measuring carotid intima media thickness (CIMT) in patients with hypertension and healthy controls. DESIGN AND METHODS A total of 28 hypertensive and 28 healthy controls were enrolled. MiR-21 expression was analyzed by quantitative reverse transcription-PCR and NOx, and eNOS levels were measured by ELISA assay. CIMT was evaluated by ultrasonography and CIMT ≥ 0.8 mm was accepted as increased CIMT (iCIMT). RESULTS C-reactive protein (CRP) level, plasma miR-21 expression level and CIMT were found to be significantly higher in the hypertension group when compared to the control group (p = 0.009, p = 0.002 and p < 0.001, respectively). NOx and eNOS levels were significantly lower in the hypertension group compared to the control group (p < 0.001, both). MiR-21 level was positively correlated with the clinical systolic blood pressure, clinical diastolic blood pressure, CRP and CIMT. MiR-21 was also negatively correlated with NOx and eNOS. Eighteen patients with hypertension had iCIMT. MiR-21 and CRP levels were significantly higher (p < 0.001 and p = 0.001), whereas NOx and eNOS levels were significantly lower in patients with iCIMT (p < 0.001, both). CONCLUSION The decreased levels of NOx and eNOS found in this study indicate the co-existence of endothelial dysfunction and hypertension once more. In the absence of microalbuminuria, the increased miR-21 expression in patients with iCIMT made us conclude that this miRNA might be involved in the early stages of atherosclerotic process in hypertensive patients.
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Affiliation(s)
| | | | | | | | | | | | - Ömer Faruk Karataş
- d Department of Medical Genetics, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey .,e Department of Molecular Biology and Genetics , Erzurum Technical University , Erzurum , Turkey
| | - Mustafa Özen
- d Department of Medical Genetics, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey .,f Department of Medical Genetics/Molecular Biology and Genetics , Biruni University , Istanbul , Turkey , and
| | - Hafize Uzun
- g Department of Biochemistry, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
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Polak JF, O'Leary DH. Edge-detected common carotid artery intima-media thickness and incident coronary heart disease in the multi-ethnic study of atherosclerosis. J Am Heart Assoc 2015; 4:e001492. [PMID: 26077584 PMCID: PMC4599522 DOI: 10.1161/jaha.114.001492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Common carotid artery intima–media thickness (IMT) can be measured either by hand or with an automated edge detector. We performed a direct comparison of these 2 approaches and studied their respective associations with coronary heart disease outcomes. Methods and Results We studied 5468 participants of the Multi-Ethnic Study of Atherosclerosis, composed of white, Chinese, Hispanic, and black participants with an average age of 61.9 years (47.8% men) and who were free of coronary heart disease at baseline. Manual-traced and edge-detected IMT measurements were made in the same location on ultrasound images of the right common carotid artery far wall in an area free of plaque. Manual-traced and edge-detected common carotid artery IMT measurements were added separately to multivariable Cox proportional hazards models with time to incident coronary heart disease as the outcome and adjusted for traditional coronary heart disease Framingham risk factors, lipid-lowering therapy, blood pressure–lowering therapy, and race or ethnicity. Additional models were generated after adding clinic site and reader. There were 349 events during a median follow-up of 10.2 years. In adjusted models, the hazard ratio was not significant (1.31; 95% CI 0.84 to 2.06) for each millimeter increase in manual-traced IMT but was significant for edge-detected IMT (hazard ratio 1.63; 95% CI 1.12 to 2.37). Edge-detected IMT remained statistically associated with outcomes after additional adjustment for clinic site and reader performing the IMT measurement (hazard ratio 1.59; 95% CI 1.07 to 2.35). Conclusions Edge-detected common carotid artery far wall IMT has similar if not stronger associations with coronary heart disease outcomes when compared with manual-traced IMT. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00063440.
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Affiliation(s)
- Joseph F Polak
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA (J.F.P.)
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Alshawabkeh LI, Yee LM, Gardin JM, Gottdiener JS, Odden MC, Bartz TM, Arnold AM, Mukamal KJ, Wallace RB. Years of able life in older persons--the role of cardiovascular imaging and biomarkers: the Cardiovascular Health Study. J Am Heart Assoc 2015; 4:jah3943. [PMID: 25907126 PMCID: PMC4579951 DOI: 10.1161/jaha.114.001745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background As the U.S. population grows older, there is greater need to examine physical independence. Previous studies have assessed risk factors in relation to either disability or mortality, but an outcome that combines both is still needed. Methods and Results The Cardiovascular Health Study is a population‐based, prospective study where participants underwent baseline echocardiogram, measurement of carotid intima‐media thickness (IMT), and various biomarkers, then followed for up to 18 years. Years of able life (YAL) constituted the number of years the participant was able to perform all activities of daily living. Linear regression was used to model the relationship between selected measures and outcomes, adjusted for confounding variables. Among 4902 participants, mean age was 72.6±5.4 years, median YAL for males was 8.8 (interquartile range [IQR], 4.3 to 13.8) and 10.3 (IQR, 5.8 to 15.8) for females. Reductions in YAL in the fully adjusted model for females and males, respectively, were: −1.34 (95% confidence interval [CI], −2.18, −0.49) and −1.41 (95% CI, −2.03, −0.8) for abnormal left ventricular (LV) ejection fraction, −0.5 (95% CI, −0.78, −0.22) and −0.62 (95% CI, −0.87, −0.36) per SD increase in LV mass, −0.5 (95% CI, −0.7, −0.29) and −0.79 (95% CI, −0.99, −0.58) for IMT, −0.5 (95% CI, −0.64, −0.37) and −0.79 (95% CI, −0.94, −0.65) for N‐terminal pro‐brain natriuretic peptide, −1.08 (95% CI, −1.34, −0.83) and −0.73 (95% CI, −0.97, −0.5) for high‐sensitivity troponin‐T, and −0.26 (95% CI, −0.42, −0.09) and −0.23 (95% CI, −0.41, −0.05) for procollagen‐III N‐terminal propeptide. Most tested variables remained significant even after adjusting for incident cardiovascular (CV) disease. Conclusions In this population‐based cohort, variables obtained by CV imaging and biomarkers of inflammation, coagulation, atherosclerosis, myocardial injury and stress, and cardiac collagen turnover were associated with YAL, an important outcome that integrates physical ability and longevity in older persons.
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Affiliation(s)
- Laith I Alshawabkeh
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, IA (L.I.A.) Carver College of Medicine and the College of Public Health, University of Iowa, Iowa City, IA (L.I.A., R.B.W.)
| | - Laura M Yee
- Department of Biostatistics, University of Washington, Seattle, WA (L.M.Y., T.M.B., A.M.A.)
| | - Julius M Gardin
- Department of Medicine, Hackensack University Medical Center, Hackensack, NJ (J.M.G.)
| | - John S Gottdiener
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Michelle C Odden
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR (M.C.O.)
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA (L.M.Y., T.M.B., A.M.A.)
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, WA (L.M.Y., T.M.B., A.M.A.)
| | - Kenneth J Mukamal
- Divisions of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (K.J.M.)
| | - Robert B Wallace
- Department of Internal Medicine, University of Iowa, Iowa City, IA (R.B.W.) Carver College of Medicine and the College of Public Health, University of Iowa, Iowa City, IA (L.I.A., R.B.W.)
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Yoda K, Inaba M, Hamamoto K, Yoda M, Tsuda A, Mori K, Imanishi Y, Emoto M, Yamada S. Association between poor glycemic control, impaired sleep quality, and increased arterial thickening in type 2 diabetic patients. PLoS One 2015; 10:e0122521. [PMID: 25875738 PMCID: PMC4396841 DOI: 10.1371/journal.pone.0122521] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/12/2015] [Indexed: 01/16/2023] Open
Abstract
Objective Poor sleep quality is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and objective sleep architecture and its influence on arteriosclerosis in patients with type-2 diabetes mellitus (DM). The present study examined the association of objective sleep architecture with both glycemic control and arteriosclerosis in type-2 DM patients. Design Cross-sectional study in vascular laboratory. Methods The subjects were 63 type-2 DM inpatients (M/F, 32/31; age, 57.5±13.1) without taking any sleeping promoting drug and chronic kidney disease. We examined objective sleep architecture by single-channel electroencephalography and arteriosclerosis by carotid-artery intima-media thickness (CA-IMT). Results HbA1c was associated significantly in a negative manner with REM sleep latency (interval between sleep-onset and the first REM period) (β=-0.280, p=0.033), but not with other measurements of sleep quality. REM sleep latency associated significantly in a positive manner with log delta power (the marker of deep sleep) during that period (β=0.544, p=0.001). In the model including variables univariately correlated with CA-IMT (REM sleep latency, age, DM duration, systolic blood pressure, and HbA1c) as independent variables, REM sleep latency (β=-0.232, p=0.038), but not HbA1c were significantly associated with CA-IMT. When log delta power was included in place of REM sleep latency, log delta power (β=-0.257, p=0.023) emerged as a significant factor associated with CA-IMT. Conclusions In type-2 DM patients, poor glycemic control was independently associated with poor quality of sleep as represented by decrease of REM sleep latency which might be responsible for increased CA-IMT, a relevant marker for arterial wall thickening.
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Affiliation(s)
- Koichiro Yoda
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kae Hamamoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Maki Yoda
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Tsuda
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Katsuhito Mori
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuo Imanishi
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Takahara M, Katakami N, Osonoi T, Saitou M, Sakamoto F, Matsuoka TA, Shimomura I. Different Impacts of Cardiovascular Risk Factors on Arterial Stiffness versus Arterial Wall Thickness in Japanese Patients with Type 2 Diabetes Mellitus. J Atheroscler Thromb 2015; 22:971-80. [PMID: 25864887 DOI: 10.5551/jat.29090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM We statistically investigated whether the impact of cardiovascular risk factors on arterial stiffness would be different from that on arterial wall thickness. METHODS We analyzed 1648 Japanese type 2 diabetic patients. Arterial stiffness was evaluated by pulse wave verbosity (PWV) and wall thickness was assessed with carotid intima-media thickness (IMT) by ultrasonography. We developed a common regression model to PWV and IMT by extending the linear mixed model and statistically detected the difference in the impact of cardiovascular risk factors between the two indices. RESULTS There was a significant correlation between PWV and IMT (r=0.365, p < 0.001). Sex, diabetic duration, hemoglobin A1c levels, and the presence of retinopathy and cardiovascular disease were comparable independent risk factors for elevated PWV and IMT. On the other hand, the impact of age, systolic blood pressure, and low- and high-density lipoprotein cholesterol levels were significantly different between the two measurements (all p < 0.05). Cholesterol levels were significantly associated with IMT but not with PWV. Age and systolic blood pressure had a significant impact on both measurements, but the impact on PWV was significantly greater than that on IMT. Indeed, patients with low IMT but with advanced age and high systolic pressure had high PWV, whereas patients with low PWV but with impaired cholesterol levels had high IMT. CONCLUSION The extended linear mixed model statistically confirmed that the impact of cardiovascular risk factors on elevated PWV and IMT were not identical in Japanese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine
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Agarwal I, Arnold A, Glazer NL, Barasch E, Djousse L, Fitzpatrick AL, Gottdiener JS, Ix JH, Jensen RA, Kizer JR, Rimm EB, Siscovick DS, Tracy RP, Wong TY, Mukamal KJ. Fibrosis-related biomarkers and large and small vessel disease: the Cardiovascular Health Study. Atherosclerosis 2015; 239:539-46. [PMID: 25725316 PMCID: PMC4517825 DOI: 10.1016/j.atherosclerosis.2015.02.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/07/2015] [Accepted: 02/10/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Fibrosis has been implicated in a number of pathological, organ-based conditions of the liver, kidney, heart, and lungs. The objective of this study was to determine whether biomarkers of fibrosis are associated with vascular disease in the large and/or small vessels. METHODS We evaluated the associations of two circulating biomarkers of fibrosis, transforming growth factor-β (TGF-β) and procollagen type III N-terminal propeptide (PIIINP), with incident peripheral artery disease (PAD) and subclinical macrovascular (carotid intima-media thickness, flow-mediated vasodilation, ankle-brachial index, retinal vein diameter), and microvascular (retinal artery diameter and retinopathy) disease among older adults in the Cardiovascular Health Study. We measured TGF-β and PIIINP from samples collected in 1996 and ascertained clinical PAD through 2011. Measurements of large and small vessels were collected between 1996 and 1998. RESULTS After adjustment for sociodemographic, clinical, and biochemical risk factors, TGF-β was associated with incident PAD (hazard ratio [HR] = 1.36 per doubling of TGF-β, 95% confidence interval [CI] = 1.04, 1.78) and retinal venular diameter (1.63 μm per doubling of TGF-β, CI = 0.23, 3.02). PIIINP was not associated with incident PAD, but was associated with carotid intima-media thickness (0.102 mm per doubling of PIIINP, CI = 0.029, 0.174) and impaired brachial artery reactivity (-0.20% change per doubling of PIIINP, CI = -0.39, -0.02). Neither TGF-β nor PIIINP were associated with retinal arteriolar diameter or retinopathy. CONCLUSIONS Serum concentrations of fibrosis-related biomarkers were associated with several measures of large vessel disease, including incident PAD, but not with small vessel disease. Fibrosis may contribute to large vessel atherosclerosis in older adults.
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Affiliation(s)
- Isha Agarwal
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
| | - Alice Arnold
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Eddy Barasch
- Department of Research and Education, St. Francis Hospital/SUNY at Stony Brook, Stony Brook, NY, USA
| | - Luc Djousse
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Boston Veterans Healthcare System, Boston, MA, USA
| | | | - John S Gottdiener
- Department of Medicine, University of Maryland Medical School, Baltimore, MD, USA
| | - Joachim H Ix
- Department of Medicine, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Richard A Jensen
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David S Siscovick
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Russell P Tracy
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Tien Y Wong
- Department of Ophthalmology, Singapore Eye Research Institute, National University of Singapore, Singapore
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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