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Quesada O, Kulandavelu S, Vladutiu CJ, DeFranco E, Minissian MB, Makarem N, Bello NA, Wong MS, Pabón MA, Chandra AA, Avilés-Santa L, Rodríguez CJ, Bairey Merz CN, Sofer T, Hurwitz BE, Talavera GA, Claggett BL, Solomon SD, Cheng S. Cardiac Abnormalities in Hispanic/Latina Women With Prior De Novo Hypertensive Disorders of Pregnancy. Hypertension 2024; 81:255-263. [PMID: 38047358 PMCID: PMC10793810 DOI: 10.1161/hypertensionaha.123.21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/22/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with long-term maternal risks for cardiovascular disease for reasons that remain incompletely understood. METHODS The HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a multi-center community-based cohort of Hispanic/Latino adults recruited 2008 to 2011, was used to evaluate the associations of history of de novo HDP (gestational hypertension, preeclampsia, eclampsia) with echocardiographic measures of cardiac structure and function in Hispanic/Latina women with ≥1 prior pregnancy and the proportion of association mediated by current hypertension (>140/90 mm Hg or antihypertensive therapy). RESULTS. The study cohort included 5168 Hispanic/Latina women with an average age (SD) of 58.7 (9.7) years at time of echocardiogram. Prior de novo HDP was reported by 724 (14%) of the women studied and was associated with lower left ventricle (LV) ejection fraction -0.66 (95% confidence interval [CI], -1.21 to -0.11), higher LV relative wall thickness 0.09 (95% CI, 0-0.18), and 1.39 (95% CI, 1.02-1.89) higher risk of abnormal LV geometry after adjusting for blood pressure and other confounders. The proportion of the association mediated by current hypertension between HDP and LV ejection fraction was 0.09 (95% CI, 0.03-0.45), LV relative wall thickness was 0.28 (95% CI, 0.16-0.51), abnormal LV geometry was 0.14 (95% CI, 0.12-0.48), concentric left ventricular hypertrophy was 0.31 (95% CI, 0.19-0.86), and abnormal LV diastolic dysfunction was 0.58 (95% CI, 0.26-0.79). CONCLUSIONS. In a large cohort of Hispanic/Latina women those with history of de novo HDP had detectable and measurable subclinical alterations in cardiac structure and both systolic and diastolic dysfunction that were only partially mediated by current hypertension.
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Affiliation(s)
- Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (O.Q.)
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (O.Q.)
| | | | - Catherine J. Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill (C.J.V.)
| | - Emily DeFranco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH (E.D.)
| | - Margo B. Minissian
- Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.B.M.)
| | - Nour Makarem
- Mialman School of Public Health, Columbia University Irving Center, NY (N.M.)
| | - Natalie A. Bello
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Melissa S. Wong
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (M.S.W.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Maria A. Pabón
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alvin A. Chandra
- University of Texas Southwestern Medical Center, Dallas (A.A.C.)
| | - Larissa Avilés-Santa
- National Institute on Minority Health and Health Disparities, Bethesda, MD (L.A.-S.)
| | | | - C. Noel Bairey Merz
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
- Barbra Streisand Women’s Heart Center (C.N.B.M.)
| | - Tamar Sofer
- Department of Medicine (T.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Gregory A. Talavera
- South Bay Latino Research Center, Department of Psychology, San Diego State University, CA (G.A.T.)
| | - Brian L. Claggett
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Scott D. Solomon
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Susan Cheng
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
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2
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Martinez CA, Rikhi R, Fonseca Nogueira N, Pester MS, Salazar AS, Ashinne B, Aguilar N, Melara A, Porras V, Parker M, Mendez A, Cyrus E, De Santis JP, Jones DL, Brown TT, Hurwitz BE, Alcaide ML. Estrogen-Based Gender-Affirming Hormone Therapy and Subclinical Cardiovascular Disease in Transgender Women with HIV. LGBT Health 2023; 10:576-585. [PMID: 37459150 PMCID: PMC10712365 DOI: 10.1089/lgbt.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Purpose: Transgender women (TW) are disproportionately affected by HIV infection and cardiovascular disease (CVD). This study evaluated whether estrogen-based gender-affirming hormone therapy (GAHT) in TW with HIV (TWH-GAHT) is associated with indices of subclinical CVD. Methods: Of the 40 HIV-seropositive persons enrolled, 20-60 years of age, on antiretroviral treatment with undetectable viral load, assessments were performed on 15 TWH; of these persons, 11 were GAHT treated. These TWH-GAHT were matched with HIV+ cisgender men and women based on age, ethnicity/race, body mass index, and antihypertensive medication use. Sex hormones, and cardiometabolic (waist circumference, blood pressure, insulin resistance, lipid profile, and C-reactive protein), vascular (flow-mediated dilation [FMD] and arterial stiffness), and proinflammatory measures were obtained. Results: TWH-GAHT displayed elevated estradiol and suppressed testosterone levels relative to normative ranges. Analyses indicated the TWH-GAHT displayed lower low-density lipoprotein compared with cisgender groups (p < 0.05). Although no difference was seen on FMD, the central augmentation index of aortic stiffness was higher in cisgender HIV+ women than cisgender HIV+ men (p < 0.05). No other group difference on subclinical CVD markers was observed. For TWH, partial correlations indicated associations of certain sex hormones with selected cardiometabolic outcomes and the inflammatory cytokine, interleukin-8. Conclusion: When well matched to HIV+ cisgender men and women, subclinical CVD pathophysiology did not appear elevated in TWH-GAHT, although tendencies emerged suggesting that some subclinical CVD indices may be higher, but others lower than cisgender groups. Longitudinal studies of TWH are needed to more precisely evaluate the moderating effect of GAHT on cardiometabolic pathophysiology.
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Affiliation(s)
- Claudia A. Martinez
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rishi Rikhi
- Division of Cardiology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mollie S. Pester
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Ana S. Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Beteal Ashinne
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Natalie Aguilar
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Abraham Melara
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valeria Porras
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Meela Parker
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Armando Mendez
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Joseph P. De Santis
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Deborah L. Jones
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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April-Sanders AK, Gallo L, Lee UJ, Hurwitz BE, Daviglus ML, Talavera GA, Shook-Sa B, Isasi CR, Rodriguez CJ. Abstract P266: Complex Patterns of Early Life Adversity Vary by Gender: Associations With Cardiometabolic Health and Pre-Heart Failure Among Hispanics/Latinos in the Midlife. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background:
Early life adversities (ELA) are known risk factors for cardiovascular disease, but less understood is how distinct configurations of ELA impart differential risks for cardiometabolic health and heart failure (HF) in adulthood.
Objective:
To determine distinct profiles of ELA and assess whether there are associations between the resultant profiles and multiple indicators of cardiometabolic disease and pre-HF among Hispanic/Latino adults.
Methods:
Data from the Hispanic Community Health Study/Study of Latinos SCAS and ECHO-SOL (N=1143, mean age 55.9±0.4 years, 58.2% female) were used. Latent class analysis was used to identify the optimal number of classes characterizing ELA co-occurrence overall and by gender. Prevalent pre-HF was defined as systolic dysfunction (left ventricular (LF) ejection fraction <50%/ global longitudinal strain >15%) or diastolic dysfunction (≥ Grade 1) or LV remodeling (LV mass index >115 for males, >95 for females/ relative wall thickness >0.42). Weighted multivariable logit models were used to examine associations.
Results:
The best fitting latent classes and characterization are shown in Figure 1. By gender, ELA profiles were associated with cardiometabolic factors. E.g., females with high adversity had greater odds of obesity than those with a low adversity (OR=2.27, 95% CI: 1.39 - 3.72). Alternatively, males experiencing household dysfunction had lower odds of high cholesterol than those with low adversity (OR=0.39, 95% CI: 0.19 - 0.80). Associations were not explained by age, childhood economic hardship, nativity, and Hispanic/Latino background. ELA profiles were not associated with pre-HF (e.g., high adversity OR=0.60, household dysfunction OR=0.75; all p>0.05).
Conclusions:
Distinct patterns of ELA among Hispanic/Latino adults vary by gender; females experience more complex and varied patterns of adversity. Exposure to specific patterns of ELA were associated with several cardiometabolic outcomes, but no associations were found with any measures of pre-HF.
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Affiliation(s)
| | | | - Un Jung Lee
- Albert Einstein College of Medicine, Bronx, NY
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Duran Luciano P, April-Sanders AK, Lee UJ, McLeod J, Kaplan R, Hurwitz BE, Swett K, Daviglus ML, Bilsker M, Sotres-Alvarez D, Ponce S, Kansal MM, Cai J, Talavera GA, Rodriguez CJ. Abstract P181: Impact of Blood Pressure on Longitudinal Patterns of Pre-Heart Failure in a Hispanic/Latino Population-Based Cohort: Results From the Echocardiographic Study of Latinos (ECHO SOL). Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
Hypertension (HTN) is a modifiable risk factor for heart failure (HF) and a common antecedent for pre-HF, but its effect on pre-HF is not well known.
Hypothesis:
Variations in blood pressure (BP) will be related to distinct patterns of pre-HF (prevalent and incident).
Methods:
Two echocardiograms were performed ∼4.3 years apart on 1643 adults in the Hispanic/Latino cohort ECHO SOL. Pre-HF was defined as systolic dysfunction (LVEF <50%/ global longitudinal strain >15%) or diastolic dysfunction (≥ Grade 1) or left ventricular remodeling (left ventricular mass index >115 for men, >95 for women/ relative wall thickness >0.42). At visit 1 (V1), 953 were normotensives, and 690 hypertensives [controlled and uncontrolled]. Groups were subdivided at visit 2 (V2) based on maintenance or changes from V1 BP status. Logistic regression models were used to determine the association of BP with pre-HF. All analyses were weighted due to complex survey design.
Results:
Higher BP at baseline (linear and by tertiles) was significantly associated with prevalent pre HF (table 1). Higher pulse pressure was significantly associated with incident pre-HF (table 1). Normotensives at V1 who later developed HTN (≥ 130/80 mmHg) at V2 had higher odds of having prevalent (2.05 [95% CI, 1.24 - 3.39]) and incident (2.42 [95% CI, 1.07 - 5.51]) pre-HF than those who remained with BP <130/80 mmHg at V2. When defining uncontrolled HTN as BP ≥ 130/80 mmHg, we found that uncontrolled hypertensives at V1 who remained uncontrolled at V2 had higher odds (2.75 [95% CI, 1.18 - 6.41]) of having prevalent pre-HF compared to uncontrolled hypertensives who progressed to controlled HTN at V2 (<130/80 mmHg).
Conclusion
A significant association exists between BP and prevalent/incident pre-HF in the Hispanic/Latino population. Additionally, those who progress from normal BP to hypertension face an increased risk of developing prevalent/incident pre-HF compared to those who remain normotensives. Blood pressure control of <130/80 mmHg could result in less prevalent pre-HF.
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Affiliation(s)
| | | | - Un Jung Lee
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | | | | | | | - Sonia Ponce
- Univ of New Mexico, Albuquerque, New Mexico, NM
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5
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Esquivel JH, Logan JG, Sotres-Alvarez D, Ponce S, Allison MA, Hurwitz BE, Kaplan R, Isasi CR, Cai J, Daviglus ML, Kansal MM, Rodriguez CJ. Abstract P588: The Association of Anthropometric Measures With Risk for Pre-HF. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Obesity is an epidemiologic challenge and a key risk factor for heart failure (HF). Pre-heart failure (pre-HF) has been recognized as an important entity to prevent progression to clinical HF. Defining the long-term effect of obesity on pre-HF is essential for understanding of HF risk and prevention.
Purpose:
To determine the prospective association of obesity on the incidence of pre-HF (defined as the presence of abnormal cardiac structure or function among persons without clinical HF).
Methods:
Data from 1580 individuals without HF and with anthropometric data from the population-based Echocardiographic-Study of Latinos were included.
Pre-HF
was defined as: 1)
Systolic dysfunction
- LV ejection fraction (LVEF) < 50% and global longitudinal strain (GLS) <15%; 2)
LV diastolic dysfunction
- E/e’ >10 and left atrial volume index (LAVI) >34 mL/m
2
; or 3)
LV remodeling
- LV mass index (LVMI)> 115gm/m
2
, >95gm/m
2
(male and female, respectively) and relative wall thickness (RWT) >0.42. Anthropometric data were: (body mass index {BMI}, waist circumference {WC}, waist-to-hip ratio {WHR}, fat mass {FM) and free fat mass {FFM}). Echocardiographic and anthropometric data were collected twice, on average 4.3 years apart, and analyzed using survey-weighted multivariable-adjusted regression models. Incident pre-HF was determined among participants
Results:
Mean age of 56 (42-74) years and 1048 (66%) were female. Baseline mean BMI was 29.9 kgm
2
, FM kg 28.3, FFM kg 50.1, WC 99.7cm, and WHR 0.94. Baseline BMI, FFM, FM, WC and WHR were significantly higher in individuals with prevalent pre-HF (all p<0.007). Longitudinal data showed that WC and WHR were associated with greater probability of incident pre-HF (WC and WHR p<0.0006. Regression models showed BMI, WC, WHR and FFM were associated with increased odds of incident Pre-HF (Table 1).
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Affiliation(s)
| | | | | | - Sonia Ponce
- UNIVERSITY OF CALIFORNIA SAN DIEGO, La Jolla, CA
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6
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Kim Y, Carver CS, Hurwitz BE. Developing a stress induction tool relevant to relationships in a health context. Front Psychol 2023; 14:1103081. [PMID: 36844294 PMCID: PMC9948606 DOI: 10.3389/fpsyg.2023.1103081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Concerns pertaining to health and to problems in close relationships are both known to be major stressors, yet existing tools are inadequate to assess individual reactions to such stressors. Thus, we sought to develop and preliminarily validate a stress-inducing task for use in a laboratory setting that pertains to the sorts of health-related concerns people face in close relationships. Heterosexual dating couples (44 individuals: mean age 22) were randomized to be paired with their own partner or a stranger and to play a role of speaker or listener. Participants were asked to imagine a scenario in which one person is hit by a car (listener role) and the partner has no means to provide or seek out help for the victim (speaker role). The session consisted of baseline, speech preparation, stress task, and recovery phases. General linear modeling results revealed that the task induced stress, evidenced in cardiovascular activities and self-reported negative affect. Giving a brief speech about the stressful situation creates physiological and psychological strains, regardless of pairing with one's own partner or stranger. Furthermore, cardiovascular and negative affect reactivity to the STress Induction Tool for Close relationships and Health (STITCH) task tended to vary by individual characteristics that reflect one's sensitivity to close relationship-and health-related stress. This tool is intended to be used for testing relationship theory-driven phenomenon and longer-term implications of physiological and affective reactivities in the quality of life and health outcomes of those who experienced a medically stressful circumstance personally or in the family.
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Affiliation(s)
| | | | - Barry E. Hurwitz
- Department of Psychology, University of Miami, Coral Gables, FL, United States
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7
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McIntosh R, Hidalgo M, Lobo J, Dillon K, Szeto A, Hurwitz BE. Circulating endothelial and angiogenic cells predict hippocampal volume as a function of HIV status. J Neurovirol 2023; 29:65-77. [PMID: 36418739 DOI: 10.1007/s13365-022-01101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022]
Abstract
Circulating endothelial cells (CECs) and myeloid angiogenic cells (MACs) have the capacity to stabilize human blood vessels in vivo. Evidence suggests that these cells are depleted in dementia and in persons living with HIV (PWH), who have a higher prevalence of dementia and other cognitive deficits associated with aging. However, the associations of CECs and MACs with MRI-based measures of aging brain health, such as hippocampal gray matter volume, have not been previously demonstrated. The present study examined differences in these associations in 51 postmenopausal women with and without HIV infection. Gray matter volume was quantified using MRI. CECs and MACs were enumerated using fluorescence-activated cell sorting. Analyses examined the association of these cell counts with left and right hippocampal gray matter volume while controlling for age and hypertension status. The main finding was an interaction suggesting that compared to controls, postmenopausal PWH with greater levels of CECs and MACs had significantly greater hippocampus GMV. Further research is necessary to examine potential underlying pathophysiological mechanisms in HIV infection linking morpho-functional circulatory reparative processes with more diminished hippocampal volume in postmenopausal women.
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Affiliation(s)
- Roger McIntosh
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, FL, USA.
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA.
- Division of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Melissa Hidalgo
- Department of Internal Medicine, Broward Health North, Fort Lauderdale, FL, USA
| | - Judith Lobo
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Kaitlyn Dillon
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Angela Szeto
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Barry E Hurwitz
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, FL, USA
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA
- Division of Endocrinology, Diabetes and Metabolism, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
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8
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Inestroza KL, Hurtado V, Larson M, Severdija R, Satish S, Ebner B, Vincent L, Grant J, Powell A, Hurwitz BE, Boulanger C, Jayaweera D, Martinez C. Abstract P036: The Association Of CD4:CD8 Ratio With Cardiometabolic Risk Factors In People With HIV. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In People with HIV (PWH) with virologic suppression, the CD4:CD8 ratio inversely correlates with immune senescence response. The association between CD4:CD8 ratio and cardiovascular (CV) risk in PWH remains unclear.
Methods:
A retrospective chart review was performed of patients who received HIV care at the University of Miami/Jackson Memorial Hospital between 2017-2019 with available CD4: CD8 ratio (n=1,137). We stratified patients according to the CD4:CD8 ratio ≥1 or <1, and compared available data.
Results:
The prevalence of CD4:CD8 ratio <1 was 69.5%. A ratio <1 was associated with male gender (57.1% vs 45.8%, p<0.001), lower body mass index (28.29 vs 29.80 kg/m2, p=0.001), lower HDL cholesterol (Chol) (47.57 vs. 53.25 mg/dL, p<0.001), higher total Chol/HDL (4.22 vs. 3.8, p=0.001), higher CRP levels (4.94 vs. 2.61 mg/L, and less statin use (25% vs 35.3%, p<0.001), p=0.02) compared to those with a ratio ≥1. Those with a CD4:CD8 ratio <1 were more likely to have a detectable viral load (35.9% vs. 14.6%. p<0.001), have been on antiretroviral therapy for <6 months (4% vs 1.5%, p=0.27), to be current smokers (27.6% vs. 16.5%, p<0.001), current drug users (9.7% vs 5.5%, p=0.025), and had higher rates of atrial fibrillation/flutter (1.9% vs 0%, p=0.008) than those with a ratio ≥1.
Conclusion:
Patients with an inverted CD4:CD8 ratio had higher total Chol/HDL levels, which has been associated with a higher risk of CV disease. Statin use in this high-risk population was lower despite having more CV risk factors and atrial fibrillation/flutter. Further studies are needed to determine the usefulness of the CD4:CD8 ratio as a marker of immune activation and predictor of CV risk in PWH.
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9
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Pester MS, Gonzalez A, Schmaus JA, Wohlgemuth W, McCabe PM, Iacobellis G, Schneiderman N, Hurwitz BE. Sex differences in the association of vital exhaustion with regional fat deposition and subclinical cardiovascular disease risk. J Psychosom Res 2022; 157:110785. [PMID: 35366516 PMCID: PMC10986308 DOI: 10.1016/j.jpsychores.2022.110785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Vital exhaustion (VE) is more strongly associated with cardiovascular disease (CVD) risk for women than men. This study examined whether sex differences in associations of VE with CVD risk markers are accounted for by unique associations of VE with regional adiposity. METHODS The study enrolled 143 persons (18-55 years) without diagnosed conditions. VE was assessed by the Maastricht questionnaire. CVD indices were measured using the euglycemic-hyperinsulinemia clamp, resting blood pressure, and blood draws. Regional adiposity was measured using computed tomography and 2-D echocardiography. This cross-sectional study employed a path analysis approach, including relevant covariates. RESULTS Of the cohort, aged 38.7 ± 8.4 years, 65% were men, and 41% were obese. The final model had excellent fit (χ2(36) = 36.5, p = .45; RMSEA = 0.009, CFI = 0.999). For women, but not men, the model indicated paths from VE to: 1) lower insulin sensitivity (B = -0.10, p = .04), and higher total cholesterol to HDL ratio (B = 0.12, p = .09), triglycerides (B = 0.10, p = .08), and C-reactive protein (B = 0.08, p = .09) through visceral adiposity; 2) higher mean arterial pressure (B = 0.14, p = .04), lower insulin sensitivity (B = -0.09, p = .08), and higher C-reactive protein (B = 0.12, p = .07) through subcutaneous adiposity; 3) lower insulin sensitivity (B = -0.07, p = .08) and higher total cholesterol to HDL ratio (B = 0.16, p = .03) through liver adiposity; and 4) higher C-reactive protein (B = 0.08, p = .09) through epicardial adiposity. CONCLUSION Results extend prior evidence by showing that the association of VE with CVD risk in women is linked with specific regional adiposity elevation. Further study of adiposity-related mechanisms in women who experience early decline in vitality may inform clinical targets for CVD prevention.
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Affiliation(s)
- Mollie S Pester
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Alex Gonzalez
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA.
| | - Jennifer A Schmaus
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - William Wohlgemuth
- Psychology and Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare System, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA.
| | - Philip M McCabe
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Gianluca Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Neil Schneiderman
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Barry E Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA.
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10
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Martinez CA, Rikhi R, Pester MS, Parker M, Gonzalez A, Larson M, Chavez J, Mendez A, Raines JK, Kolber MA, Schulman IH, Alcaide ML, Hurwitz BE. Abacavir antiretroviral therapy and indices of subclinical vascular disease in persons with HIV. PLoS One 2022; 17:e0264445. [PMID: 35271614 PMCID: PMC8912137 DOI: 10.1371/journal.pone.0264445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Indices of cardiovascular disease (CVD) risk, vascular endothelial dilation, arterial stiffness and endothelial repair were examined in persons with HIV (PWH) on an antiretroviral therapy (ART) that included abacavir (ABC+) in comparison with PWH on ART without abacavir (ABC-), and with HIV seronegative (HIV-) individuals. Approach The 115 participants (63% men), aged 30–50 years, did not have CVD, metabolic, endocrine, or chronic renal conditions. PWH were on stable ART for six-months or more. Vascular assessments included flow-mediated dilation (FMD), aortic, radial and femoral arterial stiffness (cAIx, crPWV, cfPWV), and thigh and calf arterial compliance (Vmax50). Endothelial repair was indexed by endothelial progenitor cell colony forming units (EPC-CFU). Traditional CVD risk measures included blood pressure, central adiposity, lipids, insulin resistance (HOMA-IR), CRP and ASCVD score. Analyses controlled for demographics (age, sex, education), medications (antihypertensive, statin/fibrate, antipsychotic), and substance abuse (ASSIST). Results No group differences were observed in central adiposity, HOMA-IR, CRP, or ASCVD risk score. However, the ABC- group displayed greater dyslipidemia. The ABC+ group displayed no difference on FMD, cAIx, cfPWV or calf Vmax50 compared with other groups. When CD4 count and viral load were controlled, no additional differences between the ABC+ and ABC- groups emerged. Analyses of crPWV and thigh Vmax50 suggested supported by a trend toward lower EPC-CFU in the HIV+ groups than the HIV- group. Conclusions Findings indicate that ABC treatment of 30–50 year-old PWH on stable ART is not likely to contribute in a robust way to higher CVD risk.
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Affiliation(s)
- Claudia A. Martinez
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
| | - Rishi Rikhi
- Division of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Mollie S. Pester
- Behavioral Medicine Research Center, University of Miami, Miami, Florida, United States of America
- Department of Psychology, University of Miami, Coral Gables, Florida, United States of America
| | - Meela Parker
- Behavioral Medicine Research Center, University of Miami, Miami, Florida, United States of America
| | - Alex Gonzalez
- Behavioral Medicine Research Center, University of Miami, Miami, Florida, United States of America
| | - Michaela Larson
- Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Jennifer Chavez
- Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Armando Mendez
- Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Jeffrey K. Raines
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Michael A. Kolber
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Ivonne H. Schulman
- Katz Family Division of Nephrology & Hypertension, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Maria L. Alcaide
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, Florida, United States of America
- Department of Psychology, University of Miami, Coral Gables, Florida, United States of America
- Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
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11
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Redwine LS, Hong S, Kohn J, Martinez C, Hurwitz BE, Pung MA, Wilson K, Pruitt C, Greenberg BH, Mills PJ. Systemic Inflammation and Cognitive Decrements in Patients With Stage B Heart Failure. Psychosom Med 2022; 84:133-140. [PMID: 34654027 DOI: 10.1097/psy.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the role of systemic inflammation in reduced cognitive functioning in patients with early-stage heart failure (HF) while determining associations with other cardiovascular risk factors. METHODS Patients with stage B HF (n = 270; mean [standard deviation] age = 66.1 [10.1] years) were examined cross-sectionally for relationships among cardiovascular disease (CVD) and psychological risk factors, C-reactive protein (CRP), and Montreal Cognitive Assessment (MoCA) scores. A subsample (n = 83) at high risk for stage C HF (B-type natriuretic peptide levels ≥65 pg/ml) were followed up for 12 months for relationships between CRP levels and cognitive function. RESULTS Baseline smoking (χ2 = 6.33), unmarried (χ2 = 12.0), hypertension (χ2 = 5.72), greater body mass index (d = 0.45), and physical fatigue (d = 0.25) were related to higher CRP levels (p values < .05). Cross-sectionally, CRP levels were negatively related to MoCA scores, beyond CVD (ΔR2 = 0.022, β = -0.170, p < .010) and psychological risk factors (ΔR2 = 0.016, β = 0.145, p < .027), and related to mild cognitive impairment criteria (odds ratio = 1.35, 95% confidence interval [CI] = 1.00-1.81, p = .046). Across 12 months, B-type natriuretic peptide high-risk patients with CRP levels ≥3 mg/L had lower MoCA scores (23.6; 95% CI = 22.4-24.8) than did patients with CRP levels <3 mg/L (25.4; 95% CI = 24.4-26.5; p = .024). CONCLUSIONS Patients with stage B HF and heightened CRP levels had greater cognitive impairment at baseline and follow-up, independent of CVD and potentially psychological risk factors. Low-grade systemic inflammation may be one mechanism involved in cognitive dysfunction at early stages of HF.
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Affiliation(s)
- Laura S Redwine
- From the College of Behavioral and Community Sciences (Redwine), University of South Florida, Tampa, Florida; Departments of Psychiatry (Hong, Kohn) and Family Medicine and Public Health (Hong, Kohn, Pung, Pruitt, Mills), University of California School of Medicine, San Diego, California; Division of Cardiology (Martinez), University of Miami Miller School of Medicine; Behavioral Medicine Research Center (Hurwitz), University of Miami, Miami; Department of Psychology (Hurwitz), University of Miami, Coral Gables; Division of Endocrinology, Diabetes and Metabolism (Hurwitz), Miller School of Medicine, University of Miami, Miami, Florida; Department of Medicine (Greenberg), University of California School of Medicine, San Diego, California; and Department of Public Health Sciences (Redwine), University of Miami Miller School of Medicine, Miami, Florida
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12
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Rodriguez VJ, Abbamonte JM, Parrish MS, Jones DL, Weiss S, Pallikkuth S, Toborek M, Alcaide ML, Jayaweera D, Pahwa S, Rundek T, Hurwitz BE, Kumar M. Predicting cardiovascular risk using a novel risk score in young and middle-age adults with HIV: associations with biomarkers and carotid atherosclerotic plaque. Int J STD AIDS 2022; 33:144-155. [PMID: 34727754 PMCID: PMC9356383 DOI: 10.1177/09564624211050335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Traditional risk factors associated with cardiovascular disease (CVD) include older age, smoking, poor diet, lack of exercise, obesity, high blood pressure, high cholesterol, and family history. Young-to-middle age adults (YMAA) are less often identified as being at risk of CVD, but traditional risk scores primarily target older adults and do not accurately estimate risk among YMAA. METHODS This study examined biomarkers associated with CVD risk in YMAA in the context of HIV and cocaine use; risk was assessed by two methods: (1) a relative cardiovascular (CV) risk score that includes several factors and (2) carotid atherosclerotic plaque. Associations between CVD risk (CV risk score and carotid atherosclerotic plaque) and proinflammatory cytokines, markers of immune activation, HIV status, and cocaine use were examined. Participants (N = 506) included people with and without HIV and people who use or do not use cocaine. RESULTS Participants' mean age was 36 (SD = 9.53); half (51%) were men. Cocaine use and C-reactive protein were associated with greater relative CV risk scores, but no associations between biomarkers and CV risk emerged. Age and CV risk scores were associated with carotid atherosclerotic plaque, but biomarkers were not. HIV was not associated with CV risk scores or carotid atherosclerotic plaque. CONCLUSIONS Among YMAA, CV risk scores may help providers identify lifestyle changes needed among those at risk for CVD before more advanced risk (e.g., atherosclerotic plaque) is identified. Implications are discussed.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Department of Psychology, University of Georgia, Athens, GA, USA
| | - John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manasi S Parrish
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Suresh Pallikkuth
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dushyantha Jayaweera
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Savita Pahwa
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Barry E Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA,Department of Psychology, University of Miami, Coral Gables, FL, USA,Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mahendra Kumar
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Izquierdo MC, Shanmugarajah N, Lee SX, Kraakman MJ, Westerterp M, Kitamoto T, Harris M, Cook JR, Gusarova GA, Zhong K, Marbuary E, O-Sullivan I, Rasmus NF, Camastra S, Unterman TG, Ferrannini E, Hurwitz BE, Haeusler RA. Hepatic FoxOs link insulin signaling with plasma lipoprotein metabolism through an apolipoprotein M/sphingosine-1-phosphate pathway. J Clin Invest 2022; 132:146219. [PMID: 35104242 PMCID: PMC8970673 DOI: 10.1172/jci146219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Multiple beneficial cardiovascular effects of HDL depend on sphingosine-1-phosphate (S1P). S1P associates with HDL by binding to apolipoprotein M (ApoM). Insulin resistance is a major driver of dyslipidemia and cardiovascular risk. However, the mechanisms linking alterations in insulin signaling with plasma lipoprotein metabolism are incompletely understood. The insulin-repressible FoxO transcription factors mediate key effects of hepatic insulin action on glucose and lipoprotein metabolism. This work tested whether hepatic insulin signaling regulates HDL-S1P and aimed to identify the underlying molecular mechanisms. We report that insulin-resistant, nondiabetic individuals had decreased HDL-S1P levels, but no change in total plasma S1P. This also occurred in insulin-resistant db/db mice, which had low ApoM and a specific reduction of S1P in the HDL fraction, with no change in total plasma S1P levels. Using mice lacking hepatic FoxOs (L-FoxO1,3,4), we found that hepatic FoxOs were required for ApoM expression. Total plasma S1P levels were similar to those in controls, but S1P was nearly absent from HDL and was instead increased in the lipoprotein-depleted plasma fraction. This phenotype was restored to normal by rescuing ApoM in L-FoxO1,3,4 mice. Our findings show that insulin resistance in humans and mice is associated with decreased HDL-associated S1P. Our study shows that hepatic FoxO transcription factors are regulators of the ApoM/S1P pathway.
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Affiliation(s)
- María Concepción Izquierdo
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Niroshan Shanmugarajah
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Samuel X Lee
- Naomi Berrie Diabetes Center, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Michael J Kraakman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Marit Westerterp
- Department of Pediatrics, University of Groningen, Groningen, Netherlands
| | - Takumi Kitamoto
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Michael Harris
- Naomi Berrie Diabetes Center, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Joshua R Cook
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Galina A Gusarova
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Kendra Zhong
- Naomi Berrie Diabetes Center, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Elijah Marbuary
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - InSug O-Sullivan
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, United States of America
| | - Nikolaus F Rasmus
- Naomi Berrie Diabetes Center, Columbia University College of Physicians and Surgeons, New York, United States of America
| | - Stefania Camastra
- Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Terry G Unterman
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, United States of America
| | - Ele Ferrannini
- Department of Internal Medicine, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Barry E Hurwitz
- Department of Psychology, University of Miami, Miami, United States of America
| | - Rebecca A Haeusler
- Naomi Berrie Diabetes Center, Columbia University College of Physicians and Surgeons, New York, United States of America
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14
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Berdy AE, Upadhya B, Ponce S, Swett K, Stacey RB, Kaplan R, Vasquez PM, Qi Q, Schneiderman N, Hurwitz BE, Daviglus ML, Kansal M, Evenson KR, Rodriguez CJ. Associations between physical activity, sedentary behaviour and left ventricular structure and function from the Echocardiographic Study of Latinos (ECHO-SOL). Open Heart 2021; 8:openhrt-2021-001647. [PMID: 34261776 PMCID: PMC8311330 DOI: 10.1136/openhrt-2021-001647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The cross-sectional association between accelerometer-measured physical activity (PA), sedentary behaviour (SB) and cardiac structure and function is less well described. This study's primary aim was to compare echocardiographic measures of cardiac structure and function with accelerometer measured PA and SB. METHODS Participants included 1206 self-identified Hispanic/Latino men and women, age 45-74 years, from the Echocardiographic Study of Latinos. Standard echocardiographic measures included M-mode, two-dimensional, spectral, tissue Doppler and myocardial strain. Participants wore an Actical accelerometer at the hip for 1 week. RESULTS The mean±SE age for the cohort was 56±0.4 years, 57% were women. Average moderate to vigorous PA (MVPA) was 21±1.1 min/day, light PA was 217±4.2 min/day and SB was 737±8.1 min/day. Both higher levels of light PA and MVPA (min/day) were associated with lower left ventricular (LV) mass index (LVMI)/end-diastolic volume and a lower E/e' ratio. Higher levels of MVPA (min/day) were associated with better right ventricular systolic function. Higher levels of SB were associated with increased LVMI. In a multivariable linear regression model adjusted for demographics and cardiovascular disease modifiable factors, every 10 additional min/day of light PA was associated with a 0.03 mL/m2 increase in left atrial volume index (LAVI) (p<0.01) and a 0.004 cm increase in tricuspid annular plane systolic excursion (p<0.01); every 10 additional min/day of MVPA was associated with a 0.18 mL/m2 increase in LAVI (p<0.01) and a 0.24% improvement in global circumferential strain (p<0.01). CONCLUSIONS Our findings highlight the potential positive association between the MVPA and light PA on cardiac structure and function.
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Affiliation(s)
- Andrew E Berdy
- Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Bharathi Upadhya
- Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Sonia Ponce
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Katrina Swett
- Department of Medicine, Epidemiology & Population Health, Albert Einstein College of Medicine Department of Neurology, Bronx, New York, USA
| | - Richard B Stacey
- Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Robert Kaplan
- Department of Medicine, Epidemiology & Population Health, Albert Einstein College of Medicine Department of Neurology, Bronx, New York, USA
| | - Priscilla M Vasquez
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Qibin Qi
- Department of Medicine, Epidemiology & Population Health, Albert Einstein College of Medicine Department of Neurology, Bronx, New York, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Barry E Hurwitz
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Martha L Daviglus
- Cardiovascular Medicine, University of Illinois Hospital and Health Sciences, Chicago, Illinois, USA
| | - Mayank Kansal
- Cardiovascular Medicine, University of Illinois Hospital and Health Sciences, Chicago, Illinois, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carlos J Rodriguez
- Department of Medicine, Epidemiology & Population Health, Albert Einstein College of Medicine Department of Neurology, Bronx, New York, USA
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15
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McLeod J, Hurwitz BE, Sotres-Alvarez D, Kansal MM, Swett K, Kaplan R, Bilsker M, Daviglus ML, Talavera GA, Cai J, Ponce S, Lee UJ, Rodriguez C. Abstract 068: Hypertension And Longitudinal Changes In Cardiac Structure And Function In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Hypertension, one of the most modifiable risk factors of heart disease, induces cardiac remodeling and worsens myocardial function prior to the development of clinical symptoms. Using a comprehensive cohort of Hispanic/Latino adults, we assessed cardiac structure and function, in relation to hypertension, and the longitudinal impact of blood pressure control.
Hypothesis:
If baseline hypertensive adults are stratified by longitudinal blood pressure (BP) control, there will be differences in the progression of cardiac structure and function parameters.
Methods:
The Echo-SOL Ancillary Study provided serial comprehensive echocardiographic assessments of Hispanic adults aged 45-74 years. They were arranged into two groups based on the presence of baseline hypertension (>140/90mmHg). Linear regression models were used to estimate the association between baseline BP properties and the longitudinal change in echocardiogram parameters. We then subdivided each group based on whether the they maintained BP control (<140/90mmHg) on follow up and used linear regression models to test for significance among the mean longitudinal change of echocardiogram parameters. All analyses accounted for the complex sampling design of HCHS/SOL and Echo-SOL.
Results:
There was a total of 1818 adults at baseline, with 1643 obtaining serial echocardiograms an average of 4.3 years later, mean age of approximately 56 years. Among all adults, baseline pulse pressure was significantly associated with a longitudinal increase in left ventricular (LV) end diastolic volume (β=0.13, p=0.02), whereas the change in LV mass index longitudinally decreased with baseline diastolic BP (β=-0.14, p<0.01). When isolating the subgroup defined as hypertensive at baseline, the adults who had uncontrolled BP on follow up had a greater absolute increase in the average E/E’ ratio and greater decrease in average E’ velocity, 0.95±0.08 and -0.96±0.06 respectively, compared to the adults with controlled BP 0.04±0.07 and -0.74± 0.04 respectively (p<0.01). In addition, the controlled BP group had a greater absolute reduction in LV end-diastolic volume of 6.94mL than those with uncontrolled BP, 4.60mL (p<0.01).
Conclusions:
Our study is the first to study the association of longitudinal impact of blood pressure control with cardiac structure and function in Hispanic/Latino adults. We found that higher baseline brachial BP properties were associated with reduced in LV mass index and increased LV end diastolic volumes. Among the baseline hypertensive adults, there was a significantly higher progression in diastolic dysfunction among the participants who had poor BP control, but those with controlled BP on follow up had greater LV enlargement. Despite these differences, both subgroups ultimately showed a collective progression in diastolic dysfunction and a decrease in end-diastolic volume over time.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sonia Ponce
- UNIVERSITY OF CALIFORNIA SAN DIEGO, La Jolla, CA
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16
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Oxman JM, Lopez L, Rodriguez F, Gallo L, Hurwitz BE, Perreira K, Daviglus ML, Kansal MM, Gonzalez F, Lutsey PL, Rodriguez CJ. Abstract 001: Perceived Discrimination Is Associated With Abnormal Left Ventricular Structure And Function: The Hispanic Community Health Study/Study Of Latinos: ECHO-SOL Ancillary Study. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Perceived discrimination stress and acculturation are associated with CVD, but their association with cardiac structure and function have not been well studied.
Hypothesis:
We hypothesized that increased discrimination would be associated with abnormal LV structure and function and that low acculturation positively moderates this association after adjusting for CVD risk factors.
Methods:
ECHO-SOL enrolled Hispanics/Latinos, aged 45-74, living in the Bronx, Chicago, Miami, and San Diego. Echocardiographic measurements included: LV Mass Index (LVMI), LV geometry, left atrial volume index (LAVI), LV diastolic dysfunction (LVDD), and LVEF. Discrimination scales from the Brief PEDQ-CV included: total discrimination, exclusion/rejection, stigmatization/devaluation, discrimination at work/school, and threat/aggression. Spanish-language preference, foreign-born and shorter length of U.S. residence defined low acculturation. Linear regression, using sampling weights, assessed the association of outcomes with discrimination measures, adjusting for CVD risk factors, followed by stratification by acculturation level.
Results:
Participants (n=1818) were largely Spanish-speaking (86%), foreign-born (92%), with 49% living in the U.S. >20 years. Mean age was 56.4 years (SE = 0.37). Fifty percent had hypertension, 28% had diabetes, and 44% were obese. Mean total discrimination was 24.8 (SE = 0.4). LVDD was 52% and abnormal LV geometry was 45%. In unadjusted analysis, stigmatization/devaluation was associated with higher LVMI (β = 0.88; p = 0.003) and LAVI (β = 0.26; p = 0.003). Discrimination at work/school was associated with higher LVEF (β = 0.197; p = 0.007). In adjusted analysis, stigmatization/devaluation continued to predict higher LAVI (β = 0.30; p = 0.0009) but not LVMI. Discrimination at work/school continued to predict increasing LVEF (β = 0.22; p = 0.001). Total discrimination became significant for increased LVEF (β = 0.06; p = 0.006). In adjusted analyses stratified by acculturation, stigmatization/devaluation predicted higher LAVI among Spanish language preference (β = 0.30; p = 0.004) and foreign-born individuals (β = 0.32; p = 0.0016). Work/school discrimination (β = 0.20; p = 0.006) predicted increasing LVEF in foreign-born individuals. Total discrimination predicted increased LVEF among Spanish language preference (β = 0.073; p = 0.008) and foreign-born individuals (β = 0.07; p = 0.007). Stigma/devaluation was associated with higher LVMI among Spanish language preference (β = 0.97; p = 0.004) and foreign-born individuals (β = 1.09; p = 0.0005) in unadjusted but not adjusted models.
Conclusions:
In conclusion, stigma/devaluation predicted higher LVMI and LAVI in unadjusted analyses but only higher LAVI when adjusted. Total and work/school discrimination predicted higher LVEF. Low acculturation stratification resulted in similar findings.
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Affiliation(s)
| | - Lenny Lopez
- San Francisco VA Med Cntr, San Francisco, CA
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17
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Genuardi MV, Ogilvie RP, Magnani JW, Redline S, Daviglus ML, Shah N, Kansal M, Cai J, Ramos AR, Hurwitz BE, Ponce S, Patel SR, Rodriguez CJ. Response by Genuardi et al to Letter Regarding Article, "Association Between Sleep Disordered Breathing and Left Ventricular Function: a Cross-Sectional Analysis of the ECHO-SOL Ancillary Study". Circ Cardiovasc Imaging 2020; 13:e011428. [PMID: 32873068 DOI: 10.1161/circimaging.120.011428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael V Genuardi
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA (M.V.G., J.W.M., S.R.P.).,Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (M.V.G.)
| | | | - Jared W Magnani
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA (M.V.G., J.W.M., S.R.P.).,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (J.W.M.)
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL (M.L.D.)
| | - Neomi Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.)
| | - Mayank Kansal
- Division of Cardiology, University of Illinois Hospital and Health Sciences, Chicago, IL (M.K.)
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC (J.C.)
| | - Alberto R Ramos
- Departments of Neurology (A.R.R.), University of Miami Miller School of Medicine, Miami, FL
| | - Barry E Hurwitz
- Psychology, Behavioral Medicine Research Center (B.E.H.), University of Miami Miller School of Medicine, Miami, FL
| | | | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA (M.V.G., J.W.M., S.R.P.).,Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA (S.R.P.)
| | - Carlos J Rodriguez
- Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (C.J.R.)
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Burroughs Peña MS, Uwamungu JC, Bulka CM, Swett K, Perreira KM, Kansal MM, Loop MS, Hurwitz BE, Daviglus M, Rodriguez CJ. Occupational Exposures and Cardiac Structure and Function: ECHO-SOL (Echocardiographic Study of Latinos). J Am Heart Assoc 2020; 9:e016122. [PMID: 32842829 PMCID: PMC7660755 DOI: 10.1161/jaha.120.016122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/01/2020] [Indexed: 01/13/2023]
Abstract
Background Our objective was to determine associations of occupational exposures with cardiac structure and function in Hispanic/Latino adults. Methods and Results Employed participants were included (n=782; 52% women, mean age 52.9 years). Occupational exposures to burning wood, vehicle exhaust, solvents, pesticides, and metals at the current and longest-held job were assessed by questionnaire. Survey multivariable linear regression analyses were used to model the relationship of each self-reported exposure with echocardiographic measures of cardiac structure and function. Exposure to burning wood at the current job was associated with decreased left ventricular (LV) ejection fraction (-3.1%; standard error [SE], 1.0 [P=0.002]). When the analysis was restricted to exposure at the longest-held job, occupational exposure to burning wood was associated with increased LV diastolic volume (6.7 mL; SE, 1.6 [P<0.0001]), decreased LV ejection fraction (-2.7%; SE, 0.6 [P<0.0001]), worse LV global longitudinal strain (1.0%; SE, 0.3 [P=0.0009]), and decreased right ventricular fractional area change (-0.02; SE, 0.004 [P<0.001]). Exposure to pesticides was associated with worse average global longitudinal strain (0.8%; SE, 0.2 [P<0.0001]). Exposure to metals was associated with worse global longitudinal strain in the 2-chamber view (1.0%; SE, 0.5 [P=0.04]), increased stroke volume (3.6 mL; SE, 1.6 [P=0.03]), and increased LV mass indexed to BSA (9.2 g/m2; SE, 3.8 [P=0.01]) or height (4.4 g/m2.7; SE, 1.9 [P=0.02]). Conclusions Occupational exposures to burning wood, vehicle exhaust, pesticides, and metals were associated with abnormal parameters of LV and right ventricular systolic function. Reducing exposures to toxic chemicals and particulates in the workplace is a potential opportunity to prevent cardiovascular disease in populations at risk.
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Affiliation(s)
| | | | - Catherine M. Bulka
- Department of Environmental Sciences and EngineeringUniversity of North CarolinaChapel HillNC
| | - Katrina Swett
- Department of MedicineAlbert Einstein College of MedicineBronxNY
- Department Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
| | - Krista M. Perreira
- Department of Social MedicineUniversity of North Carolina School of MedicineChapel HillNC
| | - Mayank M. Kansal
- Institute for Minority Health ResearchUniversity of IllinoisChicagoIL
| | - Matthew Shane Loop
- Department of BiostatisticsUniversity of North Carolina Gillings School of Global Public HealthChapel HillNC
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center, Miller School of MedicineUniversity of MiamiFL
- Department of PsychologyUniversity of MiamiCoral GablesFL
| | - Martha Daviglus
- Institute for Minority Health ResearchUniversity of IllinoisChicagoIL
| | - Carlos J. Rodriguez
- Department of MedicineAlbert Einstein College of MedicineBronxNY
- Department Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
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19
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Martinez C, Rikhi R, Haque T, Fazal A, Kolber M, Hurwitz BE, Schneiderman N, Brown TT. Gender Identity, Hormone Therapy, and Cardiovascular Disease Risk. Curr Probl Cardiol 2020; 45:100396. [DOI: 10.1016/j.cpcardiol.2018.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
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20
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Ogilvie RP, Genuardi MV, Magnani JW, Redline S, Daviglus ML, Shah N, Kansal M, Cai J, Ramos AR, Hurwitz BE, Ponce S, Patel SR, Rodriguez CJ. Association Between Sleep Disordered Breathing and Left Ventricular Function: A Cross-Sectional Analysis of the ECHO-SOL Ancillary Study. Circ Cardiovasc Imaging 2020; 13:e009074. [PMID: 32408831 PMCID: PMC8117672 DOI: 10.1161/circimaging.119.009074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. METHODS We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. RESULTS Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1-0.3) lower E', 0.3 (0.1-0.5) greater E/E' ratio, and 1.07-fold (1.03-1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3-2.4) g/m2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. CONCLUSIONS Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.
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Affiliation(s)
- Rachel P. Ogilvie
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Michael V. Genuardi
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Division of Cardiology, University of Pittsburgh Medical Center
| | - Jared W. Magnani
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Division of Cardiology, University of Pittsburgh Medical Center
| | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago
| | | | | | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Alberto R. Ramos
- Department of Neurology, University of Miami, Miller School of Medicine
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center, University of Miami, Department of Psychology and Miller School of Medicine
| | | | - Sanjay R. Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh
| | - Carlos J. Rodriguez
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine
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21
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Grant JK, Vincent L, Ebner B, Hurwitz BE, Alcaide ML, Martinez C. Early Insights into COVID-19 in Persons Living with HIV and Cardiovascular Manifestations. J AIDS HIV Treat 2020; 2:68-74. [PMID: 33748827 PMCID: PMC7971556 DOI: 10.33696/aids.2.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Persons living with HIV-1 (PLHIV) are at increased risk of cardiovascular complications in part due to the persistent inflammatory state despite viral suppression. SARS-CoV-2, the virus causing COVID-19, was declared a pandemic virus in March 2020, and caused over 30 million cases and 900,000 deaths worldwide to date. Individuals with COVID-19 are manifesting acute cardiovascular complications because of the inflammatory response associated with SARS-CoV-2 infection. It is not yet known whether having COVID-19 in the context of ongoing HIV-1 infection results in worse cardiovascular complications than in PLHIV who have not had COVID-19 infection. In this review, the potential for exacerbated cardiovascular manifestations in persons coinfected with HIV-1 and COVID-19 is considered.
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Affiliation(s)
- Jelani K. Grant
- Department of Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA
| | - Louis Vincent
- Department of Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA
| | - Bertrand Ebner
- Department of Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, Florida, USA
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
- Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maria L. Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Claudia Martinez
- Department of Medicine, Division of Cardiovascular Disease, University of Miami Miller School of Medicine, Miami, Florida, USA
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22
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Rangel MO, Kaplan R, Daviglus M, Schneiderman N, Hurwitz BE, Cai J, Gonzalez F, Kitzman D, Kansal M, Rodriguez CJ. Estimation of Incident Heart Failure Risk among US Hispanics/Latinos Using a Validated Echocardiographic Risk-Stratification Index: the Echocardiographic Study of Latinos. J Card Fail 2018; 24:622-624. [PMID: 30223030 DOI: 10.1016/j.cardfail.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 07/31/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Jianwen Cai
- University of North Carolina; Chapel Hill, North Carolina
| | | | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mayank Kansal
- University of Illinois at Chicago, Chicago, Illinois
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23
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Garcia KA, Wohlgemuth WK, Ferrannini E, Mari A, Gonzalez A, Mendez AJ, Bizzotto R, Skyler JS, Schneiderman N, Hurwitz BE. Sleeping oxygen saturation, rapid eye movement sleep, and the adaptation of postprandial metabolic function in insulin sensitive and resistant individuals without diabetes. Physiol Behav 2018; 191:123-130. [PMID: 29655763 DOI: 10.1016/j.physbeh.2018.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 02/27/2018] [Accepted: 04/07/2018] [Indexed: 12/25/2022]
Abstract
AIMS Sleeping oxygen saturation (SaO2) and sleep stage duration have been linked with prediabetic alterations but the pathogenic pathways are not well understood. This study of insulin sensitive and resistant adults examined the effect on postprandial metabolic regulation of repeated mixed-meal challenges of different carbohydrate loading. The aim was to examine whether the relationship between lower sleeping oxygen saturation (SaO2) and poorer fasting and postprandial metabolic function may be linked with reduced slow wave sleep (SWS) and rapid eye movement (REM) duration, independent of age, sex and total adiposity. METHODS The 24 men and women, aged 25-54 years, had no diabetes or other diagnosed conditions, were evaluated with polysomnography to derive indices of SaO2 and sleep architecture. In addition, an OGTT and two 14-h serial mixed-meal tests were administered over 3 successive in-patient days. The carbohydrate content of the mixed-meals was manipulated to compare a standard-load day with a double-load day (300 vs. 600 kcal/meal). Quantitative modeling was applied to derive β-cell glucose sensitivity (β-GS), early insulin secretion rate sensitivity (ESRS), and total postprandial insulinemia (AUCINS). RESULTS Analyses showed that, for the 14-h tests, the SaO2 relationship with metabolic outcomes was associated significantly with percent time spent in REM but not SWS, independent of age, sex and total adiposity. Specifically, indirect pathways indicated that lower SaO2 was related to shorter REM duration, and shorter REM was respectively associated with higher β-GS, ESRS, and AUCINS for the 300- and 600-load days (300 kcal/meal: β = -8.68, p < .03, β = -8.54, p < .002, and β = -10.06, p < .008; 600 kcal/meal: β = -11.45, p < .003, β = -11.44, p < .001, and β = -11.00, p < .03). CONCLUSION Sleeping oxygen desaturation and diminished REM duration are associated with a metabolic pattern that reflects a compensatory adaptation of postprandial insulin metabolism accompanying preclinical diabetic risk.
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Affiliation(s)
- Karin A Garcia
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Ele Ferrannini
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Andrea Mari
- National Research Council Institute of Neurosciences, Padua, Italy
| | - Alex Gonzalez
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA
| | - Armando J Mendez
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Roberto Bizzotto
- National Research Council Institute of Neurosciences, Padua, Italy
| | - Jay S Skyler
- Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Neil Schneiderman
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Barry E Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA.
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24
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Rangel MO, Soto A, Kaplan R, Ponce S, Kansal M, Shah SJ, Cai J, Bilsker M, Hurwitz BE, Pu M, Rodriguez C. ECHOCARDIOGRAPHIC LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN IN U.S. HISPANICS/LATINOS: HCHS/SOL ECHOCARDIOGRAPHIC STUDY OF LATINOS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32203-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Burroughs Peña M, Swett K, Schneiderman N, Spevack DM, Ponce SG, Talavera GA, Kansal MM, Daviglus ML, Cai J, Hurwitz BE, Llabre MM, Rodriguez CJ. Cardiac structure and function with and without metabolic syndrome: the Echocardiographic Study of Latinos (Echo-SOL). BMJ Open Diabetes Res Care 2018; 6:e000484. [PMID: 30116540 PMCID: PMC6091897 DOI: 10.1136/bmjdrc-2017-000484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE We assessed the hypothesis that metabolic syndrome is associated with adverse changes in cardiac structure and function in participants of the Echocardiographic Study of Latinos (Echo-SOL). METHODS Non-diabetic Echo-SOL participants were included in this cross-sectional analysis. Metabolic syndrome was defined according to the American Heart Association/National Heart, Lung, and Blood Institute 2009 Joint Scientific Statement. Survey multivariable linear regression analyses using sampling weights were used adjusting for multiple potential confounding variables. Additional analysis was stratified according to the presence/absence of obesity (body mass index (BMI) ≥25 kg/m2) and the presence/absence of metabolic syndrome. RESULTS Within Echo-SOL, 1260 individuals met inclusion criteria (59% female; mean age 55.2 years). Compared with individuals without metabolic syndrome, those with metabolic syndrome had lower medial and lateral E' velocities (-0.4 cm/s, (SE 0.1), p=0.0002; -0.5 cm/s (0.2), p=0.02, respectively), greater E/E' (0.5(0.2), p=0.01) and worse two-chamber left ventricular longitudinal strain (0.9%(0.3), p=0.009), after adjusting for potential confounding variables. Increased left ventricular mass index (9.8 g/m2 (1.9), p<0.0001 and 7.5 g/m2 (1.7), p<0.0001), left ventricular end-diastolic volume (11.1 mL (3.0), p=0.0003 and 13.3 mL (2.7), p<0.0001), left ventricular end-systolic volume (5.0 mL (1.4), p=0.0004 and 5.7 mL (1.3) p<0.0001) and left ventricular stroke volume (10.2 mL (1.8), p<0.0001 and 13.0 mL (2.0), p<0.0001) were observed in obese individuals with and without metabolic syndrome compared with individuals with normal weight without metabolic syndrome. In sensitivity analyses, individuals with normal weight (BMI <25 kg/m2) and metabolic syndrome had worse left ventricular global longitudinal strain (2.1%(0.7), p=0.002) and reduced left ventricular ejection fraction (-3.5%(1.4), p=0.007) compared with normal-weight individuals without metabolic syndrome. CONCLUSIONS In a sample of US Hispanics/Latinos metabolic syndrome was associated with worse left ventricular systolic and diastolic function. Adverse changes in left ventricular size and function were observed in obese individuals with and without metabolic syndrome but decreased left ventricular function was also present in normal-weight individuals with metabolic syndrome.
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Affiliation(s)
| | - Katrina Swett
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Neil Schneiderman
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Daniel M Spevack
- Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sonia G Ponce
- Department of Family and Preventive Medicine, University of California, San Diego, California, USA
| | - Gregory A Talavera
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Mayank M Kansal
- Division of Cardiology, University of Illinois, Chicago, Illinois, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois, Chapel Hill, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barry E Hurwitz
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maria M Llabre
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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26
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Hanna DB, Xu S, Melamed ML, Gonzalez F, Allison MA, Bilsker MS, Hurwitz BE, Kansal MM, Schneiderman N, Shah SJ, Kaplan RC, Rodriguez CJ, Kizer JR. Association of Albuminuria With Cardiac Dysfunction in US Hispanics/Latinos. Am J Cardiol 2017; 119:2073-2080. [PMID: 28438309 DOI: 10.1016/j.amjcard.2017.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 12/15/2022]
Abstract
Higher urine albumin-to-creatinine ratio (UACR) has been associated with cardiac dysfunction in the general population. We assessed the association of UACR with cardiac structure and function in the Echocardiographic Study of Latinos (Echo-SOL), an ancillary study of the Hispanic Community Health Study/Study of Latinos across 4 US sites. Echo-SOL participants underwent standard 2-dimensional echocardiography, including speckle-tracking strain analysis. UACR was categorized as normal and high-normal (based on the midpoint of values below microalbuminuria), microalbuminuria (≥17 mg/g for men; ≥25 mg/g for women), and macroalbuminuria (≥250 mg/g; ≥355 mg/g). Simultaneous assessments were made of left ventricular (LV) mass index and hypertrophy and measures of LV systolic and diastolic dysfunction. We assessed the association of UACR with subclinical cardiac measures, adjusting for sociodemographic and cardiometabolic factors. Among 1,815 participants (median age 54, women 65%), 42% had normal UACR, 43% high-normal UACR, 13% microalbuminuria, and 2% macroalbuminuria. Prevalence of LV hypertrophy was 13%, LV systolic dysfunction (ejection fraction <50%) 3%, and diastolic dysfunction 53%. After covariate adjustment, both micro- and macroalbuminuria were significantly associated with a twofold increase in LV hypertrophy. Microalbuminuria but not macroalbuminuria was associated with worse global longitudinal strain. Elevated UACR, even at high-normal levels, was significantly associated with greater diastolic dysfunction. In conclusion, elevated UACR was associated with LV hypertrophy and diastolic dysfunction in the largest known population sample of US Hispanic/Latinos. Screening and detection of even high-normal UACR could be of value to guide cardiovascular disease prevention efforts among Hispanic/Latino Americans.
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27
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Demmer RT, Allison MA, Cai J, Kaplan RC, Desai AA, Hurwitz BE, Newman JC, Shah SJ, Swett K, Talavera GA, Thai A, Youngblood ME, Rodriguez CJ. Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos). Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005032. [PMID: 27729362 DOI: 10.1161/circimaging.116.005032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/26/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND We examined the relationship between glucose homeostasis and comprehensive measures of cardiac structure and function among a representative sample of US Hispanics. METHODS AND RESULTS ECHO-SOL (Echocardiographic Study of Latinos), an echocardiographic ancillary study of the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), enrolled 1818 Hispanic/Latino men (43%) and women (57%) aged ≥45 years (mean=56). Glucose intolerance was defined as follows: (1) prediabetes: hemoglobin (HbA1c) ≥5.7 and <6.5% and (2) diabetes mellitus: fasting plasma glucose ≥126 mg/dL, 2-hour postload glucose ≥200 mg/dL, HbA1c ≥6.5%, or hypoglycemic agent use. Uncontrolled diabetes mellitus was defined as HbA1c ≥7.0%. Insulin resistance was defined using the homeostatic model assessment for insulin resistance. Echocardiography examinations assessed left ventricular structure and systolic/diastolic function. Multivariable linear and logistic regression models were used. Prediabetes prevalence was 42%, and diabetes mellitus prevalence was 28% (47% uncontrolled). Glucose intolerance was associated with increased left ventricular posterior wall and interventricular septal and relative wall thicknesses (all P<0.05), reduced ejection fraction (P<0.01), reduced stroke and end-diastolic volumes (both P<0.001), decreased peak E' velocity (lateral and septal P<0.001), and increased E/E' ratio (lateral and septal P<0.01). The odds ratios (95% confidence intervals) for diastolic dysfunction among individuals with prediabetes and diabetes mellitus (versus diabetes mellitus free) were 1.36 (0.96-1.9) and 1.90 (1.3-2.8), respectively(P=0.006). Results were consistent for uncontrolled diabetes mellitus versus diabetes mellitus. Homeostatic model assessment for insulin resistance was associated with increased E/E' (P<0.001), and greater relative wall thickness and septal thickness (both P<0.05); lower stroke volume (P<0.0001); and lower peak lateral and septal E' velocities (both P<0.01). CONCLUSIONS Glucose intolerance and insulin resistance are associated with unfavorable cardiac structure and function, particularly worsened measures of diastolic function, even before the development of diabetes mellitus.
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Affiliation(s)
- Ryan T Demmer
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
| | - Matthew A Allison
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Jianwen Cai
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Robert C Kaplan
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Ankit A Desai
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Barry E Hurwitz
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Jill C Newman
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Sanjiv J Shah
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Katrina Swett
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Gregory A Talavera
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Ashley Thai
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Marston E Youngblood
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Carlos J Rodriguez
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
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Aggarwal SR, Herrington DM, Vladutiu CJ, Newman JC, Swett K, Gonzalez F, Kizer JR, Kominiarek MA, Tabb KM, Gallo LC, Talavera GA, Hurwitz BE, Rodriguez CJ. Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos. Open Heart 2017; 4:e000530. [PMID: 28674618 PMCID: PMC5471863 DOI: 10.1136/openhrt-2016-000530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort. Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol. Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p<0.01). In full multivariate models, higher parity was significantly associated with greater left ventricular end-systolic volumes, end-diastolic volumes, left atrial volume indices and presence of DD (all p<0.01) but was not associated with ejection fraction. The log odds for having any grade of DD in grand-multiparous women was over three times that seen in nulliparous women (OR=3.4, 95% CI 1.5 to 7.9, p<0.01) in models further adjusted for income and education. Conclusions Higher parity is associated with increased cardiac mass, volumes and the presence of DD. Further studies are needed to elucidate this apparent deleterious relation and whether parity can help explain the increased risk of HFpEF in women.
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Affiliation(s)
| | | | | | - Jill C Newman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katrina Swett
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jorge R Kizer
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Karen M Tabb
- University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Linda C Gallo
- San Diego State University, San Diego, California, USA
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29
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Hurwitz BE, Mendes ES, Schmid A, Parker M, Arana J, Gonzalez A, Wanner A. Airway and Pulmonary β 2-Adrenergic Vasodilatory Function in Current Smokers and Never Smokers. Chest 2016; 151:650-657. [PMID: 28012803 DOI: 10.1016/j.chest.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/21/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cigarette smoking has been associated with diminished vasodilatory function in the airway circulation. It is possible that cigarette smoking similarly affects the pulmonary circulation before resting pulmonary circulatory abnormalities become manifested. The aim of this study was to compare the acute effect of inhaled albuterol on airway and pulmonary hemodynamic function as an index of β2-adrenoceptor-mediated vasodilation in smokers and never smokers. METHODS In 30 adults, airway and pulmonary vascular function was assessed before and 15 min after albuterol inhalation (270 μg). From mean systemic arterial pressure, cardiac output, airway blood flow, and mean pulmonary arterial pressure, airway vascular resistance (AVR) and pulmonary vascular resistance (PVR) were derived. RESULTS Albuterol induced a substantial drop in mean (± SE) PVR (-67.2% ± 5%), with no difference between groups. In contrast, the albuterol-induced decrease in AVR was significantly greater in never smokers than in smokers (-28.6% ± 3% vs -3.1% ± 6%; P < .02). CONCLUSIONS These results are consistent with a dysfunction in a β2-adrenergic signaling pathway mediating vasorelaxation in the airway circulation of current smokers. The vasodilatory deficit in the airway circulation but not in the pulmonary circulation could be related to local differences in the impact of cigarette smoke on the vascular endothelium.
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Affiliation(s)
- Barry E Hurwitz
- Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, Coral Gables, FL; Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Coral Gables, FL; Department of Psychology, University of Miami, Coral Gables, FL.
| | - Eliana S Mendes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Andreas Schmid
- Division of Pulmonary, Critical Care, and Sleep Medicine, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Meela Parker
- Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Johana Arana
- Division of Pulmonary, Critical Care, and Sleep Medicine, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Alex Gonzalez
- Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Adam Wanner
- Division of Pulmonary, Critical Care, and Sleep Medicine, Miller School of Medicine, University of Miami, Coral Gables, FL
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Qureshi WT, Leigh JA, Swett K, Dharod A, Allison MA, Cai J, Gonzalez F, Hurwitz BE, Shah SJ, Desai AA, Spevack DM, Rodriguez CJ. Comparison of Echocardiographic Measures in a Hispanic/Latino Population With the 2005 and 2015 American Society of Echocardiography Reference Limits (The Echocardiographic Study of Latinos). Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.003597. [PMID: 26712159 DOI: 10.1161/circimaging.115.003597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reference limits for echocardiographic quantification of cardiac chambers in Hispanics are not well studied. METHODS AND RESULTS We examined the reference values of left atrium and left ventricle (LV) structure in a large ethnically diverse Hispanic cohort. Two-dimensional transthoracic echocardiography was performed in 1818 participants of the Echocardiographic Study of Latinos (ECHO-SOL). Individuals with body mass index ≥30 kg/m(2), hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation were excluded leaving 525 participants defined as healthy reference cohort. We estimated 95th weighted percentiles of LV end systolic volume, LV end diastolic volume, relative wall and septal thickness, LV mass, and left atrial volume. We then used upper reference limits of the 2005 and 2015 American Society of Echocardiography (ASE) and 95th percentile of reference cohort to classify the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) target population into abnormal and normal. Reference limits were also calculated for each of 6 Hispanic origins. Using ASE 2015 defined reference values, we categorized 7%, 21%, 57%, and 17% of men and 18%, 29%, 60%, and 26% of women as having abnormal LV mass index, relative, septal, and posterior wall thickness, respectively. Conversely, 10% and 11% of men and 4% and 2% of women were classified as having abnormal end-diastolic volume and internal diameter by ASE 2015 cutoffs, respectively. Similar differences were found when we used 2005 ASE cutoffs. Several differences were noted in distribution of cardiac structure and volumes among various Hispanic/Latino origins. Cubans had highest values of echocardiographic measures, and Central Americans had the lowest. CONCLUSIONS This is the first large study that provides normal reference values for cardiac structure. It further demonstrates that a considerable segment of Hispanic/Latinos residing in the United States may be classified as having abnormal measures of cardiac chambers when 2015 and 2005 ASE reference cutoffs are used.
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Affiliation(s)
- Waqas T Qureshi
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.).
| | - J Adam Leigh
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Katrina Swett
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Ajay Dharod
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Matthew A Allison
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Jianwen Cai
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Franklyn Gonzalez
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Barry E Hurwitz
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Sanjiv J Shah
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Ankit A Desai
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Daniel M Spevack
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Carlos J Rodriguez
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
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Hurwitz BE, Schneiderman N, Marks JB, Mendez AJ, Gonzalez A, Llabre MM, Smith SR, Bizzotto R, Santini E, Manca ML, Skyler JS, Mari A, Ferrannini E. Adaptation of β-Cell and Endothelial Function to Carbohydrate Loading: Influence of Insulin Resistance. Diabetes 2015; 64:2550-9. [PMID: 25754957 PMCID: PMC4477346 DOI: 10.2337/db15-0106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/02/2015] [Indexed: 12/23/2022]
Abstract
High-carbohydrate diets have been associated with β-cell strain, dyslipidemia, and endothelial dysfunction. We examined how β-cell and endothelial function adapt to carbohydrate overloading and the influence of insulin resistance. On sequential days in randomized order, nondiabetic subjects (classified as insulin-sensitive [IS] [n = 64] or insulin-resistant [IR] [n = 79] by euglycemic clamp) received four mixed meals over 14 h with either standard (300 kcal) or double carbohydrate content. β-Cell function was reconstructed by mathematical modeling; brachial artery flow-mediated dilation (FMD) was measured before and after each meal. Compared with IS, IR subjects showed higher glycemia and insulin hypersecretion due to greater β-cell glucose and rate sensitivity; potentiation of insulin secretion, however, was impaired. Circulating free fatty acids (FFAs) were less suppressed in IR than IS subjects. Baseline FMD was reduced in IR, and postprandial FMD attenuation occurred after each meal, particularly with high carbohydrate, similarly in IR and IS. Throughout the two study days, higher FFA levels were significantly associated with lower (incretin-induced) potentiation and impaired FMD. In nondiabetic individuals, enhanced glucose sensitivity and potentiation upregulate the insulin secretory response to carbohydrate overloading. With insulin resistance, this adaptation is impaired. Defective suppression of endogenous FFA is one common link between impaired potentiation and vascular endothelial dysfunction.
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Affiliation(s)
- Barry E Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, FL Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL Department of Psychology, University of Miami, Coral Gables, FL
| | - Neil Schneiderman
- Behavioral Medicine Research Center, University of Miami, Miami, FL Department of Psychology, University of Miami, Coral Gables, FL
| | - Jennifer B Marks
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Armando J Mendez
- Behavioral Medicine Research Center, University of Miami, Miami, FL Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Alex Gonzalez
- Behavioral Medicine Research Center, University of Miami, Miami, FL
| | - Maria M Llabre
- Behavioral Medicine Research Center, University of Miami, Miami, FL Department of Psychology, University of Miami, Coral Gables, FL
| | - Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL
| | - Roberto Bizzotto
- National Research Council Institute of Biomedical Engineering, Padua, Italy
| | - Eleonora Santini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jay S Skyler
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Andrea Mari
- National Research Council Institute of Biomedical Engineering, Padua, Italy
| | - Ele Ferrannini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy National Research Council Institute of Clinical Physiology, Pisa, Italy
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Abstract
BACKGROUND Trait anger consists of affective, behavioral, and cognitive (ABC) dimensions and may increase vulnerability for interpersonal conflict, diminished social support, and greater psychological distress. The concurrent influence of anger and psychosocial dysfunction on Human Immunodeficiency Virus (HIV) disease severity is unknown. PURPOSE The purpose of this study was to examine plausible psychosocial avenues (e.g., coping, social support, psychological distress), whereby trait anger may indirectly influence HIV disease status. METHODS Three hundred seventy-seven HIV seropositive adults, aged 18-55 years (58% AIDS-defined), completed a battery of psychosocial surveys and provided a fasting blood sample for HIV-1 viral load and T lymphocyte count assay. RESULTS A second-order factor model confirmed higher levels of the multidimensional anger trait, which was directly associated with elevated psychological distress and avoidant coping (p<.001) and indirectly associated with greater HIV disease severity (p<.01) (comparative fit index (CFI)=0.90, root-mean-square error of approximation (RMSEA)=0.06, standardized root-mean-square residual (SRMR)=0.06). CONCLUSION The model supports a role for the ABC components of anger, which may negatively influence immune function through various psychosocial mechanisms; however, longitudinal study is needed to elucidate these effects.
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Affiliation(s)
- Roger C McIntosh
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA,
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Premer C, Blum A, Bellio MA, Schulman IH, Hurwitz BE, Parker M, Dermarkarian CR, DiFede DL, Balkan W, Khan A, Hare JM. Allogeneic Mesenchymal Stem Cells Restore Endothelial Function in Heart Failure by Stimulating Endothelial Progenitor Cells. EBioMedicine 2015; 2:467-75. [PMID: 26137590 PMCID: PMC4485912 DOI: 10.1016/j.ebiom.2015.03.020] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endothelial dysfunction, characterized by diminished endothelial progenitor cell (EPC) function and flow-mediated vasodilation (FMD), is a clinically significant feature of heart failure (HF). Mesenchymal stem cells (MSCs), which have pro-angiogenic properties, have the potential to restore endothelial function. Accordingly, we tested the hypothesis that MSCs increase EPC function and restore flow-mediated vasodilation (FMD). METHODS Idiopathic dilated and ischemic cardiomyopathy patients were randomly assigned to receive autologous (n = 7) or allogeneic (n = 15) MSCs. We assessed EPC-colony forming units (EPC-CFUs), FMD, and circulating levels of vascular endothelial growth factor (VEGF) in patients before and three months after MSC transendocardial injection (n = 22) and in healthy controls (n = 10). FINDINGS EPC-colony forming units (CFUs) were markedly reduced in HF compared to healthy controls (4 ± 3 vs. 25 ± 16 CFUs, P < 0.0001). Similarly, FMD% was impaired in HF (5.6 ± 3.2% vs. 9.0 ± 3.3%, P = 0.01). Allogeneic, but not autologous, MSCs improved endothelial function three months after treatment (Δ10 ± 5 vs. Δ1 ± 3 CFUs, P = 0.0067; Δ3.7 ± 3% vs. Δ-0.46 ± 3% FMD, P = 0.005). Patients who received allogeneic MSCs had a reduction in serum VEGF levels three months after treatment, while patients who received autologous MSCs had an increase (P = 0.0012), and these changes correlated with the change in EPC-CFUs (P < 0.0001). Lastly, human umbilical vein endothelial cells (HUVECs) with impaired vasculogenesis due to pharmacologic nitric oxide synthase inhibition, were rescued by allogeneic MSC conditioned medium (P = 0.006). INTERPRETATION These findings reveal a novel mechanism whereby allogeneic, but not autologous, MSC administration results in the proliferation of functional EPCs and improvement in vascular reactivity, which in turn restores endothelial function towards normal in patients with HF. These findings have significant clinical and biological implications for the use of MSCs in HF and other disorders associated with endothelial dysfunction.
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Affiliation(s)
- Courtney Premer
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL, USA
| | - Arnon Blum
- Department of Medicine and Cardiology, Baruch Padeh Poria Hospital, Bar Ilan University, Lower Galilee 15208, Israel
| | - Michael A Bellio
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL, USA
| | | | - Barry E Hurwitz
- Department of Psychology, University of Miami Miller School of Medicine, FL, USA
| | - Meela Parker
- Department of Psychology, University of Miami Miller School of Medicine, FL, USA
| | | | - Darcy L DiFede
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL, USA
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL, USA
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Birnbaum-Weitzman O, Goldberg R, Hurwitz BE, Llabre MM, Gellman MD, Gutt M, McCalla JR, Mendez AJ, Schneiderman N. Depressive symptoms linked to 1-h plasma glucose concentrations during the oral glucose tolerance test in men and women with the metabolic syndrome. Diabet Med 2014; 31:630-6. [PMID: 24344735 PMCID: PMC3988212 DOI: 10.1111/dme.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/25/2013] [Accepted: 10/26/2013] [Indexed: 11/29/2022]
Abstract
AIMS The addition of the 1-h plasma glucose concentration measure from an oral glucose tolerance test to prediction models of future Type 2 diabetes has shown to significantly strengthen their predictive power. The present study examined the relationship between severity of depressive symptoms and hyperglycaemia, focusing on the 1-h glucose concentration vs. fasting and 2-h glucose measures from the oral glucose tolerance test. METHODS Participants included 140 adults with the metabolic syndrome and without diabetes who completed a baseline psychobiological assessment and a 2-h oral glucose tolerance test, with measurements taken every 30 min. Depressive symptoms were assessed using the Beck Depression Inventory. RESULTS Multivariate linear regression revealed that higher levels of depressive symptoms were associated with higher levels of 1-h plasma glucose concentrations after adjusting for age, gender, ethnicity, BMI, antidepressant use and high-sensitivity C-reactive protein. Results were maintained after controlling for fasting glucose as well as for indices of insulin resistance and secretion. Neither fasting nor 2-h plasma glucose concentrations were significantly associated with depressive symptoms. CONCLUSIONS Elevated depressive symptoms in persons with the metabolic syndrome were associated with greater glycaemic excursion 1-h following a glucose load that was not accounted for by differences in insulin secretory function or insulin sensitivity. Consistent with previous findings, this study highlights the value of the 1-h plasma glucose measurement from the oral glucose tolerance test in the relation between depressive symptoms and glucose metabolism as an indicator of metabolic abnormalities not visible when focusing on fasting and 2-h post-oral glucose tolerance test measurements alone.
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Affiliation(s)
- O Birnbaum-Weitzman
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Miami, FL, USA
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Mendes ES, Cancado JED, Rebolledo P, Arana J, Parker M, Gonzalez A, Hurwitz BE, Wanner A. Airway Vascular Endothelial Function in Healthy Smokers Without Systemic Endothelial Dysfunction. Chest 2013; 143:1733-1739. [DOI: 10.1378/chest.12-1033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hurwitz BE. Sleep Debt and Postprandial Metabolic Function in Subclinical Cardiometabolic Pathophysiology. Endocrinol Metab Syndr 2012; 1:e107. [PMID: 25309821 PMCID: PMC4189802 DOI: 10.4172/2161-1017.1000e107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Barry E. Hurwitz
- Corresponding author: Barry E. Hurwitz, Behavioral Medicine Research Center, University of Miami, Clinical Research Building #777, 1120 NW 14th Street, Miami, FL 33136, USA, Tel: 305-243-1444; Fax: 305-243-1445;
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Hurwitz BE, Henry N, Goldberg RB. Long-term oral contraceptive treatment, metabolic syndrome and measures of cardiovascular risk in pre-menopausal women: National Health and Nutrition Examination Survey 1999-2004. Gynecol Endocrinol 2009; 25:441-9. [PMID: 19499415 DOI: 10.1080/09513590902770149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIM Differences in subclinical cardiometabolic measures were examined as a function of oral contraceptive pills (OCP) treatment duration to compare never-treated women with four OCP-treatment groups (<1, 1-5, 5-10 and >10 years). METHODS The NHANES (1999-2004) database was used to evaluate 2089 healthy, pre-menopausal women, aged 18-55 years, with or without OCP history, no other hormonal treatment or history of systemic conditions. Outcome measures included body mass, central obesity, blood pressure, glycemia, insulinemia, lipid profile and inflammation. Analyses evaluated differences in prevalence of Metabolic Syndrome (MetS), constituent MetS and other clinical risk criteria, as well as outcome magnitudes. Analyses controlled for demographic and health-related variables, and study-eligible conditions. RESULTS Relative to other groups, women with >10 years OCP-use, and to some extent those with 5-10 years treatment, displayed no differences in prevalence of MetS and most risk criteria. Further analysis showed that, relative to women treated for <5 years, those with more prolonged OCP treatment displayed lower body mass and fasting glycemia with higher HDL-c levels, but more elevated LDL-c and total cholesterol. CONCLUSIONS The findings of both beneficial and detrimental subclinical cardiometabolic differences with more long-term OCP-treatment reinforces the need to monitor changes in these factors within the context of the treated patient's risk-benefit profile. However, because the magnitude of these differences was small, relative to normative ranges, it may be concluded that OCPs, as used in recent decades, are unlikely to markedly affect cardiometabolic risk.
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Affiliation(s)
- Barry E Hurwitz
- Behavioral Medicine Research Centre, University of Miami, Clinical Research Building #777, 1120 NW 14th Street, Miami, FL 33136, USA.
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Klaus JR, Hurwitz BE, Llabre MM, Skyler JS, Goldberg RB, Marks JB, Bilsker MS, Schneiderman N. Central Obesity and Insulin Resistance in the Cardiometabolic Syndrome: Pathways to Preclinical Cardiovascular Structure and Function. ACTA ACUST UNITED AC 2009; 4:63-71. [DOI: 10.1111/j.1559-4572.2008.00038.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Greeson JM, Hurwitz BE, Llabre MM, Schneiderman N, Penedo FJ, Klimas NG. Psychological distress, killer lymphocytes and disease severity in HIV/AIDS. Brain Behav Immun 2008; 22:901-11. [PMID: 18321678 DOI: 10.1016/j.bbi.2008.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 01/02/2008] [Accepted: 01/05/2008] [Indexed: 11/17/2022] Open
Abstract
Immunocellular mechanisms that account for the association between psychosocial risk factors and increased susceptibility to faster progression of HIV/AIDS are largely unknown. This study used structural equation modeling to test the hypothesis that enumerative and functional alterations in killer lymphocytes mediate the relationship between higher levels of psychological distress (defined by perceived stress, anxiety and depressive symptoms) and greater HIV disease severity (defined by HIV-1 viral load and T-helper (CD4(+)) cell count), independent of standard demographic and various HIV-related covariates. Participants were 200 HIV-1 seropositive adults on combination antiretroviral therapy (ages 20-55 years; 67% men; 62% black; 84% AIDS). The data fit a psychoimmune model in which the significant relationship between higher distress levels and greater disease severity was mediated by diminished natural killer (NK) cell count and cytotoxic function, as well as increased cytotoxic (CD8(+)) T-cell activation. Overall the findings indicated that the psychoimmune model accounted for 67% of the variation in HIV disease severity. In contrast, the data did not support a reverse directionality mediation model, where greater HIV disease severity predicted greater distress as a function of killer lymphocyte status. In sum, the psychoimmune associations of the final model are physiologically consistent and suggest that distress-related alterations in killer lymphocyte immunity may play a role in the biobehavioral mechanisms linked with HIV-1 pathogenesis.
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Affiliation(s)
- G J Paz-Filho
- Center for Pharmacogenomics, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Hurwitz BE, Klaus JR, Llabre MM, Gonzalez A, Lawrence PJ, Maher KJ, Greeson JM, Baum MK, Shor-Posner G, Skyler JS, Schneiderman N. Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: a randomized controlled trial. ACTA ACUST UNITED AC 2007; 167:148-54. [PMID: 17242315 DOI: 10.1001/archinte.167.2.148] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite findings that selenium supplementation may improve immune functioning, definitive evidence of its impact on human immunodeficiency virus (HIV) disease severity is lacking. METHODS High selenium yeast supplementation (200 mug/d) was evaluated in a double-blind, randomized, placebo-controlled trial. Intention-to-treat analyses assessed the effect on HIV-1 viral load and CD4 count after 9 months of treatment. Unless otherwise indicated, values are presented as mean +/- SD. RESULTS Of the 450 HIV-1-seropositive men and women who underwent screening, 262 initiated treatment and 174 completed the 9-month follow-up assessment. Mean adherence to study treatment was good (73.0% +/- 24.7%) with no related adverse events. The intention-to-treat analyses indicated that the mean change (Delta) in serum selenium concentration increased significantly in the selenium-treated group and not the placebo-treated group (Delta = 32.2 +/- 24.5 vs 0.5 +/- 8.8 microg/L; P<.001), and greater levels predicted decreased HIV-1 viral load (P<.02), which predicted increased CD4 count (P<.04). Findings remained significant after covarying age, sex, ethnicity, income, education, current and past cocaine and other drug use, HIV symptom classification, antiretroviral medication regimen and adherence, time since HIV diagnosis, and hepatitis C virus coinfection. Follow-up analyses evaluating treatment effectiveness indicated that the nonresponding selenium-treated subjects whose serum selenium change was less than or equal to 26.1 microg/L displayed poor treatment adherence (56.8% +/- 29.8%), HIV-1 viral load elevation (Delta = +0.29 +/- 1.1 log(10) units), and decreased CD4 count (Delta = -25.8 +/- 147.4 cells/microL). In contrast, selenium-treated subjects whose serum selenium increase was greater than 26.1 microg/L evidenced excellent treatment adherence (86.2% +/- 13.0%), no change in HIV-1 viral load (Delta = -0.04 +/- 0.7 log(10) units), and an increase in CD4 count (Delta = +27.9 +/- 150.2 cells/microL). CONCLUSIONS Daily selenium supplementation can suppress the progression of HIV-1 viral burden and provide indirect improvement of CD4 count. The results support the use of selenium as a simple, inexpensive, and safe adjunct therapy in HIV spectrum disease. Trial Registration isrctn.org Identifier: ISRCTN22553118.
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Affiliation(s)
- Barry E Hurwitz
- Behavioral Medicine Research Center, University of Miami, c/o VA Medical Center, FL 33125, USA.
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Hurwitz BE, Quillian RE, Marks JB, Schneiderman N, Agramonte RF, Freeman CR, La Greca AM, Skyler JS. Resting parasympathetic status and cardiovascular response to orthostatic and behavioral challenges in type I insulin-dependent diabetes mellitus. Int J Behav Med 2006; 1:137-62. [PMID: 16250810 DOI: 10.1207/s15327558ijbm0102_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- B E Hurwitz
- Behavioral Medicine Research Center, Department of Psychology, University of Miami, Coral Gables, FL 33124, USA
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Motivala SJ, Hurwitz BE, LaGreca AM, Llabre MM, Marks JB, Skyler JS, Schneiderman N. Aberrant parasympathetic and hemodynamic function distinguishes a subgroup of psychologically distressed individuals with asymptomatic type-I diabetes mellitus. Int J Behav Med 2006; 6:78-94. [PMID: 16250693 DOI: 10.1207/s15327558ijbm0601_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In a previous study, a subgroup of asymptomatic insulin-dependent diabetic individuals (termed IDDM-2) were identified on the basis of diminished parasympathetic cardiac input and elevated heart rate at rest. When compared to another group of asymptomatic IDDM participants (termed IDDM-1), and a nondiabetic healthy control group, the IDDM-2 group displayed elevated blood pressure, supported by elevated total peripheral resistance. Measures of psychological regulation were also taken in this study, and form the basis of this article, which examined whether these IDDM-2 patients differed from the other two groups on these measures. The possible role of glycemic control, IDDM duration, and number of somatic complaints among group differences in psychological regulation was also examined. The IDDM-2 group reported increased psychological distress, as reflected by increased dysphoric or depressive symptoms, trait anxiety, perceived stress, and cynical hostility, as well as decreased optimism and interpersonal, but not family, social support. Glycemic control did not account for any of the group differences in psychological regulation. However, group differences in dysphoria and anxiety were accounted for by differences in somatic complaints, whereas differences in interpersonal social support were accounted for by IDDM duration. Moreover, none of the variables investigated accounted for the diminished optimism of the IDDM-2 group. Therefore, in individuals with IDDM, who would otherwise be considered, after medical examination, as no different from other asymptomatic IDDM individuals, the combination of diminished parasympathetic cardiac input and elevated heart rate was associated with aberrant alterations of both hemodynamic and psychological functioning; the increased psychological distress in these individuals may be influenced, in part, by increased diabetes duration and number of somatic symptoms.
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Affiliation(s)
- S J Motivala
- Behavioral Medicine Research Center, Department of Psychology, University of Miami, FL 33124, USA
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Hurwitz BE, Brownley KA, Motivala SJ, Milanovich JR, Kibler JL, Fillion L, LeBlanc WG, Kumar M, Klimas NG, Fletcher MA, Schneiderman N. Sympathoimmune anomalies underlying the response to stressful challenge in human immunodeficiency virus spectrum disease. Psychosom Med 2005; 67:798-806. [PMID: 16204441 DOI: 10.1097/01.psy.0000181279.06164.6e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined immune, endocrine, and cardiovascular reactivity during stressful behavioral challenge in human immunodeficiency virus (HIV) seropositive (HIV+) and seronegative (HIV-) men and women and assessed whether immunocellular reactivity was differentially associated with concomitant alterations in sympathetic response. METHODS The 133 HIV+ [84 asymptomatic, 49 symptomatic] and 92 HIV- subjects completed a speech stress reactivity protocol. RESULTS Immunocellular reactivity to the speech stressor did not differ among asymptomatic and symptomatic HIV+ groups; however, relative to seronegatives, reactivity differences were present. Specifically, HIV+ subjects exhibited greater increases in total number of T cells, as well as in cytotoxic/suppressor T cells, activated T cells, and activated cytotoxic/suppressor T cells, and less increase in natural killer (NK) cell numbers. In addition, less stress-induced increase in NK cell cytotoxicity was observed along with greater suppression of the lymphoproliferative response to mitogen stimulation in the HIV+ group. Although no group differences in catecholamine reactivity were observed, the association of immunoreactivity with catecholamine responsiveness differed between serostatus groups. Specifically, the HIV+ subjects compared with HIV- subjects displayed greater lymphocytosis per unit change in norepinephrine; whereas NK cell reactivity was positively related to epinephrine responsiveness, but only in the HIV- group. These findings were present even after controlling for age and body mass, as well as other potential influences on immunocellular migration, such as cortisol levels and prevailing cardiac output. CONCLUSION Early in HIV spectrum disease, functional abnormalities in the stress-induced migratory ability of specific immunocellular subsets are present that may reflect an underlying pathophysiological alteration in sympathoimmune communication.
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Affiliation(s)
- Barry E Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, Florida 33125, USA.
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Hurwitz BE, Klimas NG, Llabre MM, Maher KJ, Skyler JS, Bilsker MS, McPherson-Baker S, Lawrence PJ, Laperriere AR, Greeson JM, Klaus JR, Lawrence R, Schneiderman N. HIV, metabolic syndrome X, inflammation, oxidative stress, and coronary heart disease risk : role of protease inhibitor exposure. Cardiovasc Toxicol 2005; 4:303-16. [PMID: 15470277 DOI: 10.1385/ct:4:3:303] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Revised: 03/02/2004] [Accepted: 03/09/2004] [Indexed: 11/11/2022]
Abstract
Differences on measures of metabolic syndrome X and coronary heart disease (CHD) risk, as well as potential pathophysiological mediators, inflammation, and oxidative stress, were examined as a function of HIV serostatus and highly active antiretroviral therapy (HAART) regimen with and without protease inhibitors (PIs). Data from 164 men and women, aged 18 to 55 yr, were used to compare 82 HIV+ subjects who were free of hepatitis C virus and were on a stable HAART regimen for >/=6 mo, with 82 seronegative subjects matched on age, sex, body mass index, and ethnicity. For the HIV+ subjects, after controlling for diabetes status and HIV disease progression, PI exposure was associated with greater oxidative stress, triglyceridemia, and lipidemia than it was for non-PI-exposed HIV+ subjects, and the risk of a future myocardial infarction was up to 56% greater in PI-exposed than in non-PI-exposed subjects and 129% greater than in controls. Although it is likely that the greatest proportion of CHD risk in the HIV+ subjects may be accounted for by pathological conditions linked to HIV infection in interaction with mediating processes such as inflammation, central obesity, and dyslipidemia, which was greater than in controls, it appears that PI medications may exacerbate oxidative stress and hypertriglyceridemia to enhance this risk.
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Affiliation(s)
- Barry E Hurwitz
- Behavioral Medicine Research Center, Division of Endocrinology and Metabolism, University of Miami, Miami, FL 33125, USA.
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Motivala SJ, Hurwitz BE, Llabre MM, Klimas NG, Fletcher MA, Antoni MH, LeBlanc WG, Schneiderman N. Psychological distress is associated with decreased memory helper T-cell and B-cell counts in pre-AIDS HIV seropositive men and women but only in those with low viral load. Psychosom Med 2003; 65:627-35. [PMID: 12883114 DOI: 10.1097/01.psy.0000041549.72780.5b] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although some studies have demonstrated the association of psychological distress and diminished immune system function in HIV spectrum disease, other studies have yielded apparently conflicting findings; the lack of consideration of the role of HIV viral burden may be central to this controversy. This study examined whether HIV viral burden moderated the relationship between psychological distress and enumerative and functional immune measures in pre-AIDS HIV spectrum disease. METHODS This cross-sectional study used factor analysis to derive a composite measure of psychological distress incorporating measures of dysphoria, anxiety, and perceived stress. Multiple regression analyses used distress as the predictor, immune measures as the outcome variables, with viral load as the moderator variable, while controlling for age, medication use, and HIV symptomatology. Subjects were 148 pre-AIDS, HIV seropositive men and women (89 asymptomatic, 59 symptomatic), aged 18 to 45 years. The main outcome measures were enumerative and functional immune measures. RESULTS A model of psychological distress was derived using each of the proposed measures. Findings indicated that high distress was associated with decreased numbers of helper T (memory) cells and B cells, but only at low levels of viral burden after controlling for age, medication use, and HIV-related symptoms. CONCLUSIONS These findings highlight the importance of assessing the role of HIV viral burden when examining distress-immunity relationships in HIV-infected individuals. The lack of association in those persons with high viral load suggests that, even before AIDS onset, disease-related processes are disrupting CNS and immune system communication.
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Affiliation(s)
- Sarosh J Motivala
- Behavioral Medicine Research Center, University of Miami, Miami, Florida 33125, USA
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Affiliation(s)
- Kimberly A Brownley
- Department of Psychiatry, University of North Carolina, Chapel Hill, N.C., USA.
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Peckerman A, Hurwitz BE, Nagel JH, Leitten C, Agatston AS, Schneiderman N. Effects of gender and age on the cardiac baroreceptor reflex in hypertension. Clin Exp Hypertens 2001; 23:645-56. [PMID: 11728009 DOI: 10.1081/ceh-100107394] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The present study examined whether alterations in the cardiac baroreceptor reflex in hypertension may be a function of constitutional differences associated with gender and age. These hypotheses were tested using a cross-sectional design that compared 20 normotensive and 21 hypertensive men and women of varying age for differences in baroreceptor reflex sensitivity and response latency for heart rate, obtained using a modified bolus phenylephrine (Oxford) method. Relative to their respective normotensive controls, baroreceptor reflex sensitivity was reduced in hypertensive men, but not in hypertensive women. Among normotensive subjects, men had greater baroreceptor reflex sensitivity than women. Independent from the effects associated with differences in blood pressure, age was not a significant predictor of reduction in baroreceptor reflex sensitivity. However, a combination of high blood pressure and older age was associated with a significant increase in baroreceptor reflex response time. In summary, gender and aging interacted with hypertension to alter two different aspects of the baroreceptor reflex. These results provide a preliminary indication that a decline in arterial baroreflex sensitivity may be more specific to hypertension in men than in women. Prolongation in baroreflex response latency in older hypertensive subjects also suggested that aging and hypertension may have a synergistic effect on cardiac parasympathetic function.
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Affiliation(s)
- A Peckerman
- Behavioral Medicine Research Center, Department of Psychology, University of Miami, Coral Gables, Florida, USA.
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Goldstein RZ, Hurwitz BE, Llabre MM, Schneiderman N, Gutt M, Skyler JS, Prineas RJ, Donahue RP. Modeling preclinical cardiovascular risk for use in epidemiologic studies: Miami community health study. Am J Epidemiol 2001; 154:765-76. [PMID: 11590090 DOI: 10.1093/aje/154.8.765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To develop a method for assessing preclinical cardiovascular disease risk, models of resting cardiovascular regulation and of insulin metabolic syndrome were derived from information collected from 1991 to 1996 in a culturally heterogeneous sample of 319 healthy men and women (aged 25-44 years) from Miami-Dade County, Florida. The model of resting cardiovascular regulation used 8 noninvasive measures of autonomic and cardiovascular function. Three factors were derived: 1) parasympathetic, 2) inotropy, and 3) systemic vascular resistance. The model of insulin metabolic syndrome used 12 measures assessing body mass, insulin, glucose, and lipid metabolism. Four factors were derived: 1) body mass and fat distribution, 2) glucose level and regulation, 3) insulin level and regulation, and 4) plasma lipid levels. Analyses of the association of the two models revealed that subjects with lower cardiac contractility had greater body mass, higher fasting and postload insulin and glucose levels, and lower insulin sensitivity. Subjects with greater vascular resistance had greater body mass, higher total cholesterol and triglyceride levels, and lower high density lipoprotein cholesterol levels. These findings indicate that preclinical cardiovascular disease risk may involve pathophysiologic processes in which cardiac inotropic and vasodilatory functions are linked to specific aspects of insulin metabolic syndrome.
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Affiliation(s)
- R Z Goldstein
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA
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Brownley KA, Milanovich JR, Motivala SJ, Schneiderman N, Fillion L, Graves JA, Klimas NG, Fletcher MA, Hurwitz BE. Autonomic and cardiovascular function in HIV spectrum disease: early indications of cardiac pathophysiology. Clin Auton Res 2001; 11:319-26. [PMID: 11758799 DOI: 10.1007/bf02332978] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Autonomic dysfunction in persons with acquired immune deficiency syndrome (AIDS) has been reported previously but its incidence in early stage HIV infection and its relation to cardiovascular function have not been fully examined. The present study evaluated cardiovascular and autonomic function in 55 HIV-seronegative, and 52 HIV-asymptomatic and 31 HIV-symptomatic seropositive men. Measures of hemodynamic and autonomic function were obtained at rest and during a standardized battery of autonomic tests. Results were compared across groups while controlling for age, body mass, and physical activity. Analyses indicated that measures of autonomic function did not differ among groups. However, at rest, both HIV seropositive groups exhibited diminished stroke volume and elevated diastolic blood pressure, albeit within normotensive levels. In addition, the ability to sustain a blood pressure response during prolonged challenge and the relationship between stroke volume and baroreceptor/vagal responsiveness were disrupted in the HIV-symptomatic group. Therefore, in the pre-AIDS stages of infection, autonomic functioning appeared intact; yet alterations in baroreceptor/vagal function associated with depressed myocardial function may be an early warning signal reflecting cardiovascular pathological processes potentially exacerbated by HIV spectrum disease.
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Affiliation(s)
- K A Brownley
- Behavioral Medicine Research Center, Department of Psychology, University of Miami, Florida, USA
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