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Huang AL, Navar AM, Ayers C, Rohatgi A, Michos ED, Virani SS, Joshi P, Peterson ED, Khera A. US population qualifying for aspirin use for primary prevention of cardiovascular disease. Am J Prev Cardiol 2024; 18:100669. [PMID: 38681065 PMCID: PMC11046250 DOI: 10.1016/j.ajpc.2024.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 12/27/2023] [Revised: 02/22/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Aspirin has been used for primary prevention of atherosclerotic cardiovascular disease (ASCVD) for decades, but this indication has become controversial with recent trial data. The 2022 US Preventive Services Task Force (USPSTF) provided a recommendation to consider aspirin use for primary prevention in adults 40-59 years with a 10-year ASCVD risk ≥10 % and not at increased risk of bleeding, yet population estimates for the impact of this recommendation are unknown. The objective of this study is to determine the prevalence and demographics of the US population who meet eligibility criteria for aspirin under the new 2022 USPSTF guidelines. Methods This is a serial cross-sectional study using data from the 2011-March 2020 National Health and Nutrition Examination Survey (NHANES) database. Individuals aged 40-59 years without a self-reported history of ASCVD were included. 10-year estimated ASCVD risk ≥10 % as calculated by the Pooled Cohort Equations (PCE) and increased bleeding risk determined using variables adapted from USPSTF guidelines were further applied as inclusion and exclusion criteria, respectively. The weighted frequencies of US adults aged 40-59 years qualifying for primary prevention aspirin, subgrouped by gender, age, and race/ethnicity, were calculated. Results Among 72,840,734 US individuals aged 40-59 years, 7.2 million (10 %) are eligible for consideration of primary prevention aspirin by PCE criteria. Of these, approximately 30 % would be potentially excluded based on increased bleeding risks, resulting in a net eligible cohort of 5 million. This represents 7 % of US adults aged 40-59 years and only 2.6 % of adults ≥18 years. Men, age 50-59 years, and Black race have higher proportions meeting aspirin use eligibility. Conclusions The overall prevalence of US individuals who qualify for aspirin for primary prevention under the 2022 USPSTF guidelines is modest, with larger proportional eligibility among men, older age, and Black individuals.
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Affiliation(s)
- Athena L. Huang
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- The Texas Heart Institute, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Parag Joshi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Eric D. Peterson
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Talmor-Barkan Y, Yu J, Yacovzada NS, Pravda NS, Ayers C, de Lemos JA, Tang WHW, Hazen SL, Eisen A, Witberg G, Kornowski R, Neeland IJ. Trimethylamine-N-Oxide and Related Metabolites: Assessing Cardiovascular Risk in the Dallas Heart Study. Mayo Clin Proc 2024:S0025-6196(24)00028-4. [PMID: 38678458 DOI: 10.1016/j.mayocp.2023.12.021] [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] [Received: 09/06/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To evaluate the association between trimethylamine N-oxide (TMAO) and related metabolites with adverse cardiovascular events in a multiethnic urban primary prevention population. METHODS We performed a case-control study of 361 participants of the Dallas Heart Study, including 88 participants with an incident atherosclerotic cardiovascular disease (ASCVD) event and 273 controls matched for age, sex, and body mass index without an ASCVD event during 12 years of follow-up (January 1, 2000, through December 31, 2015). Plasma levels of TMAO, choline, carnitine, betaine, and butyrobetaine were measured by mass spectrometry. The differential odds for incident ASCVD by metabolite levels between cases and controls were compared by a conditional logistic regression model adjusted for cardiovascular risk factors. RESULTS Participants with incident ASCVD had higher levels of TMAO and related metabolites compared with those without ASCVD (P<.05 for all). Those with plasma TMAO concentrations in quartile 4 had a more than 2-fold higher odds of ASCVD compared with those in quartile 1 (odds ratio, 2.77 [95% CI, 1.05 to 7.7; P=.04] for hard ASCVD and 2.41 [95% CI, 1.049 to 5.709; P=.04]). Similar trends were seen with the related metabolites choline, betaine, carnitine, and butyrobetaine. CONCLUSION Our results suggest that TMAO and related metabolites are independently associated with ASCVD events. Although further studies are needed, measurement of TMAO and related metabolites may have a role in ASCVD risk stratification for primary prevention.
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Affiliation(s)
- Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
| | - Jiao Yu
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT
| | - Nancy-Sarah Yacovzada
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | | | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - W H Wilson Tang
- Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Stanley L Hazen
- Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
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Pandey A, Patel KV, Segar MW, Ayers C, Linge J, Leinhard OD, Anker SD, Butler J, Verma S, Joshi PH, Neeland IJ. Effect of liraglutide on thigh muscle fat and muscle composition in adults with overweight or obesity: Results from a randomized clinical trial. J Cachexia Sarcopenia Muscle 2024. [PMID: 38561962 DOI: 10.1002/jcsm.13445] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/28/2024] [Accepted: 02/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Excess muscle fat is observed in obesity and associated with greater burden of cardiovascular risk factors and higher risk of mortality. Liraglutide reduces total body weight and visceral fat but its effect on muscle fat and adverse muscle composition is unknown. METHODS This is a pre-specified secondary analysis of a randomized, double-blind, placebo-controlled trial that examined the effects of liraglutide plus a lifestyle intervention on visceral adipose tissue and ectopic fat among adults without diabetes with body mass index ≥30 kg/m2 or ≥27 kg/m2 and metabolic syndrome. Participants were randomly assigned to a once-daily subcutaneous injection of liraglutide (target dose 3.0 mg) or matching placebo for 40 weeks. Body fat distribution and muscle composition was assessed by magnetic resonance imaging at baseline and 40-week follow-up. Muscle composition was described by the combination of thigh muscle fat and muscle volume. Treatment difference (95% confidence intervals [CI]) was calculated by least-square means adjusted for baseline thigh muscle fat. The association between changes in thigh muscle fat and changes in body weight were assessed using Spearman correlation coefficients. The effect of liraglutide versus placebo on adverse muscle composition, denoted by high thigh muscle fat and low thigh muscle volume, was explored. RESULTS Among the 128 participants with follow-up imaging (92.2% women, 36.7% Black), median muscle fat at baseline was 7.8%. The mean percent change in thigh muscle fat over median follow-up of 36 weeks was -2.87% among participants randomized to liraglutide (n = 73) and 0.05% in the placebo group (absolute change: -0.23% vs. 0.01%). The estimated treatment difference adjusted for baseline thigh muscle fat was -0.24% (95% CI, -0.41 to -0.06, P-value 0.009). Longitudinal change in thigh muscle fat was significantly associated with change in body weight in the placebo group but not the liraglutide group. The proportion of participants with adverse muscle composition decreased from 11.0% to 8.2% over follow-up with liraglutide, but there was no change with placebo. CONCLUSIONS In a cohort of predominantly women with overweight or obesity in the absence of diabetes, once-daily subcutaneous liraglutide was associated with a reduction in thigh muscle fat and adverse muscle composition compared with placebo. The contribution of muscle fat improvement to the cardiometabolic benefits of liraglutide requires further study.
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Affiliation(s)
- Ambarish Pandey
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Colby Ayers
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer Linge
- AMRA Medical and Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden
| | - Olof D Leinhard
- AMRA Medical and Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Subodh Verma
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Powell-Wiley TM, Martinez MF, Heneghan J, Weatherwax C, Osei Baah F, Velmurugan K, Chin KL, Ayers C, Cintron MA, Ortiz-Whittingham LR, Sandler D, Sharda S, Whitley M, Bartsch SM, O’Shea KJ, Tsintsifas A, Dibbs A, Scannell SA, Lee BY. Health and Economic Value of Eliminating Socioeconomic Disparities in US Youth Physical Activity. JAMA Health Forum 2024; 5:e240088. [PMID: 38488779 PMCID: PMC10943408 DOI: 10.1001/jamahealthforum.2024.0088] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 03/18/2024] Open
Abstract
Importance There are considerable socioeconomic status (SES) disparities in youth physical activity (PA) levels. For example, studies show that lower-SES youth are less active, have lower participation in organized sports and physical education classes, and have more limited access to PA equipment. Objective To determine the potential public health and economic effects of eliminating disparities in PA levels among US youth SES groups. Design and Setting An agent-based model representing all 6- to 17-year-old children in the US was used to simulate the epidemiological, clinical, and economic effects of disparities in PA levels among different SES groups and the effect of reducing these disparities. Main Outcomes and Measures Anthropometric measures (eg, body mass index) and the presence and severity of risk factors associated with weight (stroke, coronary heart disease, type 2 diabetes, or cancer), as well as direct and indirect cost savings. Results This model, representing all 50 million US children and adolescents 6 to 17 years old, found that if the US eliminates the disparity in youth PA levels across SES groups, absolute overweight and obesity prevalence would decrease by 0.826% (95% CI, 0.821%-0.832%), resulting in approximately 383 000 (95% CI, 368 000-399 000) fewer cases of overweight and obesity and 101 000 (95% CI, 98 000-105 000) fewer cases of weight-related diseases (stroke and coronary heart disease events, type 2 diabetes, or cancer). This would result in more than $15.60 (95% CI, $15.01-$16.10) billion in cost savings over the youth cohort's lifetime. There are meaningful benefits even when reducing the disparity by just 25%, which would result in $1.85 (95% CI, $1.70-$2.00) billion in direct medical costs averted and $2.48 (95% CI, $2.04-$2.92) billion in productivity losses averted. For every 1% in disparity reduction, total productivity losses would decrease by about $83.8 million, and total direct medical costs would decrease by about $68.7 million. Conclusions and Relevance This study quantified the potential savings from eliminating or reducing PA disparities, which can help policymakers, health care systems, schools, funders, sports organizations, and other businesses better prioritize investments toward addressing these disparities.
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Affiliation(s)
- Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Marie F. Martinez
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Jessie Heneghan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Colleen Weatherwax
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Foster Osei Baah
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Kavya Velmurugan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Kevin L. Chin
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Colby Ayers
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Manuel A. Cintron
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Lola R. Ortiz-Whittingham
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Dana Sandler
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Sonal Sharda
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Meredith Whitley
- Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, New York
- Maties Sport, Centre for Sport Leadership, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah M. Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Kelly J. O’Shea
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Alexandra Tsintsifas
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Alexis Dibbs
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Sheryl A. Scannell
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
| | - Bruce Y. Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, New York, New York
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Grinberg T, Eisen A, Talmor-Barkan Y, Kornowski R, Hamdan A, Witberg G, Ayers C, Joshi P, Rohatgi A, Khera A, de Lemos JA, Neeland IJ. Novel plasma biomarkers of coronary artery calcium incidence or progression: Insights from the prospective multi-ethnic Dallas Heart Study cohort. Atherosclerosis 2024; 390:117469. [PMID: 38342026 PMCID: PMC10988770 DOI: 10.1016/j.atherosclerosis.2024.117469] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/17/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND AND AIMS Identifying the association of novel plasma biomarkers with coronary artery calcium (CAC) incidence or progression may provide insights into the pathophysiology of atherogenesis and plaque formation. METHODS Participants of the Dallas Heart Study (DHS), a multi-ethnic cohort of ambulatory individuals at low-intermediate risk for future atherosclerotic cardiovascular disease (ASCVD), who had their blood tested for 31 biomarkers reflecting multiple pathophysiological pathways, underwent 2 serial non-contrast computed tomography assessments for CAC a median ∼7 years apart. The collected biomarkers were explored for association with CAC incidence or progression using univariate and multivariate analysis. RESULTS A total of 1424 participants were included; mean age 43 years, 39 % male, and nearly half African-American. Over a 7-year interval between the two CAC measurements, 340 participants (23.9 %) had CAC incidence or progression, 105 (7.4 %) with incident CAC, and 309 (21.7 %) with CAC progression. Although several plasma biomarkers were associated with CAC incidence or progression in a univariate model, only soluble intercellular adhesion molecule-1 (sICAM-1), related to atherosclerosis by the inflammatory pathway, remained independently associated in a multivariate model adjusted for traditional risk factors. CONCLUSIONS Further studies are needed to characterize the role of sICAM-1 in CAC evolvement to establish whether it has a pivotal mechanistic contribution or is rather an innocent bystander. Alternate measures of coronary atherosclerosis may be needed to elucidate contributors to atherosclerosis incidence or progression.
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Affiliation(s)
- Tzlil Grinberg
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Alon Eisen
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor-Barkan
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Colby Ayers
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Parag Joshi
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Anand Rohatgi
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Amit Khera
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - James A de Lemos
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Saha S, Keshvani N, Segar MW, Patel KV, Fudim M, Rohatgi A, Ayers C, VanWagner LB, Rao VN, Drazner MH, Garg S, Singal AG, Rich NE, Browning JD, Neeland IJ, Pandey A. Association of Hepatic Triglyceride Content With Cardiac Structure and Function Among Community-Dwelling Adults. JACC Heart Fail 2023:S2213-1779(23)00750-3. [PMID: 38206228 DOI: 10.1016/j.jchf.2023.10.016] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Srishti Saha
- UT Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Kershaw V Patel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Marat Fudim
- Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Colby Ayers
- UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Vishal N Rao
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Sonia Garg
- UT Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ambarish Pandey
- Duke University School of Medicine, Durham, North Carolina, USA.
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7
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Deets A, Joshi PH, Chandra A, Singh K, Khera A, Virani SS, Ballantyne CM, Otvos JD, Dullaart RPF, Gruppen EG, Connelly MA, Ayers C, Navar AM, Pandey A, Wilkins JT, Rohatgi A. Novel Size-Based High-Density Lipoprotein Subspecies and Incident Vascular Events. J Am Heart Assoc 2023; 12:e031160. [PMID: 37929707 PMCID: PMC10727395 DOI: 10.1161/jaha.123.031160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023]
Abstract
Background High-density lipoprotein (HDL) particle concentration likely outperforms HDL cholesterol in predicting atherosclerotic cardiovascular events. Whether size-based HDL subspecies explain the atheroprotective associations of HDL particle concentration remains unknown. Our objective was to assess whether levels of specific size-based HDL subspecies associate with atherosclerotic cardiovascular disease in a multiethnic pooled cohort and improve risk prediction beyond traditional atherosclerotic cardiovascular disease risk factors. Methods and Results Seven HDL size-based subspecies were quantified by nuclear magnetic resonance (LP4 algorithm; H1=smallest; H7=largest) among participants without prior atherosclerotic cardiovascular disease in ARIC (Atherosclerosis Risk in Communities), MESA (Multi-Ethnic Study of Atherosclerosis), PREVEND (Prevention of Renal and Vascular Endstage Disease), and DHS (Dallas Heart Study) cohorts (n=15 371 people). Multivariable Cox proportional hazards models were used to evaluate the association between HDL subspecies and incident myocardial infarction (MI) or ischemic stroke at follow-up (average 8-10 years) adjusting for HDL cholesterol and risk factors. Improvement in risk prediction was assessed via discrimination and reclassification analysis. Within the pooled cohort (median age 57 years; female 54%; Black 22%) higher H1 (small) and H4 (medium) concentrations were inversely associated with incident MI (hazard ratio [HR]/SD, H1 0.88 [95% CI, 0.81-0.94]; H4 0.89 [95% CI, 0.82-0.97]). H4 but not H1 improved risk prediction indices for incident MI. Increasing H2 and H4 were inversely associated with improved risk prediction indices for composite end point of stroke, MI, and cardiovascular death (HR/SD, H2 0.94 [95% CI, 0.88-0.99]; H4 0.91 [95% CI, 0.85-0.98]). Levels of the large subspecies (H6 and H7) were not associated with any vascular end point. Conclusions Two of 7 HDL size-based subspecies modestly improved risk prediction for MI and composite vascular end points in a large multiethnic pooled cohort. These findings support assessment of precise HDL subspecies for future studies regarding clinical utility.
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Affiliation(s)
- Austin Deets
- University of Texas Southwestern Medical CenterDallasTX
| | | | - Alvin Chandra
- University of Texas Southwestern Medical CenterDallasTX
| | | | - Amit Khera
- University of Texas Southwestern Medical CenterDallasTX
| | - Salim S. Virani
- Michael E. Debakey Veteran Affairs Medical CenterHoustonTX
- Baylor College of MedicineHoustonTX
| | | | | | - Robin P. F. Dullaart
- University of Groningen and University Medical Center GroningenGroningenThe Netherlands
| | - Eke G. Gruppen
- University of Groningen and University Medical Center GroningenGroningenThe Netherlands
| | | | - Colby Ayers
- University of Texas Southwestern Medical CenterDallasTX
| | | | | | | | - Anand Rohatgi
- University of Texas Southwestern Medical CenterDallasTX
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Raygor V, Hoeting N, Ayers C, Joshi P, Canan A, Abbara S, Assadourian JN, Khera A, Peterson ED, Navar AM. Accuracy of incidental visual coronary artery calcium assessment compared with dedicated coronary artery calcium scoring. J Cardiovasc Comput Tomogr 2023; 17:453-458. [PMID: 37863760 DOI: 10.1016/j.jcct.2023.10.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION CAC can be detected on routine chest computed tomography (CT) scans and may contribute to CVD risk estimation, but the accuracy of visual CAC scoring may be affected by the specialty of the interpreting radiologist and/or the use of contrast. METHODS The accuracy of visual CAC estimation on non-gated CT scans was evaluated at UT Southwestern Medical Center (UTSW) and Parkland Health and Hospital System (PHHS). All adults who underwent CAC scanning and a non-gated CT scan within 6 months were identified and the scores from the two CTs were compared overall and stratified by type of reader and whether contrast was used. Visual CAC categories of none, small, moderate, and large were compared to CAC = 0, 1-99, 100-399, and ≥400, respectively. RESULTS From 2016 to 2021, 934 patients (mean age 60 ± 12 y, 43% male, 61% White, 34% Black, 24% Hispanic, 54% from PHHS) had both CT scans. Of these, 441 (47%) had no CAC, 278 (30%) small, 147 (16%) moderate, and 66 (7%) large CAC on non-gated CT. Visual CAC estimates were highly correlated with CAC scores (Kendalls tau-b = 0.76, p < 0.0001). Among those with no visual CAC, 76% had CAC = 0 (72% of contrast-enhanced vs 85% of non-contrast scans, 88% of scans interpreted by CT radiologist vs 78% of those interpreted by other radiologist). In those with moderate-to-large visual CAC, 99% had CAC >0 and 88% had CAC ≥100, including 89% of those with contrast, 90% of those without contrast, 80% of those read by a CT radiologist, and 88% of those read by a non-CT radiologist. DISCUSSION Visual CAC estimates on non-gated CT scans are concordant with Agatston score categories from cardiac CT scans. A lack of visual CAC on non-gated CT scans may not be sufficient to "de-risk" patients, particularly for contrast-enhanced scans and those read by non-CT radiologists. However, the presence of moderate-to-large CAC, including on contrasted scans and regardless of radiologist type, is highly predictive of CAC and may be used to identify high-risk patients for prevention interventions.
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Affiliation(s)
- Viraj Raygor
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Natalie Hoeting
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA
| | - Colby Ayers
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA
| | - Parag Joshi
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Arzu Canan
- University of Texas Southwestern, Cardiothoracic Imaging, Department of Radiology, Dallas, TX, USA
| | - Suhny Abbara
- University of Texas Southwestern, Cardiothoracic Imaging, Department of Radiology, Dallas, TX, USA
| | | | - Amit Khera
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Eric D Peterson
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Ann Marie Navar
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA.
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Gordon J, Michelis KC, Pandey A, Ayers C, Thibodeau JT, Grodin JL, Drazner MH. Oxygen Uptake Efficiency Slope and Prognosis in Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 201:273-280. [PMID: 37393730 DOI: 10.1016/j.amjcard.2023.06.033] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023]
Abstract
The prognostic utility of the oxygen uptake efficiency slope (OUES) in heart failure with reduced ejection fraction is uncertain. In this post hoc analysis of the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial (n = 2,074), we tested for associations of OUES and peak oxygen uptake (VO2) with heart failure hospitalization or cardiovascular death in multivariable Cox regression models, adjusting for minute ventilation/carbon dioxide production (VE/VCO2) slope and other important confounders. Harrell's C-statistics assessed the discriminatory performance of OUES and peak VO2. Lower OUES was associated with increased risk of the outcome (quartile 1 vs 4: hazard ratio 2.1 [1.5 to 2.9, p <0.001]). Peak VO2 had greater discrimination than OUES in comparable models (e.g., C-statistic = 0.73 vs 0.70, p <0.001, respectively). In the subgroup with respiratory exchange ratio <1 (n = 358), peak VO2 was associated with the outcome (p <0.001) but OUES was not (p = 0.96). In conclusion, whereas OUES was associated with clinical outcomes independently of VE/VCO2 slope, its prognostic utility was inferior to that of peak VO2, even when measured at submaximal effort.
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Affiliation(s)
- Jonathan Gordon
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine C Michelis
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Colby Ayers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennifer T Thibodeau
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin L Grodin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark H Drazner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Eleazu I, Ayers C, Navar AM, Salhadar K, Albert M, Carnethon M, Brown S, Nwobodo LO, Carter S, Bess C, Powell-Wiley TM, de Lemos JA. Associations of Cumulative Perceived Stress with Cardiovascular Risk Factors and Outcomes: Findings from The Dallas Heart Study. medRxiv 2023:2023.06.15.23291460. [PMID: 37398246 PMCID: PMC10312845 DOI: 10.1101/2023.06.15.23291460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Data remain sparse regarding the impact of chronic stress on cardiovascular disease (CVD) risk factors and outcomes. Prior work has been limited by incomplete assessments of perceived stress and focus on single stress domains. We evaluated the association between a composite measure of perceived stress and CVD risk factors and outcomes. Methods Participants from the Dallas Heart Study phase 2 (2007-2009) without prevalent CVD who completed questionnaire assessments of perceived stress were included (n=2685). Individual perceived stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated into a single cumulative stress score (CSS) with equal weighting for each component. Associations between CSS and demographics, psychosocial variables and cardiac risk factors were assessed in univariable and multivariable analyses. Cox proportional hazards models were used to determine associations of the CSS with atherosclerotic CVD (ASCVD) and Global CVD (ASCVD, heart failure, and atrial fibrillation) after adjustment for demographics and traditional risk factors. Results Median age of the study population was 48 years, 55% were female, 49% Black and 15% Hispanic/Latinx. CSS was higher among participants who were younger, female, Black or Hispanic, and those with lower income and educational attainment (p<.0001 for each). Higher CSS was associated with self-report of racial/ethnic discrimination, lack of health insurance and last medical contact > one year previously (p<.0001 for each). In multivariable regression models adjusting for age, gender, race/ethnicity, income and education, higher CSS associated with hypertension, smoking, and higher body mass index, waist circumference Hemoglobin A1C, hs-CRP and sedentary time (p< 0.01 for each). Over a median follow-up of 12.4 years, higher CSS associated with ASCVD (adjusted HR 1.22 per SD, 95% CI 1.01-1.47) and Global CVD (HR 1.20, 95% CI 1.03-1.40). No interactions were seen between CSS, demographic factors, and outcomes. Conclusion Composite multidimensional assessments of perceived stress may help to identify individuals at risk for CVD who may be targeted for stress mitigation or enhanced prevention strategies. These approaches may be best focused on vulnerable populations, given the higher burden of stress in women, Black and Hispanic individuals, and those with lower income and education. WHAT IS NEW? A novel measure of cumulative stress was created that integrates generalized, psychosocial, financial, and neighborhood perceived stress.Cumulative stress was higher among women, Black and Hispanic participants, younger individuals and persons with lower income and educational attainment and was associated with adverse health behaviors and increased burden of cardiovascular disease (CVD) risk factors.In a diverse cohort, higher cumulative stress associated with incident CVD after adjustment for demographics and traditional risk factors. No interactions were seen based on demographic factors. CLINICAL IMPLICATIONS Although associations of chronic stress with CVD were similar across demographic subgroups, the higher burden of stress among younger individuals, women, Black and Hispanic participants, and those with lower SES suggests that CVD risk associated with higher stress affects marginalized groups disproportionately.Cumulative Stress is associated with modifiable risk factors and health behaviors. Future studies should explore targeting behavioral modification and risk factor reduction programs, as well as stress reduction strategies, to individuals with high cumulative stress.Additional research is needed to uncover mechanisms that underly the association between chronic stress and cardiovascular disease.
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Khera R, Kondamudi N, Liu M, Ayers C, Spatz ES, Rao S, Essien UR, Powell-Wiley TM, Nasir K, Das SR, Capers Q, Pandey A. Lifetime healthcare expenses across demographic and cardiovascular risk groups: The application of a novel modeling strategy in a large multiethnic cohort study. Am J Prev Cardiol 2023; 14:100493. [PMID: 37397263 PMCID: PMC10314135 DOI: 10.1016/j.ajpc.2023.100493] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Objective To understand the burden of healthcare expenses over the lifetime of individuals and evaluate differences among those with cardiovascular risk factors and among disadvantaged groups based on race/ethnicity and sex. Methods We linked data from the longitudinal multiethnic Dallas Heart Study, which recruited participants between 2000 and 2002, with inpatient and outpatient claims from all hospitals in the Dallas-Fort Worth metroplex through December 2018, capturing encounter expenses. Race/ethnicity and sex, as well as five risk factors, hypertension, diabetes, hyperlipidemia, smoking, and overweight/obesity, were defined at cohort enrollment. For each individual, expenses were indexed to age and cumulated between 40 and 80 years of age. Lifetime expenses across exposures were evaluated as interactions in generalized additive models. Results A total of 2184 individuals (mean age, 45±10 years; 61% women, 53% Black) were followed between 2000 and 2018. The mean modeled lifetime cumulative healthcare expenses were $442,629 (IQR, $423,850 to $461,408). In models that included 5 risk factors, Black individuals had $21,306 higher lifetime healthcare spending compared with non-Black individuals (P < .001), and men had modestly higher expenses than women ($5987, P < .001). Across demographic groups, the presence of risk factors was associated with progressively higher lifetime expenses, with significant independent association of diabetes ($28,075, P < .001), overweight/obesity ($8816, P < .001), smoking ($3980, P = .009), and hypertension ($528, P = .02) with excess spending. Conclusion Our study suggests Black individuals have higher lifetime healthcare expenses, exaggerated by the substantially higher prevalence of risk factors, with differences emerging in older age.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, United States
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT, United States
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, United States
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States
| | - Mengni Liu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, United States
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, United States
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, United States
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, United States
| | - Shreya Rao
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, United States
| | - Utibe R Essien
- Department of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, United States
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, NIH, 3131 Center Drive, Bethesda, MD, United States
- Intramural Research Program, National Institute on Minority Health and Health Disparities, NIH, 6707 Democracy Boulevard, Suite 800, Bethesda, MD, United States
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist, 6565 Fannin St, Houston, TX, United States
| | - Sandeep R Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States
| | - Quinn Capers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States
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Raygor V, Ayers C, Segar MW, Agusala K, Khera A, Pandey A, Joshi PH. Impact of Family History of Premature Coronary Artery Disease on Noninvasive Testing in Stable Chest Pain. J Am Heart Assoc 2023; 12:e029266. [PMID: 37158070 DOI: 10.1161/jaha.122.029266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Viraj Raygor
- Division of Cardiology, Department of Internal Medicine Parkland Hospital Dallas TX USA
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Matthew W Segar
- Department of Cardiology Texas Heart Institute Houston TX USA
| | - Kartik Agusala
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
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Saha A, Patel KV, Ayers C, Ballantyne CM, Correa A, Defilippi C, Hall ME, Mentz RJ, Seliger SL, Yimer W, Butler J, Berry JD, De Lemos JA, Pandey A. Longitudinal Changes in Cardiac Troponin and Risk of Heart Failure Among Black Adults. J Card Fail 2023; 29:6-15. [PMID: 35690315 DOI: 10.1016/j.cardfail.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Among Black adults, high-sensitivity cardiac troponin I (hs-cTnI) is associated with heart failure (HF) risk. The association of longitudinal changes in hs-cTnI with risk of incident HF, HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively), among Black adults is not well-established. METHODS AND RESULTS This study included Black participants from the Jackson Heart Study with available hs-cTnI data at visits 1 (2000-2004) and 2 (2005-2008) and no history of cardiovascular disease. Cox models were used to evaluate associations of categories of longitudinal change in hs-cTnI with incident HF risk. Among 2423 participants, 11.6% had incident elevation in hs-cTnI at visit 2, and 16.9% had stable or improved elevation (≤50% increase in hs-cTnI), and 4.0% had worsened hs-cTnI elevation (>50% increase). Over a median follow-up of 12.0 years, there were 139 incident HF hospitalizations (64 HFrEF, 58 HFpEF). Compared with participants without an elevated hs-cTnI, those with incident, stable or improved, or worsened hs-cTnI elevation had higher HF risk (adjusted hazard ratio 3.20 [95% confidence interval, 1.92-5.33]; adjusted hazard ratio 2.40, [95% confidence interval, 1.47-3.92]; and adjusted hazard ratio 8.10, [95% confidence interval, 4.74-13.83], respectively). Similar patterns of association were observed for risk of HFrEF and HFpEF. CONCLUSIONS Among Black adults, an increase in hs-cTnI levels on follow-up was associated with a higher HF risk. LAY SUMMARY The present study included 2423 Black adults from the Jackson Heart Study with available biomarkers of cardiac injury and no history of cardiovascular disease at visits 1 and 2. The majority of participants did not have evidence of cardiac injury at both visits (67.5%), 11.6% had evidence of cardiac injury only on follow-up, 14.5% had stable elevations, 4.0% had worsened elevations, and 2.4% had improved elevations of cardiac injury biomarkers during follow-up. Compared with participants without evidence of cardiac injury, those with new, stable, and worsened levels of cardiac injury had a higher risk of developing heart failure. TWEET Among Black adults, persistent or worsening subclinical myocardial injury is associated with an elevated risk of HF.
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Affiliation(s)
- Amit Saha
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Robert J Mentz
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - Stephen L Seliger
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Wondwosen Yimer
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James A De Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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Drechsler H, Ayers C, Bedimo R. Tenofovir disoproxil fumarate withdrawal and cardiovascular risk. Lancet HIV 2023; 10:e8-e9. [PMID: 36566082 DOI: 10.1016/s2352-3018(22)00362-9] [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] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/14/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Henning Drechsler
- Department of Medicine, VA North Texas Health Care System, UT Southwestern, Dallas, TX, USA.
| | - Colby Ayers
- Department of Medicine, VA North Texas Health Care System, UT Southwestern, Dallas, TX, USA
| | - Roger Bedimo
- Department of Medicine, VA North Texas Health Care System, UT Southwestern, Dallas, TX, USA
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Drechsler HJ, Ayers C, Bedimo R. 2360. Serum Cholesterol Variability and Mortality in PLWH On Lipid-Lowering Therapy. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.167] [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: 12/23/2022] Open
Abstract
Abstract
Background
In people living with HIV (PLWH), consistent use of lipid lowering therapy (LLT) is associated with lower all-cause mortality and use of tenofovir disoproxil fumarate (TDF) with reduced serum cholesterol (C). In the general population, high cholesterol variability (CV) is independently associated with all-cause mortality. We explored the relationship between consistency of LLT/TDF exposure, cholesterol variability, and mortality in PLWH.
Methods
In a cohort of 15,860 PLWH who achieved undetectable viremia on ART between 2001 and 2011 we used multivariable Cox modeling, stratified by prevalent cardiovascular disease (CVD) to identify predictors of mortality and built multi-level marginal structural models for different LLT/TDF exposure levels based on percentage of days covered (PDC) over the past year, categorizing exposures into low (PDC < 50%), high (50–93%), and consistent (≥94%). The latter two were further subdivided into single and dual exposures for a composite LLT model where we explored effect sizes before and after inclusion of time-updated absolute C values and its 1-year coefficient of variation (CoV). We also examined the relationship between consistency of LLT/TDF use and C variability in a mixed linear model.
Results
During a median follow-up (f/u) of 4.3 years, there were 2,269 deaths. For 43% of f/u time patients were exposed to TDF, for 13% to non-statin LLT, and for 17% to statins. The hazard ratio (HR) of death for consistent use was 0.38, 95% confidence interval (CI) 0.32–0.45 for TDF, 0.40 (CI:0.28–0.58) for non-statin LLT, and 0.50 (CI:0.40–0.63) for statins (Fig 1). In the composite model, increasing LLT intensity was inversely associated with mortality risk but low C and high CV remained strong independent predictors of death. High HDL C values were protective (Table). The effect sizes for high LLT intensity and high HDL-CV moderately decreased when they were modeled jointly. Compared to unexposed patients, HDL CoV was significantly lower during consistent LLT exposures but higher for patients with low LLT exposure (Fig 2).
Conclusion
In PLWHA, intensity of LLT exposure is inversely related with all-cause mortality. The highest LLT intensity levels were associated with the lowest HDL-CV. This could serve as a partial explanation for the lower mortality.
Disclosures
Roger Bedimo, MD, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|Merck & Co.: Advisor/Consultant|Merck & Co.: Grant/Research Support|ViiV Healthcare: Advisor/Consultant.
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Affiliation(s)
| | - Colby Ayers
- UT Southwestern Medical Center , Dallas, Texas
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Berlacher M, Abousaab C, Chen C, Suarez A, Garrett BE, Badia RR, Newcomer K, Lee S, Ayers C, Sulistio MS. ICD Knowledge and Attitudes at End of Life in a Diverse and Vulnerable Patient Population. J Health Care Poor Underserved 2022; 33:1793-1808. [DOI: 10.1353/hpu.2022.0138] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vijayakumar NP, Neally SJ, Potharaju KA, Curlin K, Troendle JF, Collins BS, Mitchell VM, Tamura K, Ayers C, Pita MA, Tarfa H, Thompson K, Baah FO, Baez AS, Ortiz-Whittingham L, Gallagher JW, McCoy R, Heist M, Gutierrez-Huerta CA, Turner BS, Baumer Y, Farmer N, Wallen GR, Dodge T, Powell-Wiley TM. Customizing Place-Tailored Messaging Using a Multilevel Approach: Pilot Study of the Step It Up Physical Activity Mobile App Tailored to Neighborhood Environment. Circ Cardiovasc Qual Outcomes 2022; 15:e009328. [PMID: 36378765 PMCID: PMC9680010 DOI: 10.1161/circoutcomes.122.009328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nithya P. Vijayakumar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sam J. Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kameswari A. Potharaju
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kaveri Curlin
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - James F. Troendle
- Office of Biostatistics Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Billy S. Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valerie M. Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Colby Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mario A. Pita
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hannatu Tarfa
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Keitra Thompson
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Foster Osei Baah
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew S. Baez
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lola Ortiz-Whittingham
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Wills Gallagher
- Connected Health for Applications and Interventions Core, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Regina McCoy
- Connected Health for Applications and Interventions Core, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Michael Heist
- Connected Health for Applications and Interventions Core, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Cristhian A. Gutierrez-Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Briana S. Turner
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Cainzos-Achirica M, Quispe R, Mszar R, Dudum R, Al Rifai M, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Toth PP, Rana JS, Lima JAC, Doria de Vasconcellos H, Lloyd-Jones D, Joshi PH, Ayers C, Khera A, Blaha MJ, Greenland P, Nasir K. Coronary Artery Calcium Score to Refine the Use of PCSK9i in Asymptomatic Individuals: A Multicohort Study. J Am Heart Assoc 2022; 11:e025737. [PMID: 35943062 PMCID: PMC9496288 DOI: 10.1161/jaha.122.025737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/12/2022]
Abstract
Background The value of coronary artery calcium (CAC) in the allocation of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitors) among individuals without clinically evident atherosclerotic cardiovascular disease (ASCVD) is unknown for indications that do not require confirmed familial hypercholesterolemia. We aimed to assess the ability of CAC to stratify ASCVD risk under 3 non–familial hypercholesterolemia PCSK9i allocation paradigms. Methods and Results We included participants without clinically evident ASCVD from MESA (Multi‐Ethnic Study of Atherosclerosis), CARDIA (Coronary Artery Risk Development in Young Adults) study, DHS (Dallas Heart Study), and HNR (Heinz Nixdorf Recall) study. Three PCSK9i eligibility scenarios were defined: a broad scenario informed only by high low‐density lipoprotein cholesterol levels (N=567), a restrictive one combining higher low‐density lipoprotein cholesterol levels and presence of ≥2 additional risk factors (N=127), and a high‐risk scenario where individuals with subclinical organ damage or high estimated risk would be treated to achieve low‐density lipoprotein cholesterol <55 mg/dL (N=471). The high‐risk scenario had the highest ASCVD event rates (27.8% at 10 years). CAC=0 was observed in 35% participants in the broad scenario, 25% in the restrictive scenario, and 16% in the high‐risk scenario. In all, CAC=0 was associated with the lowest incident ASCVD rates at 5 and 10 years, and CAC burden was independently associated with ASCVD events adjusting for traditional risk factors. Conclusions CAC may be used to refine the allocation of PCSK9i, potentially leading to a more conservative use if CAC=0. The value of CAC testing is greater in scenarios that use low‐density lipoprotein cholesterol levels and/or traditional risk factors to define PCSK9i eligibility (CAC=0 present in 1 of 3–4 patients), whereas its prevalence is lower when allocation is informed by presence of noncoronary subclinical organ damage.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
| | - Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
| | - Reed Mszar
- Center for Outcomes Research Yale School of Medicine New Haven CT
| | - Ramzi Dudum
- Division of Cardiovascular Medicine Stanford University Stanford CA
| | | | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany.,Department of Epidemiology, School of Public Health Boston University Boston MA
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Sara Schramm
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD.,CGH Medical Center Sterling IL.,University of Illinois College of Medicine Peoria IL
| | - Jamal S Rana
- Divisions of Cardiology and Research Kaiser Permanente Northern California Oakland CA
| | - Joao A C Lima
- Division of Cardiovascular Imaging Johns Hopkins Medical Institutions Baltimore MD
| | | | - Donald Lloyd-Jones
- Departments of Preventive Medicine and Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD.,Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research Johns Hopkins University Baltimore MD
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
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19
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Shah S, Segar MW, Kondamudi N, Ayers C, Chandra A, Matulevicius S, Agusala K, Peshock R, Abbara S, Michos ED, Drazner MH, Lima JAC, Longstreth WT, Pandey A. Supranormal Left Ventricular Ejection Fraction, Stroke Volume, and Cardiovascular Risk: Findings From Population-Based Cohort Studies. JACC Heart Fail 2022; 10:583-594. [PMID: 35902163 DOI: 10.1016/j.jchf.2022.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Supranormal ejection fraction by echocardiography in clinically referred patient populations has been associated with an increased risk of cardiovascular disease (CVD). The prognostic implication of supranormal left ventricular ejection fraction (LVEF)-assessed by cardiac magnetic resonance (CMR)-in healthy, community-dwelling individuals is unknown. OBJECTIVES The purpose of this study is to investigate the prognostic implication of supranormal LVEF as assessed by CMR and its inter-relationship with stroke volume among community-dwelling adults without CVD. METHODS Participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) cohorts free of CVD who underwent CMR with LVEF above the normal CMR cutoff (≥57%) were included. The association between cohort-specific LVEF categories and risk of clinically adjudicated major adverse cardiovascular events (MACE) was assessed using adjusted Cox models. Subgroup analysis was also performed to evaluate the association of LVEF and risk of MACE among individuals stratified by left ventricular stroke volume index. RESULTS The study included 4,703 participants from MESA and 2,287 from DHS with 727 and 151 MACE events, respectively. In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs Q1) in both cohorts after accounting for potential confounders (MESA: HR = 1.27 [95% CI: 1.01-1.60], P = 0.04; DHS: HR = 1.72 [95% CI: 1.05-2.79], P = 0.03). A significant interaction was found between the continuous measures of LVEF and left ventricular stroke volume index (P interaction = 0.02) such that higher LVEF was significantly associated with an increased risk of MACE among individuals with low but not high stroke volume. CONCLUSIONS Among community-dwelling adults without CVD, LVEF in the supranormal range is associated with a higher risk of adverse cardiovascular outcomes, particularly in those with lower stroke volume.
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Affiliation(s)
- Sonia Shah
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Alvin Chandra
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Susan Matulevicius
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kartik Agusala
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ron Peshock
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
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20
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Huynh K, Ayers C, Butler J, Neeland I, Kritchevsky S, Pandey A, Barton G, Berry JD. Association Between Thigh Muscle Fat Infiltration and Incident Heart Failure: The Health ABC Study. JACC Heart Fail 2022; 10:485-493. [PMID: 35772859 DOI: 10.1016/j.jchf.2022.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excess adiposity is a well-known risk factor for heart failure (HF). Fat accumulation in and around the peripheral skeletal muscle may further inform risk for HF. OBJECTIVES The purpose of this study was to evaluate the association between intramuscular and intermuscular fat deposition and incident HF in a longitudinal cohort of community-dwelling older adults. METHODS The associations of intramuscular and intermuscular fat with incident HF were assessed using Cox models among 2,399 participants from the Health ABC (Health, Aging and Body Composition) study (70-79 years of age, 48% male, 40.2% Black) without baseline HF. Intramuscular fat was determined by bilateral thigh muscle density on computed tomography and intermuscular fat area was determined with computed tomography. RESULTS After a median follow-up of 12.2 years, there were 485 incident HF events. Higher sex-specific tertiles of intramuscular and intermuscular fat were each associated with HF risk. After multivariable adjustment for age, sex, race, education, blood pressure, fasting blood sugar, current smoking, prevalent coronary disease, and creatinine, higher intramuscular fat, but not intermuscular fat, was associated with higher risk for HF (HR: 1.34 [95% CI: 1.06-1.69]; P = 0.012, tertile 3 vs tertile 1). This association remained significant after additional adjustment for body mass index (HR: 1.32 [95% CI: 1.03-1.69]), total percent fat (HR: 1.33 [95% CI: 1.03-1.72]), visceral fat (HR: 1.30 [95% CI: 1.01-1.65]), and indexed thigh muscle strength (HR: 1.30 [95% CI: 1.03-1.64]). The association between higher intramuscular fat and HF appeared specific to higher risk of incident HF with reduced ejection fraction (HR: 1.53 [95% CI: 1.03-2.29]), but not with HF with preserved ejection fraction (HR: 1.28 [95% CI: 0.82-1.98]). CONCLUSIONS Intramuscular, but not intermuscular, thigh muscle fat is independently associated with HF after adjustment for cardiometabolic risk factors and other measurements of adiposity.
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Affiliation(s)
- Kevin Huynh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Javed Butler
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ian Neeland
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen Kritchevsky
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gregory Barton
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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21
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Kelly SA, Thibodeau JT, Pham D, Ayers C, Garg S, Grodin JL, Drazner MH. Subclinical Cardiac Injury And Clinical Congestion. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.206] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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McNamara DA, Bennett AJ, Ayers C, Berry JD, de Lemos JA, Link MS. Relations Between Cardiac Magnetic Resonance Imaging-Derived Left Ventricular Mass, Early Repolarization, and Cardiovascular Events (from the Dallas Heart Study). Am J Cardiol 2021; 161:108-114. [PMID: 34794607 DOI: 10.1016/j.amjcard.2021.08.057] [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] [Received: 05/17/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
Early repolarization pattern (ERP) is associated with increased mortality in case-control studies, but the mechanism and role of left ventricular mass (LVM) remain unclear. Our objectives were to understand (1) whether ERP associates with adverse outcomes in a multiethnic population and (2) to explore the role of LVM in these associations. Participants from the Dallas Heart Study with an electrocardiogram interpretable for ERP, defined as J point elevation ≥1 mm in 2 contiguous leads, were included. Combined all-cause mortality and nonfatal cardiovascular disease (CVD) events and individual components were assessed using Cox proportional hazards modeling after adjustment for demographics, traditional CVD risk factors, electrocardiogram intervals, and cardiac magnetic resonance imaging-derived factors. Cardiac magnetic resonance imaging-defined LVM was then added to the most fully adjusted model. Of the 2,686 participants, 240 (8.9%) demonstrated ERP. Participants with ERP were more likely to be male and Black, with lower body mass index, greater left ventricular end-diastolic volumes, and LVM. Over a median follow-up of 11 years, the combined end point occurred in 326 patients. Multivariable modeling demonstrated ERP was associated with the combined end point (HR [95% CI] 1.61 [1.14 to 2.26]), all-cause mortality (1.67 [1.00 to 2.80]). However, further adjusting for LVM attenuated the associations of ERP with the primary end point (HR [95% CI] 1.22 [0.85 to 1.77]) and secondary end points of mortality (1.39 [0.80 to 2.41]) and nonfatal CVD (1.05 [0.68 to 1.64]). ERP was associated with increased mortality and nonfatal CVD events, which was attenuated after adjusting for LVM, a previously under-recognized clinical phenotype. Previous associations of ERP with adverse cardiovascular outcomes may be partially explained by greater LVM in those with ERP.
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Affiliation(s)
- David A McNamara
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan; Division of Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Ari J Bennett
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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23
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Cainzos-Achirica M, Quispe R, Dudum R, Greenland P, Lloyd-Jones D, Rana JS, Lima JAC, Doria de Vasconcellos H, Joshi PH, Khera A, Ayers C, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Toth PP, Patel KV, Blaha MJ, Bittencourt M, Nasir K. CAC for Risk Stratification Among Individuals With Hypertriglyceridemia Free of Clinical Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging 2021; 15:641-651. [PMID: 34922873 DOI: 10.1016/j.jcmg.2021.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/09/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In this study, we sought to evaluate whether the coronary artery calcium (CAC) score can enhance current paradigms for risk stratification among individuals with hypertriglyceridemia in primary prevention. The eligibility criteria for icosapent ethyl (IPE) were used as case example. BACKGROUND Recent trials of atherosclerotic cardiovascular disease (ASCVD) risk-reduction therapies for individuals with hypertriglyceridemia without clinical ASCVD restricted enrollment to participants with diabetes or various other risk factors. These criteria were mirrored in the Food and Drug Administration product label for IPE. METHODS We pooled 2,345 participants with triglycerides 150 to <500 mg/dL (or >178-<500 mg/dL if not on a statin) and without clinical ASCVD from MESA, CARDIA, the Dallas Heart Study, and the Heinz Nixdorf Recall study. We evaluated the incidence of ASCVD events overall, by IPE eligibility (as defined in the product label), and further stratified by CAC scores (0, >0-100, >100). The number needed to treat for 5 years (NNT5) to prevent 1 event was estimated among IPE-eligible participants, assuming a 21.8% relative risk reduction with IPE. In exploratory analyses, the NNT5 was also estimated among noneligible participants. RESULTS There was marked heterogeneity in CAC burden overall (45% CAC 0; 24% CAC >100) and across IPE eligibility strata. Overall, 17% of participants were eligible for IPE and 11.9% had ASCVD events within 5 years. Among participants eligible for IPE, 38% had CAC >100, and their event rates were markedly higher (15.9% vs 7.2%) and the NNT5 2.2-fold lower (29 vs 64) than those of the 25% eligible participants with CAC 0. Among the 83% participants not eligible for IPE, 20% had CAC >100, and their 5-year incidence of ASCVD (13.9%) was higher than the overall incidence among IPE-eligible participants. CONCLUSIONS CAC can improve current risk stratification and therapy allocation paradigms among individuals with hypertriglyceridemia without clinical ASCVD. Future trials of risk-reduction therapies in hypertriglyceridemia could use CAC >100 to enroll a high-risk study sample, with implications for a larger target population.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Center for Outcomes Research, Houston Methodist, Houston, Texas, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Renato Quispe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine, Stanford, California, USA
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald Lloyd-Jones
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jamal S Rana
- Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Parag H Joshi
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Khera
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Colby Ayers
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Sara Schramm
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; CGH Medical Center, Sterling, Illinois, USA; University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marcio Bittencourt
- Center for Clinical and Epidemiologic Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Center for Outcomes Research, Houston Methodist, Houston, Texas, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jain MK, Jain MK, Sadek H, de Lemos J, mcGuire D, Ayers C, Eiston JL, Lucas C, Kamel D, Li X, Agbor BA, Williams N, Schoggins J. 525. Atovaquone for Treatment of COVID-19 (Ataq COVID-19) Trial. Open Forum Infect Dis 2021. [PMCID: PMC8644620 DOI: 10.1093/ofid/ofab466.724] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Our group performed an in-silico screen to identify FDA approved drugs that inhibit SARS-C0V-2 main protease (Mpro), followed by in vitro viral replication assays, and in vivo pharmacokinetic studies in mice. These studies identified atovaquone as a promising candidate for inhibiting viral replication. Methods Enrolled patients were randomized in a 2:1 fashion to atovaquone 1500 mg twice daily versus matched placebo. Patients received standard of care treatment including remdesivir, dexamethasone, or convalescent plasma as deemed necessary by the treating team. Patients agreed to allow collection of saliva at baseline and twice a day while hospitalized or up to 10 days. Saliva was collected and RNA extracted for viral load (VL) measurement by Real-time PCR. Our primary outcome was to examine the between group differences in log transformed VL(copies/mL) using generalized linear mixed-effect models of repeated measures from all samples. Additional analysis of Atovquone plasma concentrations were examined and correlated with viral load and body mass index (BMI). Results Of the 61 patients enrolled; 41 were received atovaquone and 19 placebo. Overall the population was predominately male Hispanic with a mean age of 51 years. The two groups were balanced (Table 1) with regard to age, gender, race, co-morbidities, days from onset of symptoms, baseline oxygen requirements, and receipt of COVID-19 specific standard of care treatment. A higher proportion with diabetes was noted in the Atovaquone arm. The log10 VL was 5.25 copies/mL vs. 4.79 copies/mL at baseline in the atovaquone vs. placebo group. Although there was a decrease in VL over time, there was no differences between the atovaquone plus standard of care arm versus the standard of care arm (Figure 1). Additional analysis of atovaquone plasma concentration demonstrated a wide variation in atovaquone levels, inverse association between atovaquone levels and BMI (rho -0.44, p=0.03), and Day 5 concentrations and VL (rho -0.54, p=0.005). ![]()
Figure 1. Mean viral load of COVID-19 over time of atovaquone (blue) vs. placebo (red). Table 1. Baseline characteristics ![]()
Conclusion Although atovaquone showed promising in vitro antiviral properties for COVID-19, in this pilot study we did not detect a change in VL in patients who received atovaquone compared to placebo, possibly due to failure of patients achieve adequate drug levels. Disclosures Mamta K. Jain, MD, MPH, Gilead Sciences Inc. (Individual(s) Involved: Self): Research Grant or Support, Scientific Research Study Investigator; GlaxoSmithKline (Individual(s) Involved: Self): Scientific Research Study Investigator; Merck (Individual(s) Involved: Self): Scientific Research Study Investigator; Vasgene (Individual(s) Involved: Self): Scientific Research Study Investigator
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dena Kamel
- UT Southwestern Medical Center, Dallas, TX
| | - Xilong Li
- UT Southwestern Medical Center, Dallas, TX
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Rao S, Hughes A, Segar MW, Wilson B, Ayers C, Das S, Halm EA, Pandey A. Longitudinal Trajectories and Factors Associated With US County-Level Cardiovascular Mortality, 1980 to 2014. JAMA Netw Open 2021; 4:e2136022. [PMID: 34846526 PMCID: PMC8634057 DOI: 10.1001/jamanetworkopen.2021.36022] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Cardiovascular (CV) mortality has declined for more than 3 decades in the US. However, differences in declines among residents at a US county level are not well characterized. OBJECTIVE To identify unique county-level trajectories of CV mortality in the US during a 35-year study period and explore county-level factors that are associated with CV mortality trajectories. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cross-sectional analysis of CV mortality trends used data from 3133 US counties from 1980 to 2014. County-level demographic, socioeconomic, environmental, and health-related risk factors were compiled. Data were analyzed from December 2019 to September 2021. EXPOSURES County-level characteristics, collected from 5 county-level data sets. MAIN OUTCOMES AND MEASURES Cardiovascular mortality data were obtained for 3133 US counties from 1980 to 2014 using age-standardized county-level mortality rates from the Global Burden of Disease study. The longitudinal K-means approach was used to identify 3 distinct clusters based on underlying mortality trajectory. Multinomial logistic regression models were constructed to evaluate associations between county characteristics and cluster membership. RESULTS Among 3133 US counties (median, 49.5% [IQR, 48.9%-50.5%] men; 30.7% [IQR, 27.1%-34.4%] older than 55 years; 9.9% [IQR, 4.5%-22.7%] racial minority group [individuals self-identifying as Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian, Pacific Islander, other, or multiple races/ethnicities]), CV mortality declined by 45.5% overall and by 38.4% in high-mortality strata (694 counties), by 45.0% in intermediate-mortality strata (1382 counties), and by 48.3% in low-mortality strata (1057 counties). Counties with the highest mortality in 1980 continued to demonstrate the highest mortality in 2014. Trajectory groups were regionally distributed, with high-mortality trajectory counties focused in the South and in portions of Appalachia. Low- vs high-mortality groups varied significantly in demographic (racial minority group proportion, 7.6% [IQR, 4.1%-14.5%]) vs 23.9% [IQR, 6.5%-40.8%]) and socioeconomic characteristics such as high-school education (9.4% [IQR, 7.3%-12.6%] vs 20.1% [IQR, 16.1%-23.2%]), poverty rates (11.4% [IQR, 8.8%-14.6%] vs 20.6% [IQR, 17.1%-24.4%]), and violent crime rates (161.5 [IQR, 89.0-262.4] vs 272.8 [IQR, 155.3-431.3] per 100 000 population). In multinomial logistic regression, a model incorporating demographic, socioeconomic, environmental, and health characteristics accounted for 60% of the variance in the CV mortality trajectory (R2 = 0.60). Sociodemographic factors such as racial minority group proportion (odds ratio [OR], 1.70 [95% CI, 1.35-2.14]) and educational attainment (OR, 6.17 [95% CI, 4.55-8.36]) and health behaviors such as smoking (OR for high vs low, 2.04 [95% CI, 1.58-2.64]) and physical inactivity (OR, 3.74 [95% CI, 2.83-4.93]) were associated with the high-mortality trajectory. CONCLUSIONS AND RELEVANCE Cardiovascular mortality declined in all subgroups during the 35-year study period; however, disparities remained unchanged during that time. Disparate trajectories were associated with social and behavioral risks. Health policy efforts across multiple domains, including structural and public health targets, may be needed to reduce existing county-level cardiovascular mortality disparities.
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Affiliation(s)
- Shreya Rao
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Amy Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Matthew W. Segar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Brianna Wilson
- School of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sandeep Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ethan A. Halm
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Parizher G, Phelan DM, Ayers C, Goodwin R, Levine BD. A Video-Enhanced, Electronic Modality for Preparticipation Examination of Young Athletes. Curr Sports Med Rep 2021; 20:485-488. [PMID: 34524192 DOI: 10.1249/jsr.0000000000000879] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We developed a video-enhanced preparticipation evaluation symptom questionnaire (the V-PPE), intended to help screen athletes for heart disease. We now report results of a pilot quality improvement study evaluating V-PPE's performance. In a prospective before-and-after study, approximately 5700 high-school athletes were prompted to voluntarily fill out the V-PPE questionnaire. We compared symptom frequencies on standard PPE to those on V-PPE. Of 5700 athletes, 46 (0.8%), 117 (2.0%), 33 (0.6%), and 101 (1.8%) reported syncope, angina, palpitations, and dyspnea, respectively on routine screening. Four hundred and ninety-two (8.6%) voluntarily filled out the V-PPE. Athletes were more likely to report palpitations on V-PPE than PPE, but not angina, dyspnea, syncope, or at least one symptom. Symptom frequencies on electronic PPE questionnaires are lower than recent reports suggest. Embedded videos can alter screening yield. More research is necessary to evaluate the predictive value of the V-PPE for clinically relevant cardiac pathology.
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Affiliation(s)
- Gary Parizher
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dermot M Phelan
- Sports Cardiology Center, Heart, Vascular, and Thoracic Institute, Cleveland, Clinic, Cleveland OH
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Patel KV, Simek S, Ayers C, Neeland IJ, deFilippi C, Seliger SL, Lonergan K, Minniefield N, Mentz RJ, Correa A, Yimer WK, Hall ME, Rodriguez CJ, de Lemos JA, Berry JD, Pandey A. Physical Activity, Subclinical Myocardial Injury, and Risk of Heart Failure Subtypes in Black Adults. JACC Heart Fail 2021; 9:484-493. [PMID: 34119468 PMCID: PMC10563362 DOI: 10.1016/j.jchf.2021.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study sought to evaluate the independent associations and interactions between high-sensitivity cardiac troponin I (hs-cTnI) and physical activity (PA) with risk of heart failure (HF) subtypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). BACKGROUND Black adults are at high risk for developing HF. Physical inactivity and subclinical myocardial injury, as assessed by hs-cTnI concentration, are independent risk factors for HF. METHODS Black adults from the Jackson Heart Study without prevalent HF who had hs-cTnI concentration and self-reported PA assessed at baseline were included. Adjusted Cox models were used to evaluate the independent and joint associations and interaction between hs-cTnI concentrations and PA with risk of HFpEF and HFrEF. RESULTS Among 3,959 participants, 25.1% had subclinical myocardial injury (hs-cTnI ≥4 and ≥6 ng/l in women and men, respectively), and 48.2% were inactive (moderate-to-vigorous PA = 0 min/week). Over 12.0 years of follow-up, 163 and 150 participants had an incident HFpEF and HFrEF event, respectively. In adjusted analysis, higher hs-cTnI concentration (per 1-U log increase) was associated with higher risk of HFpEF (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.25 to 1.72]) and HFrEF (HR: 1.57; 95% CI: 1.35 to 1.83]). In contrast, higher PA (per 1-U log increase) was associated with a lower risk of HFpEF (HR: 0.93; 95% CI: 0.88 to 0.99]) but not HFrEF. There was a significant interaction between hs-cTnI and PA for risk of HFpEF (p interaction = 0.04) such that inactive participants with subclinical myocardial injury were at higher risk of HFpEF but active participants were not. CONCLUSIONS Among Black adults with subclinical myocardial injury, higher levels of PA were associated with attenuated risk of HFpEF.
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Affiliation(s)
- Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Shawn Simek
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ian J Neeland
- Division of Cardiology, Department of Medicine, University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Stephen L Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Katy Lonergan
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Minniefield
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert J Mentz
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Wondwosen K Yimer
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Carlos J Rodriguez
- Division of Cardiology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Segar MW, Jaeger BC, Patel KV, Nambi V, Ndumele CE, Correa A, Butler J, Chandra A, Ayers C, Rao S, Lewis AA, Raffield LM, Rodriguez CJ, Michos ED, Ballantyne CM, Hall ME, Mentz RJ, de Lemos JA, Pandey A. Development and Validation of Machine Learning-Based Race-Specific Models to Predict 10-Year Risk of Heart Failure: A Multicohort Analysis. Circulation 2021; 143:2370-2383. [PMID: 33845593 PMCID: PMC9976274 DOI: 10.1161/circulationaha.120.053134] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 12/30/2022]
Abstract
BACKGROUND Heart failure (HF) risk and the underlying risk factors vary by race. Traditional models for HF risk prediction treat race as a covariate in risk prediction and do not account for significant parameters such as cardiac biomarkers. Machine learning (ML) may offer advantages over traditional modeling techniques to develop race-specific HF risk prediction models and to elucidate important contributors of HF development across races. METHODS We performed a retrospective analysis of 4 large, community cohort studies (ARIC [Atherosclerosis Risk in Communities], DHS [Dallas Heart Study], JHS [Jackson Heart Study], and MESA [Multi-Ethnic Study of Atherosclerosis]) with adjudicated HF events. The study included participants who were >40 years of age and free of HF at baseline. Race-specific ML models for HF risk prediction were developed in the JHS cohort (for Black race-specific model) and White adults from ARIC (for White race-specific model). The models included 39 candidate variables across demographic, anthropometric, medical history, laboratory, and electrocardiographic domains. The ML models were externally validated and compared with prior established traditional and non-race-specific ML models in race-specific subgroups of the pooled MESA/DHS cohort and Black participants of ARIC. The Harrell C-index and Greenwood-Nam-D'Agostino χ2 tests were used to assess discrimination and calibration, respectively. RESULTS The ML models had excellent discrimination in the derivation cohorts for Black (n=4141 in JHS, C-index=0.88) and White (n=7858 in ARIC, C-index=0.89) participants. In the external validation cohorts, the race-specific ML model demonstrated adequate calibration and superior discrimination (Black individuals, C-index=0.80-0.83; White individuals, C-index=0.82) compared with established HF risk models or with non-race-specific ML models derived with race included as a covariate. Among the risk factors, natriuretic peptide levels were the most important predictor of HF risk across both races, followed by troponin levels in Black and ECG-based Cornell voltage in White individuals. Other key predictors of HF risk among Black individuals were glycemic parameters and socioeconomic factors. In contrast, prevalent cardiovascular disease and traditional cardiovascular risk factors were stronger predictors of HF risk in White adults. CONCLUSIONS Race-specific and ML-based HF risk models that integrate clinical, laboratory, and biomarker data demonstrated superior performance compared with traditional HF risk and non-race-specific ML models. This approach identifies distinct race-specific contributors of HF.
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Affiliation(s)
- Matthew W. Segar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,Parkland Health and Hospital System, Dallas, TX, USA
| | - Byron C. Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kershaw V. Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, TX, USA,Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alvin Chandra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shreya Rao
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,Parkland Health and Hospital System, Dallas, TX, USA
| | - Alana A. Lewis
- Division of Cardiology, Northwestern University, Chicago, IL, UA
| | - Laura M. Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Carlos J. Rodriguez
- Departments of Medicine, Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christie M. Ballantyne
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Michael E. Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Robert J. Mentz
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - James A. de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kondamudi N, Thangada N, Patel KV, Ayers C, Chandra A, Berry JD, Neeland IJ, Pandey A. Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study. J Cardiovasc Magn Reson 2021; 23:78. [PMID: 34120624 PMCID: PMC8201708 DOI: 10.1186/s12968-021-00757-w] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Low cardiorespiratory fitness (CRF), high body mass index, and excess visceral adiposity are each associated with impairment in left ventricular (LV) peak circumferential strain (Ecc), an intermediate phenotype that precedes the development of clinical heart failure (HF). However, the association of regional fat distribution and CRF with Ecc independent of each other and other potential confounders is not known. METHODS Participants from the Dallas Heart Study Phase 2 who underwent dual energy X-ray absorptiometry assessment of regional fat distribution, CRF assessment by submaximal treadmill test, and Ecc quantification by tissue-tagged cardiovascular magnetic resonance were included in the analysis. The cross-sectional associations of measures of regional adiposity, namely visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and lower-body fat (LBF) with Ecc after adjustment for CRF and other potential confounders (independent variables) were assessed using multivariable linear regression analysis. RESULTS The study included 1089 participants (55% female, 39% black). In the unadjusted analysis, higher VAT was associated with greater impairment in Ecc. After adjustment for baseline risk factors, CRF, parameters of LV structure and function, and other fat depots such as SAT and LBF, higher VAT remained associated with greater impairment in Ecc (β: 0.19, P = 0.002). SAT and LBF were not significantly associated with Ecc, however, CRF remained associated with Ecc in the fully adjusted model including all fat depots (β: - 0.15, P < 0.001). CONCLUSIONS VAT and CRF are each independently associated with impairment in Ecc, suggesting that higher VAT burden and low CRF mediate pathological cardiac remodeling through distinct mechanisms.
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Affiliation(s)
- Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Neela Thangada
- Division of Cardiology, Department of Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Kershaw V Patel
- Division of Cardiology, Department of Internal Medicine, Houston Methodist Hospital, 6550 Fannin St., Houston, TX, 77030, USA
| | - Colby Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Alvin Chandra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Jarret D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, 2103 Cornell Road, Cleveland, OH, 44106, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
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Rao A, Ranka S, Ayers C, Hendren N, Rosenblatt A, Alger HM, Rutan C, Omar W, Khera R, Gupta K, Mody P, DeFilippi C, Das SR, Hedayati SS, de Lemos JA. Association of Kidney Disease With Outcomes in COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Heart Assoc 2021; 10:e020910. [PMID: 34107743 PMCID: PMC8477855 DOI: 10.1161/jaha.121.020910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 01/08/2023]
Abstract
Background Emerging evidence links acute kidney injury (AKI) in patients with COVID‐19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID‐19. Methods and Results In a large multicenter registry including 8574 patients with COVID‐19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end‐stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all‐cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new‐onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end‐stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46–2.03]; stage 2 HR, 1.83 [95% CI, 1.52–2.20]; stage 3 HR, 1.69 [95% CI, 1.44–1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74–2.71]; stage 2 HR, 2.70 [95% CI, 2.07–3.51]; stage 3 HR, 3.06 [95% CI, 2.52–3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all‐cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID‐19.
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Affiliation(s)
- Anjali Rao
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Sagar Ranka
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Colby Ayers
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Nicholas Hendren
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Anna Rosenblatt
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | | | | | - Wally Omar
- Department of Internal Medicine Beth Israel Deaconess Medical Center Boston MA
| | - Rohan Khera
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Kamal Gupta
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Purav Mody
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Sandeep R Das
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - S Susan Hedayati
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - James A de Lemos
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
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Parizher G, Phelan D, Ayers C, Goodwin R, Levine B. A VIDEO ENHANCED, ELECTRONIC MODALITY FOR PRE-PARTICIPATION EXAMINATION (VPPE) OF YOUNG ATHLETES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04558-7] [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: 11/30/2022]
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Ustunkaya T, Ajufo E, Ayers C, Mauricio R, Rohatgi A, Joshi P, Khera A. USING READILY AVAILABLE CLINICAL INFORMATION TO IDENTIFY INDIVIDUALS WITH HIGH LIPOPROTEIN A LEVELS: THE DALLAS HEART STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02917-x] [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: 10/21/2022]
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Georgakis MK, de Lemos JA, Ayers C, Wang B, Björkbacka H, Pana TA, Thorand B, Sun C, Fani L, Malik R, Dupuis J, Engström G, Orho-Melander M, Melander O, Boekholdt SM, Zierer A, Elhadad MA, Koenig W, Herder C, Hoogeveen RC, Kavousi M, Ballantyne CM, Peters A, Myint PK, Nilsson J, Benjamin EJ, Dichgans M. Association of Circulating Monocyte Chemoattractant Protein-1 Levels With Cardiovascular Mortality: A Meta-analysis of Population-Based Studies. JAMA Cardiol 2021; 6:587-592. [PMID: 33146689 PMCID: PMC8111478 DOI: 10.1001/jamacardio.2020.5392] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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] [Received: 04/24/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022]
Abstract
Importance Human genetics and studies in experimental models support a key role of monocyte-chemoattractant protein-1 (MCP-1) in atherosclerosis. Yet, the associations of circulating MCP-1 levels with risk of coronary heart disease and cardiovascular death in the general population remain largely unexplored. Objective To explore whether circulating levels of MCP-1 are associated with risk of incident coronary heart disease, myocardial infarction, and cardiovascular mortality in the general population. Data Sources and Selection Population-based cohort studies, identified through a systematic review, that have examined associations of circulating MCP-1 levels with cardiovascular end points. Data Extraction and Synthesis Using a prespecified harmonized analysis plan, study-specific summary data were obtained from Cox regression models after excluding individuals with overt cardiovascular disease at baseline. Derived hazard ratios (HRs) were synthesized using random-effects meta-analyses. Main Outcomes and Measures Incident coronary heart disease (myocardial infarction, coronary revascularization, and unstable angina), nonfatal myocardial infarction, and cardiovascular death (from cardiac or cerebrovascular causes). Results The meta-analysis included 7 cohort studies involving 21 401 individuals (mean [SD] age, 53.7 [10.2] years; 10 012 men [46.8%]). Mean (SD) follow-up was 15.3 (4.5) years (326 392 person-years at risk). In models adjusting for age, sex, and race/ethnicity, higher MCP-1 levels at baseline were associated with increased risk of coronary heart disease (HR per 1-SD increment in MCP-1 levels: 1.06 [95% CI, 1.01-1.11]; P = .01), nonfatal myocardial infarction (HR, 1.07 [95% CI, 1.01-1.13]; P = .02), and cardiovascular death (HR, 1.12 [95% CI, 1.05-1.20]; P < .001). In analyses comparing MCP-1 quartiles, these associations followed dose-response patterns. After additionally adjusting for vascular risk factors, the risk estimates were attenuated, but the associations of MCP-1 levels with cardiovascular death remained statistically significant, as did the association of MCP-1 levels in the upper quartile with coronary heart disease. There was no significant heterogeneity; the results did not change in sensitivity analyses excluding events occurring in the first 5 years after MCP-1 measurement, and the risk estimates were stable after additional adjustments for circulating levels of interleukin-6 and high-sensitivity C-reactive protein. Conclusions and Relevance Higher circulating MCP-1 levels are associated with higher long-term cardiovascular mortality in community-dwelling individuals free of overt cardiovascular disease. These findings provide further support for a key role of MCP-1-signaling in cardiovascular disease.
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Affiliation(s)
- Marios K. Georgakis
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University, Munich, Germany
- Graduate School for Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - James A. de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Colby Ayers
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Biqi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Harry Björkbacka
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Tiberiu A. Pana
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Barbara Thorand
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
| | - Caroline Sun
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Lana Fani
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | | | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - S. Matthijs Boekholdt
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands
| | - Astrid Zierer
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Mohamed A. Elhadad
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Research Center for Cardiovascular Disease, Partner Site of Munich Heart Alliance, Munich, Germany
| | - Wolfgang Koenig
- German Research Center for Cardiovascular Disease, Partner Site of Munich Heart Alliance, Munich, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Christian Herder
- German Center for Diabetes Research, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ron C. Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Annette Peters
- German Center for Diabetes Research, München-Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Research Center for Cardiovascular Disease, Partner Site of Munich Heart Alliance, Munich, Germany
- Institute of Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Phyo K. Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Emelia J. Benjamin
- Section of Cardiovascular Medicine and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute and Boston University, Framingham, Massachusetts
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Centre for Neurodegenerative Diseases, Munich, Germany
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Flores Rosario K, Mehta A, Ayers C, Engel Gonzalez P, Pandey A, Khera R, Kaplan R, Blaha MJ, Khera A, Blumenthal RS, Nasir K, Rodriguez CJ, Joshi PH. Performance of the Pooled Cohort Equations in Hispanic Individuals Across the United States: Insights From the Multi-Ethnic Study of Atherosclerosis and the Dallas Heart Study. J Am Heart Assoc 2021; 10:e018410. [PMID: 33870702 PMCID: PMC8200750 DOI: 10.1161/jaha.120.018410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karen Flores Rosario
- Division of Cardiology Department of Medicine Duke University Hospital Durham NC
| | - Anurag Mehta
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Colby Ayers
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Pedro Engel Gonzalez
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Rohan Khera
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Robert Kaplan
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY.,Division of Public Health Sciences Fred Hutchinson Cancer Research Center Seattle WA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Amit Khera
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Khurram Nasir
- Department of Cardiology Debakey Heart & Vascular Center Houston Methodist Hospital Houston TX
| | - Carlos J Rodriguez
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY.,Division of Cardiology Montefiore Medical Center Bronx NY
| | - Parag H Joshi
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
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35
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Patel KV, Metzinger M, Park B, Allen N, Ayers C, Kawut SM, Sidney S, Goff DC, Jacobs DR, Zaky AF, Carnethon M, Berry JD, Pandey A. Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study. J Am Heart Assoc 2021; 10:e016968. [PMID: 33775106 PMCID: PMC8174339 DOI: 10.1161/jaha.120.016968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Low cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood. Methods and Results Participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow-up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. The associations of baseline and changes in CRF and BMI on follow-up (baseline to year 20) with RV systolic function parameters (tricuspid annular plane systolic excursion, RV Doppler systolic velocity of the lateral tricuspid annulus), and PASP were assessed using multivariable-adjusted linear regression models. The study included 3433 participants. In adjusted analysis, higher baseline BMI but not CRF was significantly associated with higher PASP. Among RV systolic function parameters, higher baseline CRF and BMI were significantly associated with higher tricuspid annular plane systolic excursion and RV systolic velocity of the lateral tricuspid annulus. In the subgroup of participants with follow-up assessment of CRF or BMI at year 20, less decline in CRF was associated with higher RV systolic velocity of the lateral tricuspid annulus and lower PASP, while greater increase in BMI was significantly associated with higher PASP in middle age. Conclusions Higher CRF in young adulthood and less decline in CRF over time are each significantly associated with better RV systolic function. Higher baseline BMI and greater age-related increases in BMI are each significantly associated with higher PASP in middle age. These findings provide insights into possible mechanisms through which low fitness and obesity may contribute toward risk of heart failure.
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Affiliation(s)
- Kershaw V Patel
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center TX
| | - Mark Metzinger
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Bryan Park
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Norrina Allen
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Colby Ayers
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Steven M Kawut
- Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research Oakland CA
| | - David C Goff
- Kaiser Permanente Northern California Division of Research Oakland CA.,Colorado School of Public Health Aurora CO.,Division of Cardiovascular Sciences NHLBI Bethesda MD
| | - David R Jacobs
- School of Public Health University of Minnesota Minneapolis MN
| | - Ahmed F Zaky
- Department of Anesthesiology and Perioperative Medicine University of Alabama at Birmingham AL
| | - Mercedes Carnethon
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Jarett D Berry
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
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Powell-Wiley TM, Dey AK, Rivers JP, Chaturvedi A, Andrews MR, Ceasar JN, Claudel SE, Mitchell VM, Ayers C, Tamura K, Gutierrez-Huerta CA, Teague HL, Oeser SG, Goyal A, Joshi AA, Collins BS, Baumer Y, Chung ST, Sumner AE, Playford MP, Tawakol A, Mehta NN. Chronic Stress-Related Neural Activity Associates With Subclinical Cardiovascular Disease in a Community-Based Cohort: Data From the Washington, D.C. Cardiovascular Health and Needs Assessment. Front Cardiovasc Med 2021; 8:599341. [PMID: 33778019 PMCID: PMC7988194 DOI: 10.3389/fcvm.2021.599341] [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] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Psychosocial stress correlates with cardiovascular (CV) events; however, associations between physiologic measures of stressors and CVD remain incompletely understood, especially in racial/ethnic minority populations in resource-limited neighborhoods. We examined associations between chronic stress-related neural activity, measured by amygdalar 18Fluorodeoxyglucose (18FDG) uptake, and aortic vascular FDG uptake (arterial inflammation measure) in a community-based cohort. Methods: Forty participants from the Washington, DC CV Health and Needs Assessment (DC-CHNA), a study of a predominantly African-American population in resource-limited urban areas and 25 healthy volunteers underwent detailed phenotyping, including 18FDG PET/CT for assessing amygdalar activity (AmygA), vascular FDG uptake, and hematopoietic (leukopoietic) tissue activity. Mediation analysis was used to test whether the link between AmygA and vascular FDG uptake was mediated by hematopoietic activity. Results: AmygA (1.11 ± 0.09 vs. 1.05 ± 0.09, p = 0.004) and vascular FDG uptake (1.63 ± 0.22 vs. 1.55 ± 0.17, p = 0.05) were greater in the DC-CHNA cohort compared to volunteers. Within the DC-CHNA cohort, AmygA associated with vascular FDG uptake after adjustment for Framingham score and body mass index (β = 0.41, p = 0.015). The AmygA and aortic vascular FDG uptake relationship was in part mediated by splenic (20.2%) and bone marrow (11.8%) activity. Conclusions: AmygA, or chronic stress-related neural activity, associates with subclinical CVD risk in a community-based cohort. This may in part be mediated by the hematopoietic system. Our findings of this hypothesis-generating study are suggestive of a potential relationship between chronic stress-related neural activity and subclinical CVD in an African American community-based population. Taken together, these findings suggest a potential mechanism by which chronic psychosocial stress, such as stressors that can be experienced in adverse social conditions, promotes greater cardiovascular risk amongst resource-limited, community-based populations most impacted by cardiovascular health disparities. However, larger prospective studies examining these findings in other racially and ethnically diverse populations are necessary to confirm and extend these findings.
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Affiliation(s)
- Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States.,Intramural Research Program, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD, United States
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Joshua P Rivers
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States.,Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Abhishek Chaturvedi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Sophie E Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Valerie M Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Colby Ayers
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Cristhian A Gutierrez-Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Heather L Teague
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Steffen G Oeser
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Aditya Goyal
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Aditya A Joshi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Billy S Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, United States
| | - Anne E Sumner
- Intramural Research Program, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD, United States.,Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, United States
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.,Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
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Thangada ND, Patel KV, Peden B, Agusala V, Kozlitina J, Garg S, Drazner MH, Ayers C, Berry JD, Pandey A. Cross-Sectional Associations of Objectively Measured Sedentary Time, Physical Activity, and Fitness With Cardiac Structure and Function: Findings From the Dallas Heart Study. J Am Heart Assoc 2021; 10:e015601. [PMID: 33615827 PMCID: PMC8174255 DOI: 10.1161/jaha.119.015601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Physical inactivity and low cardiorespiratory fitness (CRF) are associated with higher risk of heart failure. However, the independent contributions of objectively measured sedentary time, physical activity, and CRF toward left ventricular (LV) structure and function are not well established. Methods and Results We included 1368 participants from the DHS (Dallas Heart Study) (age, 49 years; 40% men) free of cardiovascular disease who had physical activity and sedentary time measured by accelerometer, CRF estimated from submaximal treadmill test, and cardiac magnetic resonance imaging performed using 3‐T magnetic resonance imaging. A series of linear regression models were constructed to evaluate the associations of sedentary time, moderate physical activity, vigorous physical activity, and CRF with LV parameters after adjustment for established cardiovascular risk factors. We observed a modest correlation between CRF levels and objectively measured moderate (correlation coefficient, 0.17; P<0.001) and vigorous physical activity (correlation coefficient, 0.25; P<0.001) levels. In contrast, sedentary time was not associated with CRF. In adjusted analysis, both vigorous physical activity and higher CRF were significantly associated with greater stroke volume, LV mass, LV end‐diastolic volume, and lower arterial elastance, independent of other confounders. Sedentary time and moderate physical activity levels were not associated with LV parameters. Conclusions Vigorous physical activity and CRF are significantly associated with cardiac structure and function parameters. Future studies are needed to determine if interventions aimed at improving CRF levels may favorably modify cardiac structure and function.
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Affiliation(s)
- Neela D Thangada
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Kershaw V Patel
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Bradley Peden
- Division of Cardiology Department of Internal Medicine University of Alabama School of Medicine Birmingham AL
| | - Vijay Agusala
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Julia Kozlitina
- McDermott Center for Human Growth and Development University of Texas Southwestern Medical Center Dallas TX
| | - Sonia Garg
- Division of Cardiology Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Mark H Drazner
- Division of Cardiology Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Colby Ayers
- Division of Cardiology Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Jarett D Berry
- Division of Cardiology Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Medicine UT Southwestern Medical Center Dallas TX
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Peters AE, Pandey A, Ayers C, Wegermann K, McGarrah RW, Grodin JL, Abdelmalek MF, Bekfani T, Blumer V, Diehl AM, Moylan CA, Fudim M. Association of liver fibrosis risk scores with clinical outcomes in patients with heart failure with preserved ejection fraction: findings from TOPCAT. ESC Heart Fail 2021; 8:842-848. [PMID: 33586354 PMCID: PMC8006722 DOI: 10.1002/ehf2.13250] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Non‐alcoholic fatty liver disease leads to progressive liver fibrosis and appears to be a frequent co‐morbid disease in heart failure with preserved ejection fraction (HFpEF). It is well known that liver fibrosis severity predicts future liver‐related morbidity and mortality, but its impact on outcomes in patients with HFpEF remains unknown. This analysis aimed to describe the prevalence of liver fibrosis, as assessed using surrogate biomarkers, in patients with HFpEF and the association of such biomarkers in predicting clinical outcomes in these patients. Methods and results Patients with HFpEF from TOPCAT Americas were included in the analysis. The non‐alcoholic fatty liver disease fibrosis score (NFS) and fibrosis‐4 (FIB‐4) scores were calculated using a combination of clinical characteristics and laboratory parameters. Risk of advanced fibrosis was classified as low, intermediate, and high. For the 1423 with sufficient data, we used Cox regression analysis to test the association between the risk of fibrosis severity and the combined primary endpoint of all cardiovascular death, aborted cardiac arrest, and hospitalization for heart failure. Advanced fibrosis, as determined by high fibrosis scores, was present in 37.57% by the NFS and 8.02% by the FIB‐4. Higher risk of advanced hepatic fibrosis was associated with older age. In unadjusted models, the risk of advanced fibrosis was associated with the primary cardiovascular outcome [NFS high vs. low, hazard ratio (HR) 1.709 (95% confidence interval, CI 1.238–2.358, P = 0.0011) and FIB‐4 high vs. low, HR 1.561 (95% CI 1.139–2.140, P = 0.0056)]. After multivariable adjustment, this association was diminished [NFS high vs. low, HR 1.349 (95% CI 0.938–1.939, P = 0.1064) and FIB‐4 high vs. low, HR 1.415 (95% CI 0.995–2.010, P = 0.0531)]. Conclusions Our study suggests that advanced liver fibrosis, as estimated by fibrosis risk scores, may not be uncommon in patients with HFpEF, and there appears to be a limited independent association between liver fibrosis risk scores and clinical outcomes related to heart failure events.
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Affiliation(s)
- Anthony E Peters
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby Ayers
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kara Wegermann
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Robert W McGarrah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Justin L Grodin
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manal F Abdelmalek
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Magdeburg, Germany
| | - Vanessa Blumer
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Anna Mae Diehl
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Cynthia A Moylan
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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Cainzos-Achirica M, Patel KV, Quispe R, Joshi PH, Khera A, Ayers C, Lima JAC, Rana JS, Greenland P, Bittencourt MS, Cardoso R, Blankstein R, Blumenthal RS, Blaha MJ, Nasir K. Coronary Artery Calcium for the Allocation of GLP-1RA for Primary Prevention of Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging 2021; 14:1470-1472. [PMID: 33582063 DOI: 10.1016/j.jcmg.2020.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
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Drechsler H, Ayers C, Cutrell J, Arasaratnam R, Bedimo R. Consistent use of lipid lowering therapy in HIV infection is associated with low mortality. BMC Infect Dis 2021; 21:150. [PMID: 33546621 PMCID: PMC7866454 DOI: 10.1186/s12879-021-05787-4] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In people living with HIV (PLWH), statins may be disproportionately effective but remain underutilized. A large prospective trial in patients with low to moderate cardiovascular (ASCVD) risk will reveal whether they should be considered in all PLWH. But its effect size may not apply to real-world PLWH with higher ASCVD and mortality risk. Also, the clinical role of non-statin lipid-lowering therapy (LLT) and LLT adherence in this population is unknown. METHODS Comparative multi-level marginal structural model for all-cause mortality examining four time-updated exposure levels to LLT, antihypertensives, and aspirin in a virtual cohort of older PLWH. Incident coronary, cerebrovascular, and overall ASCVD events, serious infections, and new cancer diagnoses served as explanatory outcomes. RESULTS In 23,276 HIV-infected US-veterans who were followed for a median of 5.2 years after virologic suppression overall mortality was 33/1000 patient years: > 3 times higher than in the US population. Use of antihypertensives or aspirin was associated with increased mortality. Past LLT use (> 1 year ago) had no effect on mortality. LLT exposure in the past year was associated with a reduced hazard ratio (HR) of death: 0.59, 95% confidence interval (CI) 0.51-0.69, p < 0.0001 for statin containing LLT and 0.71 (CI: 0.54-0.93), p = 0.03 for statin-free LLT. For consistent LLT use (> 11/12 past months) the HR of death was 0.48 (CI: 0.35-0.66) for statin-only LLT, 0.34 (CI: 0.23-0.52) for combination LLT, and 0.27 (CI: 0.15-0.48) for statin-free LLT (p < 0.0001 for all). The ASCVD risk in these patients was reduced in similar fashion. Use of statin containing LLT was also associated with reduced infection and cancer risk. Multiple contrasting subgroup analyses yielded comparable results. Confounding is unlikely to be a major contributor to our findings. CONCLUSIONS In PLWH, ongoing LLT use may lead to substantially lower mortality, but consistent long-term adherence may be required to reduce ASCVD risk. Consistent non-statin LLT may be highly effective and should be studied prospectively.
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Affiliation(s)
- Henning Drechsler
- VA North Texas Health Care System, Dallas, TX, USA.
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA.
| | - Colby Ayers
- VA North Texas Health Care System, Dallas, TX, USA
| | | | - Reuben Arasaratnam
- VA North Texas Health Care System, Dallas, TX, USA
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA
| | - Roger Bedimo
- VA North Texas Health Care System, Dallas, TX, USA
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA
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Metzinger MP, Saldanha S, Gulati J, Patel KV, El‐Ghazali A, Deodhar S, Joshi PH, Ayers C, Rohatgi A. Effect of Anacetrapib on Cholesterol Efflux Capacity: A Substudy of the DEFINE Trial. J Am Heart Assoc 2020; 9:e018136. [PMID: 33263263 PMCID: PMC7955402 DOI: 10.1161/jaha.120.018136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 01/07/2023]
Abstract
Background Anacetrapib is the only cholesteryl ester transfer protein inhibitor proven to reduce coronary heart disease (CHD). However, its effects on reverse cholesterol transport have not been fully elucidated. Macrophage cholesterol efflux (CEC), the initial step of reverse cholesterol transport, is inversely associated with CHD and may be affected by sex as well as haptoglobin copy number variants among patients with diabetes mellitus. We investigated the effect of anacetrapib on CEC and whether this effect is modified by sex, diabetes mellitus, and haptoglobin polymorphism. Methods and Results A total of 574 participants with CHD were included from the DEFINE (Determining the Efficacy and Tolerability of CETP Inhibition With Anacetrapib) trial. CEC was measured at baseline and 24‐week follow‐up using J774 macrophages, boron dipyrromethene difluoride–labeled cholesterol, and apolipoprotein B–depleted plasma. Haptoglobin copy number variant was determined using an ELISA assay. Anacetrapib increased CEC, adjusted for baseline CEC, risk factors, and changes in lipids/apolipoproteins (standard β, 0.23; 95% CI, 0.05–0.41). This CEC‐raising effect was seen only in men (P interaction=0.002); no effect modification was seen by diabetes mellitus status. Among patients with diabetes mellitus, anacetrapib increased CEC in those with the normal 1‐1 haptoglobin genotype (standard β, 0.42; 95% CI, 0.16–0.69) but not the dysfunctional 2‐1/2‐2 genotypes (P interaction=0.02). Conclusions Among patients with CHD, anacetrapib at a dose linked to improved CHD outcomes significantly increased CEC independent of changes in high‐density lipoprotein cholesterol or other lipids, with effect modification by sex and a novel pharmacogenomic interaction by haptoglobin genotype, suggesting a putative mechanism for reduced risk requiring validation.
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Affiliation(s)
- Mark P. Metzinger
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Suzanne Saldanha
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Jaskeerat Gulati
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Kershaw V. Patel
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Ayea El‐Ghazali
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Sneha Deodhar
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Parag H. Joshi
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Colby Ayers
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
| | - Anand Rohatgi
- Division of CardiologyDepartment of Internal MedicineUT Southwestern Medical CenterDallasTX
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Hendren NS, de Lemos JA, Ayers C, Das SR, Rao A, Carter S, Rosenblatt A, Walchok J, Omar W, Khera R, Hegde AA, Drazner MH, Neeland IJ, Grodin JL. Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation 2020; 143:135-144. [PMID: 33200947 DOI: 10.1161/circulationaha.120.051936] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obesity may contribute to adverse outcomes in coronavirus disease 2019 (COVID-19). However, studies of large, broadly generalizable patient populations are lacking, and the effect of body mass index (BMI) on COVID-19 outcomes- particularly in younger adults-remains uncertain. METHODS We analyzed data from patients hospitalized with COVID-19 at 88 US hospitals enrolled in the American Heart Association's COVID-19 Cardiovascular Disease Registry with data collection through July 22, 2020. BMI was stratified by World Health Organization obesity class, with normal weight prespecified as the reference group. RESULTS Obesity, and, in particular, class III obesity, was overrepresented in the registry in comparison with the US population, with the largest differences among adults ≤50 years. Among 7606 patients, in-hospital death or mechanical ventilation occurred in 2109 (27.7%), in-hospital death in 1302 (17.1%), and mechanical ventilation in 1602 (21.1%). After multivariable adjustment, classes I to III obesity were associated with higher risks of in-hospital death or mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.57 [1.29-1.91], 1.80 [1.47-2.20], respectively), and class III obesity was associated with a higher risk of in-hospital death (hazard ratio, 1.26 [95% CI, 1.00-1.58]). Overweight and class I to III obese individuals were at higher risk for mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.54 [1.29-1.84], 1.88 [1.52-2.32], and 2.08 [1.68-2.58], respectively). Significant BMI by age interactions were seen for all primary end points (P-interaction<0.05 for each), such that the association of BMI with death or mechanical ventilation was strongest in adults ≤50 years, intermediate in adults 51 to 70 years, and weakest in adults >70 years. Severe obesity (BMI ≥40 kg/m2) was associated with an increased risk of in-hospital death only in those ≤50 years (hazard ratio, 1.36 [1.01-1.84]). In adjusted analyses, higher BMI was associated with dialysis initiation and with venous thromboembolism but not with major adverse cardiac events. CONCLUSIONS Obese patients are more likely to be hospitalized with COVID-19, and are at higher risk of in-hospital death or mechanical ventilation, in particular, if young (age ≤50 years). Obese patients are also at higher risk for venous thromboembolism and dialysis. These observations support clear public health messaging and rigorous adherence to COVID-19 prevention strategies in all obese individuals regardless of age.
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Affiliation(s)
- Nicholas S Hendren
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
| | - James A de Lemos
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
| | - Colby Ayers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
| | - Sandeep R Das
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
| | - Anjali Rao
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
| | - Spencer Carter
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
| | - Anna Rosenblatt
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
| | | | - Wally Omar
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (W.O.)
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (R.K.)
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (R.K.)
| | - Anita A Hegde
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
| | - Mark H Drazner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
| | - Ian J Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH (I.J.N.)
| | - Justin L Grodin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.)
- Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.)
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Park JM, Reed GD, Liticker J, Putnam WC, Chandra A, Yaros K, Afzal A, MacNamara J, Raza J, Hall RG, Baxter J, Derner K, Pena S, Kallem RR, Subramaniyan I, Edpuganti V, Harrison CE, Muthukumar A, Lewis C, Reddy S, Unni N, Klemow D, Syed S, Li H, Cole S, Froehlich T, Ayers C, de Lemos J, Malloy CR, Haley B, Zaha VG. Effect of Doxorubicin on Myocardial Bicarbonate Production From Pyruvate Dehydrogenase in Women With Breast Cancer. Circ Res 2020; 127:1568-1570. [PMID: 33054563 DOI: 10.1161/circresaha.120.317970] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jae Mo Park
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas.,Radiology (J.M.P., C.R.M.), University of Texas Southwestern Medical Center, Dallas.,Electrical and Computer Engineering, The University of Texas at Dallas, Richardson (J.M.P.)
| | - Galen D Reed
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas.,GE Healthcare, Dallas, TX (G.D.R.)
| | - Jeff Liticker
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas
| | - William C Putnam
- Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University, Dallas Campus (W.C.P., J.R., R.G.H., R.R.K., I.S., V.E.)
| | - Alvin Chandra
- Division of Cardiology (A.C., A.A., J.M., C.A., J.d.L., C.R.M.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Katarina Yaros
- Department of Internal Medicine (K.Y.), University of Texas Southwestern Medical Center, Dallas
| | - Aneela Afzal
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology (A.C., A.A., J.M., C.A., J.d.L., C.R.M.), University of Texas Southwestern Medical Center, Dallas
| | - James MacNamara
- Division of Cardiology (A.C., A.A., J.M., C.A., J.d.L., C.R.M.), University of Texas Southwestern Medical Center, Dallas
| | - Jaffar Raza
- Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University, Dallas Campus (W.C.P., J.R., R.G.H., R.R.K., I.S., V.E.)
| | - Ronald G Hall
- Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University, Dallas Campus (W.C.P., J.R., R.G.H., R.R.K., I.S., V.E.)
| | - Jeannie Baxter
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas
| | - Kelley Derner
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas
| | - Salvador Pena
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas
| | - Raja Reddy Kallem
- Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University, Dallas Campus (W.C.P., J.R., R.G.H., R.R.K., I.S., V.E.)
| | - Indhu Subramaniyan
- Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University, Dallas Campus (W.C.P., J.R., R.G.H., R.R.K., I.S., V.E.)
| | - Vindhya Edpuganti
- Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University, Dallas Campus (W.C.P., J.R., R.G.H., R.R.K., I.S., V.E.)
| | - Crystal E Harrison
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas
| | - Alagar Muthukumar
- Pathology (A.M., C.L., S.R.), University of Texas Southwestern Medical Center, Dallas
| | - Cheryl Lewis
- Pathology (A.M., C.L., S.R.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Sangeetha Reddy
- Pathology (A.M., C.L., S.R.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Nisha Unni
- Division of Hematology and Oncology (N.U., D.K., S.S., H.L., S.C., T.F., B.H.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Dawn Klemow
- Division of Hematology and Oncology (N.U., D.K., S.S., H.L., S.C., T.F., B.H.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Samira Syed
- Division of Hematology and Oncology (N.U., D.K., S.S., H.L., S.C., T.F., B.H.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Hsiao Li
- Division of Hematology and Oncology (N.U., D.K., S.S., H.L., S.C., T.F., B.H.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Suzanne Cole
- Division of Hematology and Oncology (N.U., D.K., S.S., H.L., S.C., T.F., B.H.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Thomas Froehlich
- Division of Hematology and Oncology (N.U., D.K., S.S., H.L., S.C., T.F., B.H.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Colby Ayers
- Division of Cardiology (A.C., A.A., J.M., C.A., J.d.L., C.R.M.), University of Texas Southwestern Medical Center, Dallas
| | - James de Lemos
- Division of Cardiology (A.C., A.A., J.M., C.A., J.d.L., C.R.M.), University of Texas Southwestern Medical Center, Dallas
| | - Craig R Malloy
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas.,Radiology (J.M.P., C.R.M.), University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology (A.C., A.A., J.M., C.A., J.d.L., C.R.M.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.).,Veterans Affairs North Texas Healthcare System, Dallas, Texas (C.R.M.)
| | - Barbara Haley
- Division of Hematology and Oncology (N.U., D.K., S.S., H.L., S.C., T.F., B.H.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
| | - Vlad G Zaha
- Advanced Imaging Research Center (J.M.P., G.D.R., J.L., A.A., J.B., K.D., S.P., C.E.H., C.R.M., V.G.Z.), University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas (A.C., C.L., S.R., N.U., D.K., S.S., H.L., S.C., T.F., C.R.M., B.H., V.G.Z.)
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Badia R, Ayers C, Rohatgi A. Elucidating the Link Between Alcohol and HDL Metabolism in the Multiethnic Dallas Heart Study. J Clin Lipidol 2020. [DOI: 10.1016/j.jacl.2020.05.081] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bergstrom CP, Beg MS, Ayers C, Gupta A, Neeland IJ. The association of lymphotoxin-beta receptor with the subsequent diagnosis of incident gastrointestinal cancer: results from the Dallas Heart Study. J Gastrointest Oncol 2020; 11:36-44. [PMID: 32175103 DOI: 10.21037/jgo.2020.01.04] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Lymphotoxin-beta receptor (LTβR) is an immunological protein associated with inflammation, and from preclinical studies is implicated in tumorigenesis. The epidemiological relationships with cancer are unknown, hence this study investigated their associations. Methods From a multiethnic population-based cohort, 3,032 participants without a prevalent cancer (a diagnosis prior to or within one year of enrollment) at baseline underwent measurement of plasma LTβR. These participants were followed for incident cancer using the Texas Cancer Registry (TCR). Results Over a median follow-up of 12.1 years, 178 participants developed incident cancer, of which 30 participants developed incident gastrointestinal (GI) cancer. Median plasma LTβR (1.10 vs. 1.00 ng/mL, P<0.02) levels were higher in individuals with overall incident cancer compared to those without cancer. After adjustments for age, sex, and race/ethnicity, these relationships were no longer significant. When analyses were stratified by cancer type, LTβR was positively associated with GI cancer after adjustments: HR, 95% CI per 1-standard deviation increase in concentration 2.64 (1.23-5.68), P=0.013. LTβR stratified by quartiles was significantly associated temporally with the risk of incident GI cancer, log-rank: P=0.011. The median interval to incident GI cancer diagnosis was 5.9 years. Conclusions Increased plasma levels of LTβR are associated with the development of GI cancer. The antecedent findings years prior to a subsequent diagnosis of incident GI cancer suggest a role for LTβR in the pathogenesis of GI cancer. Further studies are needed to determine if LTβR can serve as an immune biomarker for GI cancer, in particular hepatocellular and colorectal cancers.
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Affiliation(s)
- Colin P Bergstrom
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Muhammad S Beg
- Division of Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arjun Gupta
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ian J Neeland
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ceasar JN, Ayers C, Andrews MR, Claudel SE, Tamura K, Das S, de Lemos J, Neeland IJ, Powell-Wiley TM. Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study. PLoS One 2020; 15:e0230041. [PMID: 32163470 PMCID: PMC7067436 DOI: 10.1371/journal.pone.0230041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/20/2018] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Neighborhood environment perception (NEP) has been associated with health outcomes. However, little is known about how NEP relates to routine healthcare utilization. This study investigated the relationship between NEP and independent subfactors with healthcare utilization behavior, as measured by self-reported (1) usual source of healthcare and (2) time since last routine healthcare check-up. We used cross-sectional data from the Dallas Heart Study, which features a diverse, probability-based sample of Dallas County residents ages 18 to 65. We used logistic regression modeling to examine the association of self-reported NEP and routine healthcare utilization. NEP was assessed via a questionnaire exploring residents' neighborhood perceptions, including violence, the physical environment, and social cohesion. Routine healthcare utilization was assessed via self-reported responses regarding usual source of care and time since last routine healthcare check-up. The analytic sample (N = 1706) was 58% black, 27% white, 15% Hispanic, 42% male, and had a mean age of 51 (SD = 10.3). Analysis of NEP by tertile demonstrated that younger age, lower income, and lower education were associated with unfavorable overall NEP (p trend <0.05 for each). After adjustment for potential confounders, including neighborhood deprivation, health insurance, disease burden and psychosocial factors, we found that individuals with more unfavorable perception of their physical environment were more likely to report lack of a usual source of care (p = 0.013). Individuals with more unfavorable perception of the neighborhood physical environment or greater neighborhood violence reported longer time periods since last routine visit (p = 0.001, p = 0.034 respectively). There was no relationship between perceived social cohesion and healthcare utilization. Using a multi-ethnic cohort, we found that NEP significantly associates with report of a usual source of care and time since last routine check-up. Our findings suggest that public health professionals should prioritize improving NEP since it may act as barrier to routine preventive healthcare and ideal health outcomes.
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Affiliation(s)
- Joniqua N. Ceasar
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Colby Ayers
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Marcus R. Andrews
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sophie E. Claudel
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kosuke Tamura
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sandeep Das
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - James de Lemos
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Ian J. Neeland
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Tiffany M. Powell-Wiley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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McCoy C, Ayers C, Neeland I. PROFILING THE DISCORDANT VISCERAL ADIPOSE TISSUE – ECTOPIC LIVER FAT PHENOTYPE: RESULTS FROM THE DALLAS HEART STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32653-x] [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: 11/24/2022]
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Riggs K, Joshi P, Khera A, Ayers C, Rohatgi A. INFLAMMATORY MARKER, GLYCA, OUTPERFORMS HSCRP IN PREDICTING CARDIOVASCULAR EVENTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32489-x] [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: 12/01/2022]
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Vasquez N, Mehta A, Ayers C, Patel J, Hooda A, Khera A, Blaha M, Blumenthal RS, Tsai M, Sperling LS, Shapiro MD, Virani SS, Joshi P. LIPOPROTEIN(A) AND CORONARY ARTERY CALCIUM SCORE FOR PREDICTING ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32473-6] [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: 10/24/2022]
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Makshood M, Joshi P, Kanaya A, Ayers C, Budoff MJ, Tsai M, Blaha M, Michos E, Post WS. ASSOCIATION BETWEEN LIPOPROTEIN (A) WITH AORTIC VALVE CALCIUM IN SOUTH ASIANS AND COMPARISON TO OTHER RACE/ETHNIC GROUPS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32557-2] [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: 11/28/2022]
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