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Hall EJ, Ayers CR, Kolkailah AA, Rutan C, Walchok J, Williams JH, Wang TY, Rodriguez F, Bradley SM, Stevens L, Hall JL, Mallya P, Roth GA, Morrow DA, Elkind MSV, Das SR, de Lemos JA. Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. Circ Cardiovasc Qual Outcomes 2023; 16:e009652. [PMID: 37017087 PMCID: PMC10178917 DOI: 10.1161/circoutcomes.122.009652] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time. METHODS We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models. RESULTS A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63). CONCLUSIONS Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.
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Affiliation(s)
- Eric J Hall
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - Ahmed A Kolkailah
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - Christine Rutan
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Jason Walchok
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Joseph H Williams
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, NC (T.Y.W.)
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, CA (F.R.)
| | | | - Laura Stevens
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Jennifer L Hall
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Pratheek Mallya
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Gregory A Roth
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (G.A.R.)
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.A.M.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Sandeep R Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
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Zuo Y, Navaz S, Liang W, Li C, Ayers CR, Rysenga CE, Harbaugh A, Norman GL, Solow EB, Bermas B, Akinmolayemi O, Rohatgi A, Karp DR, Knight JS, de Lemos JA. Prevalence of Antiphospholipid Antibodies and Association With Incident Cardiovascular Events. JAMA Netw Open 2023; 6:e236530. [PMID: 37014642 PMCID: PMC10074226 DOI: 10.1001/jamanetworkopen.2023.6530] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Importance The prevalence of antiphospholipid antibodies (aPL) and their association with future atherosclerotic cardiovascular disease (ASCVD) risk has yet to be thoroughly investigated. Objective To determine the association between measurements of aPL at a single time point and ASCVD risk in a diverse population. Design, Setting, and Participants This cohort study measured 8 aPL (anticardiolipin [aCL] IgG/IgM/IgA, anti-beta-2 glycoprotein I [aβ2GPI] IgG/IgM/IgA, and antiphosphatidylserine/prothrombin [aPS/PT] IgG/IgM) by solid-phase assays in plasma from participants of the Dallas Heart Study (DHS) phase 2, a multiethnic, population-based cohort study. Blood samples were collected between 2007 and 2009. The median follow-up was 8 years. Statistical analysis was performed from April 2022 to January 2023. Main Outcomes and Measures Associations of aPL with future ASCVD events (defined as first nonfatal myocardial infarction, first nonfatal stroke, coronary revascularization, or death from cardiovascular cause) were assessed by Cox proportional hazards models, adjusting for known risk factors, medications, and multiple comparisons. Results Among the 2427 participants (mean [SD] age, 50.6 [10.3] years; 1399 [57.6%] female; 1244 [51.3%] Black, 339 [14.0%] Hispanic, and 796 [32.8%] White), the prevalence of any positive aPL tested at a single time point was 14.5% (353 of 2427), with approximately one-third of those detected at a moderate or high titer; aCL IgM had the highest prevalence (156 individuals [6.4%]), followed by aPS/PT IgM (88 [3.4%]), aβ2GPI IgM (63 [2.6%]), and aβ2GPI IgA (62 [2.5%]). The IgA of aCL (adjusted hazard ratio [HR], 4.92; 95% CI, 1.52-15.98) and aβ2GPI (HR, 2.91; 95% CI, 1.32-6.41) were independently associated with future ASCVD events. The risk further increased when applying a positivity threshold of at least 40 units (aCL IgA: HR, 9.01 [95% CI, 2.73-29.72]; aβ2GPI IgA: HR, 4.09 [95% CI, 1.45-11.54]). Levels of aβ2GPI IgA negatively correlated with cholesterol efflux capacity (r = -0.055; P = .009) and positively correlated with circulating oxidized LDL (r = 0.055; P = .007). aβ2GPI IgA-positive plasma was associated with an activated endothelial cell phenotype as evidenced by increased surface expression of surface E-selectin, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1. Conclusions and Relevance In this population-based cohort study, aPL detectable by solid-phase assays were present in a substantial proportion of adults; positive aCL IgA and aβ2GPI IgA at a single time point were independently associated with future ASCVD events. Longitudinal studies with serial aPL measurements are needed to further explore these findings.
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Affiliation(s)
- Yu Zuo
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Sherwin Navaz
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Wenying Liang
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Christine E Rysenga
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Alyssa Harbaugh
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Gary L Norman
- Headquarters & Technology Center Autoimmunity, Werfen, San Diego, California
| | - E Blair Solow
- Division of Rheumatic Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Bonnie Bermas
- Division of Rheumatic Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Oludamilola Akinmolayemi
- Department of Internal Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - David R Karp
- Division of Rheumatic Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jason S Knight
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Thibodeau JT, Ravipati G, Pham DD, Ayers CR, Hardin EA, Chin KM, Grodin JL, Drazner MH. Disentangling the Pulmonary Capillary Wedge Pressure From the Pulmonary Artery Pressure as the Hemodynamic Underpinning of Bendopnea. Circ Heart Fail 2023; 16:e010169. [PMID: 36809040 DOI: 10.1161/circheartfailure.122.010169] [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: 01/26/2023]
Affiliation(s)
- Jennifer T Thibodeau
- Divisions of Cardiology (J.T.T., C.R.A., E.A.H., J.L.G., M.H.D.), University of Texas Southwestern Medical Center, Dallas
| | - Goutham Ravipati
- Department of Internal Medicine (G.R.), University of Texas Southwestern Medical Center, Dallas
| | - David D Pham
- Department of Medicine, Cardiovascular Division, University of Wisconsin, Madison (D.D.P.)
| | - Colby R Ayers
- Divisions of Cardiology (J.T.T., C.R.A., E.A.H., J.L.G., M.H.D.), University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth A Hardin
- Divisions of Cardiology (J.T.T., C.R.A., E.A.H., J.L.G., M.H.D.), University of Texas Southwestern Medical Center, Dallas
| | - Kelly M Chin
- Pulmonary (K.M.C.), University of Texas Southwestern Medical Center, Dallas
| | - Justin L Grodin
- Divisions of Cardiology (J.T.T., C.R.A., E.A.H., J.L.G., M.H.D.), University of Texas Southwestern Medical Center, Dallas
| | - Mark H Drazner
- Divisions of Cardiology (J.T.T., C.R.A., E.A.H., J.L.G., M.H.D.), University of Texas Southwestern Medical Center, Dallas
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Badia RR, Pradhan RV, Ayers CR, Chandra A, Rohatgi A. The Relationship of Alcohol Consumption and HDL Metabolism in the Multiethnic Dallas Heart Study. J Clin Lipidol 2023; 17:124-130. [PMID: 36464598 DOI: 10.1016/j.jacl.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Small studies have suggested that moderate alcohol consumption increases HDL cholesterol (HDL-C) levels and cholesterol efflux capacity (CEC), a main anti-atherosclerotic HDL function. OBJECTIVES This study aimed to understand the degree to which alcohol intake is associated with various HDL markers in a large, multiethnic population cohort, the Dallas Heart Study (DHS), and whether alcohol modifies the link between HDL markers and atherosclerotic cardiovascular disease (ASCVD). METHODS Participants of the DHS were included if they had self-reported alcohol intake and CEC measurements (N=2,919). Alcohol intake was analyzed continuously (grams/week) and as an ordered categorical variable (never, past, light, moderate, heavy, and binge drinkers). HDL-C, CEC, HDL particle number (HDL-P), HDL particle size (HDL-size), and ApoA-I were the primary HDL measures. RESULTS After adjustment for confounding variables, increasing continuous measure of alcohol intake was associated with increased levels of all HDL markers. Moreover, as compared to moderate drinkers, light drinkers had decreased levels of the HDL markers. CONCLUSION In a large, multiethnic cohort, increased alcohol intake was associated with increased levels of multiple markers of HDL metabolism. However, the association of HDL markers with ASCVD risk as modified by alcohol consumption is unable to be determined in this low-risk cohort.
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Affiliation(s)
- Rohit R Badia
- Department of Internal Medicine Division of Cardiology, University of Texas Southwestern Medical Center, , 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Roma V Pradhan
- Department of Internal Medicine Division of Cardiology, University of Texas Southwestern Medical Center, , 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Colby R Ayers
- Department of Internal Medicine Division of Cardiology, University of Texas Southwestern Medical Center, , 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Alvin Chandra
- Department of Internal Medicine Division of Cardiology, University of Texas Southwestern Medical Center, , 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Anand Rohatgi
- Department of Internal Medicine Division of Cardiology, University of Texas Southwestern Medical Center, , 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
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Rosenblatt AG, Ayers CR, Rao A, Howell SJ, Hendren NS, Zadikany RH, Ebinger JE, Daniels JD, Link MS, de Lemos JA, Das SR. New-Onset Atrial Fibrillation in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Registry. Circ Arrhythm Electrophysiol 2022; 15:e010666. [PMID: 35475654 DOI: 10.1161/circep.121.010666] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 12/30/2022]
Abstract
BACKGROUND New-onset atrial fibrillation (AF) in patients hospitalized with COVID-19 has been reported and associated with poor clinical outcomes. We aimed to understand the incidence of and outcomes associated with new-onset AF in a diverse and representative US cohort of patients hospitalized with COVID-19. METHODS We used data from the American Heart Association COVID-19 Cardiovascular Disease Registry. Patients were stratified by the presence versus absence of new-onset AF. The primary and secondary outcomes were in-hospital mortality and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, stroke, cardiogenic shock, and heart failure). The association of new-onset AF and the primary and secondary outcomes was evaluated using Cox proportional-hazards models for the primary time to event analyses. RESULTS Of the first 30 999 patients from 120 institutions across the United States hospitalized with COVID-19, 27 851 had no history of AF. One thousand five hundred seventeen (5.4%) developed new-onset AF during their index hospitalization. New-onset AF was associated with higher rates of death (45.2% versus 11.9%) and MACE (23.8% versus 6.5%). The unadjusted hazard ratio for mortality was 1.99 (95% CI, 1.81-2.18) and for MACE was 2.23 (95% CI, 1.98-2.53) for patients with versus without new-onset AF. After adjusting for demographics, clinical comorbidities, and severity of disease, the associations with death (hazard ratio, 1.10 [95% CI, 0.99-1.23]) fully attenuated and MACE (hazard ratio, 1.31 [95% CI, 1.14-1.50]) partially attenuated. CONCLUSIONS New-onset AF was common (5.4%) among patients hospitalized with COVID-19. Almost half of patients with new-onset AF died during their index hospitalization. After multivariable adjustment for comorbidities and disease severity, new-onset AF was not statistically significantly associated with death, suggesting that new-onset AF in these patients may primarily be a marker of other adverse clinical factors rather than an independent driver of mortality. Causality between the MACE composites and AF needs to be further evaluated.
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Affiliation(s)
- Anna G Rosenblatt
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
| | - Colby R Ayers
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
| | - Anjali Rao
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
| | - Stacey J Howell
- Division of Cardiology, Department of Medicine, University of San Francisco, CA (S.J.H.)
| | - Nicholas S Hendren
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
| | - Ronit H Zadikany
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.H.Z., J.E.E.)
| | - Joseph E Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.H.Z., J.E.E.)
| | - James D Daniels
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
| | - Mark S Link
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
| | - James A de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
| | - Sandeep R Das
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.)
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Mehta A, Vasquez N, Ayers CR, Patel J, Hooda A, Khera A, Blumenthal RS, Shapiro MD, Rodriguez CJ, Tsai MY, Sperling LS, Virani SS, Blaha MJ, Joshi PH. Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk. J Am Coll Cardiol 2022; 79:757-768. [PMID: 35210030 PMCID: PMC10966924 DOI: 10.1016/j.jacc.2021.11.058] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [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: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. OBJECTIVES This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. METHODS Plasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor-adjusted Cox regression models. RESULTS Among MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. CONCLUSIONS Lp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nestor Vasquez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaideep Patel
- Virginia Commonwealth University Pauley Heart Center, Richmond, Virginia, USA
| | - Ananya Hooda
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Michael D Shapiro
- Section of Cardiology, Department of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Carlos J Rodriguez
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Salim S Virani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Mauricio R, Singh K, Sanghavi M, Ayers CR, Rohatgi A, Vongpatanasin W, de Lemos JA, Khera A. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is associated with subclinical and clinical ASCVD: The Dallas Heart Study. Atherosclerosis 2022; 346:46-52. [DOI: 10.1016/j.atherosclerosis.2022.02.026] [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] [Received: 09/30/2021] [Revised: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 11/02/2022]
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Tejani S, McCoy C, Ayers CR, Powell-Wiley TM, Després JP, Linge J, Leinhard OD, Petersson M, Borga M, Neeland IJ. Cardiometabolic Health Outcomes Associated With Discordant Visceral and Liver Fat Phenotypes: Insights From the Dallas Heart Study and UK Biobank. Mayo Clin Proc 2022; 97:225-237. [PMID: 34598789 PMCID: PMC8818017 DOI: 10.1016/j.mayocp.2021.08.021] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the cardiometabolic outcomes associated with discordant visceral adipose tissue (VAT) and liver fat (LF) phenotypes in 2 cohorts. PATIENTS AND METHODS Participants in the Dallas Heart Study underwent baseline imaging from January 1, 2000, through December 31, 2002, and were followed for incident cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) through 2013. Associations between VAT-LF groups (low-low, high-low, low-high, and high-high) and outcomes were assessed using multivariable-adjusted regression and were replicated in the independent UK Biobank. RESULTS The Dallas Heart Study included 2064 participants (mean ± SD age, 44±9 years; 54% female; 47% black). High VAT-high LF and high VAT-low LF were associated with prevalent atherosclerosis, whereas low VAT-high LF was not. Of 1731 participants without CVD/T2DM, 128 (7.4%) developed CVD and 95 (5.5%) T2DM over a median of 12 years. High VAT-high LF and high VAT-low LF were associated with increased risk of CVD (hazard ratios [HRs], 2.0 [95% CI, 1.3 to 3.2] and 2.4 [95% CI, 1.4 to 4.1], respectively) and T2DM (odds ratios [ORs], 7.8 [95% CI, 3.8 to 15.8] and 3.3 [95% CI, 1.4 to 7.8], respectively), whereas low VAT-high LF was associated with T2DM (OR, 2.7 [95% CI, 1.1 to 6.7]). In the UK Biobank (N=22,354; April 2014-May 2020), only high VAT-low LF remained associated with CVD after multivariable adjustment for age and body mass index (HR, 1.5 [95% CI, 1.2 to 1.9]). CONCLUSION Although VAT and LF are each associated with cardiometabolic risk, these observations demonstrate the importance of separating their cardiometabolic implications when there is presence or absence of either or both in an individual.
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Affiliation(s)
- Sanaa Tejani
- University of Texas Southwestern Medical School, Dallas, TX
| | - Cody McCoy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Colby R Ayers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Tiffany M Powell-Wiley
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Jean-Pierre Després
- Department of Kinesiology, Faculty of Medicine, Université Laval and VITAM - Centre de rercherche en santé durable, CIUSSS Capitale-Nationale, Québec, QC, Canada
| | - Jennifer Linge
- AMRA Medical AB, Linköping, Sweden; Division of Society and Health, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- AMRA Medical AB, Linköping, Sweden; Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden; Department of Health, Medicine, and Caring Sciences, Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | - Magnus Borga
- AMRA Medical AB, Linköping, Sweden; Department of Health, Medicine, and Caring Sciences, Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Division of Biomedical Engineering, Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ian J Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH.
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9
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Puleo CW, Ayers CR, Garg S, Neeland IJ, Lewis AA, Pandey A, Drazner MH, de Lemos JA. Factors associated with baseline and serial changes in circulating NT-proBNP and high-sensitivity cardiac troponin T in a population-based cohort (Dallas Heart Study). Biomark Med 2021; 15:1487-1498. [PMID: 34663078 PMCID: PMC8739394 DOI: 10.2217/bmm-2021-0055] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022] Open
Abstract
Aim: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) associate with structural heart disease and heart failure risk in individuals without known cardiovascular disease (CVD). However, few data are available regarding whether factors influencing levels of these two biomarkers are similar or distinct. We performed serial measurement of NT-proBNP and hs-cTnT in a contemporary multiethnic cohort with extensive phenotyping, with the goal of identifying their respective biological determinants in a population without known or suspected CVD. Methods: We evaluated 1877 participants of the Dallas Heart Study who had NT-proBNP and hs-cTnT measured and were free from clinical CVD at the each of its two examinations (2000-2002 and 2007-2009). Variables collected included demographic and risk factors, high-sensitivity C-reactive protein, body composition via dual-energy x-ray absorptiometry, coronary artery calcium by computed tomography, and cardiac dimensions and function by cardiac MRI. Linear regression was used to identify associations of these factors with each biomarker at baseline and with changes in biomarkers over follow-up. Results: NT-proBNP and hs-cTnT were poorly correlated at baseline (Spearman rho 0.083, p = 0.015), with only moderate correlation between change values (rho 0.18, p < 0.001). hs-cTnT positively associated and NT-proBNP inversely associated with male gender and black race. At baseline, both NT-proBNP and hs-cTnT associated with left ventricular end-diastolic volume and wall thickness, but only NT-proBNP associated with left atrial size. Changes in cardiac dimensions between phases were more strongly associated with changes in NT-proBNP than hs-cTnT. NT-proBNP was more strongly associated with high-sensitivity C-reactive protein and measures of body composition than hs-cTnT. Conclusion: Among individuals without CVD in the general population, NT-proBNP and hs-cTnT are nonredundant biomarkers that are differentially associated with demographic and cardiac factors. These findings indicate that hs-cTnT and NT-proBNP may reflect different pathophysiological pathways.
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Affiliation(s)
- Christopher W Puleo
- Ochsner Medical Center, Heart and Vascular Institute, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Colby R Ayers
- University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ian J Neeland
- University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Alana A Lewis
- University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ambarish Pandey
- University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Mark H Drazner
- University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - James A de Lemos
- University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
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10
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Akinmolayemi O, Saldanha S, Joshi PH, Deodhar S, Ayers CR, Neeland IJ, Rohatgi A. Cholesterol efflux capacity and its association with prevalent metabolic syndrome in a multi-ethnic population (Dallas Heart Study). PLoS One 2021; 16:e0257574. [PMID: 34547056 PMCID: PMC8454977 DOI: 10.1371/journal.pone.0257574] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023] Open
Abstract
Metabolic syndrome (MetS) is characterized by adiposity and atherogenic dyslipidemia consisting of elevated triglyceride and decreased high density lipoprotein cholesterol (HDL-C) levels however, cholesterol concentration alone does not reflect HDL functionality. Cholesterol efflux capacity (CEC) captures a key anti-atherosclerotic function of HDL; studies linking CEC to MetS have yielded inconsistent findings and lacked racial/ethnic diversity. The aim of this study was to evaluate the association between CEC and MetS in a large multi-ethnic population utilizing two different CEC assays interrogating overlapping but distinct reverse cholesterol transport pathways. A cross-sectional study was performed using the Dallas Heart Study cohort and cholesterol efflux was measured with radiolabeled and fluorescent cholesterol assays. The relationship between CEC and MetS was assessed using multivariable regression analyses. A total of 2241 participants were included (mean age was 50 years; 38% men and 53% Blacks). CEC was independently and inversely associated with MetS irrespective of efflux assay (CEC-radiolabeled, adjusted OR 0·71 [95% CI 0·65-0·80]. CEC-fluorescent, adjusted OR 0·85 [95% CI 0·77-0·94]). Both CEC measures were inversely associated with waist circumference and directly associated with HDL-C but not with other MetS components. There was an interaction by sex but not by race such that the inverse associations between CEC and MetS were somewhat attenuated in men (OR 0·86, 95%CI 0·74-1·01). In this large multi-ethnic cohort, impaired CEC is linked to MetS irrespective of efflux assay and race/ethnicity but less so among men. Future studies are needed to assess whether CEC mediates the atherosclerotic cardiovascular disease risk of MetS.
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Affiliation(s)
- Oludamilola Akinmolayemi
- Department of Internal Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, United States of America
| | - Suzanne Saldanha
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Parag H. Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Sneha Deodhar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Colby R. Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Ian J. Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail:
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11
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Thibodeau JT, Pham DD, Kelly SA, Ayers CR, Garg S, Grodin JL, Drazner MH. Subclinical Myocardial Injury and the Phenotype of Clinical Congestion in Patients With Heart Failure and Reduced Left Ventricular Ejection Fraction. J Card Fail 2021; 28:422-430. [PMID: 34534666 DOI: 10.1016/j.cardfail.2021.09.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical congestion is associated with adverse outcomes in patients with heart failure. The pathophysiological mediators of this association remain uncertain. METHODS AND RESULTS We prospectively enrolled a cohort of patients with heart failure and reduced left ventricular ejection fraction and performed a detailed clinical examination followed on the same day by an invasive right heart catheterization and blood sampling for biomarkers. High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured. A clinical congestion score was calculated based on jugular venous pressure (cm H20 <10 = 0, 10-14 = 1, >14 = 2 points), bendopnea (0 vs 1), a third heart sound (0 vs 1), or peripheral edema (0-2). Congestion was categorized into tiers as absent (0 points), mild (1 point), or moderate to severe (≥ 2 points). We tested for associations of high-sensitivity troponin T, NT-proBNP, and elevated ventricular filling pressures with clinical congestion in both univariate and multivariable analyses. Of 153 participants, 65 (42%) had absent, 35 mild (23%), and 53 (35%) had moderate to severe clinical congestion. Congestion tier was associated with higher NT-proBNP and hs-troponin levels, and the right atrial pressure and pulmonary capillary wedge pressure (P < .001 for each). Increased congestion tier was also associated with the coexistent presence of elevated troponin T (≥52 ng/L), NT-proBNP (≥1000 pg/mL), and pulmonary capillary wedge pressure (≥22 mm Hg). Specifically, 78% of those with absent clinical congestion had 0 to 1 of these findings, whereas 75% of those with moderate-severe congestion had 2 or all 3 of these abnormalities (P < .001). An elevated hs-troponin was associated with mild or greater clinical congestion (odds ratio 3, 95% confidence interval 1.2-7.5, P = .02) in multivariable analysis adjusting for potential confounders including the right atrial pressure, pulmonary capillary wedge pressure, and NT-proBNP levels. CONCLUSIONS Clinical congestion is a phenotype in which there is a high coexistent presence of elevated ventricular filling pressures, elevated natriuretic peptide levels, and subclinical myocardial injury. An elevated troponin was associated with clinical congestion in multivariable models that adjusted for ventricular filling pressures and natriuretic peptide levels. These data strengthen the evidence base for an association of elevated troponin with clinical congestion, suggesting that subclinical myocardial injury may be an important contributor to the pathophysiology of the congested state.
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Affiliation(s)
- Jennifer T Thibodeau
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David D Pham
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samuel A Kelly
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sonia Garg
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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12
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Pham DD, Drazner MH, Ayers CR, Grodin JL, Hardin EA, Garg S, Mammen PPA, Amin A, Araj FG, Morlend RM, Thibodeau JT. Identifying Discordance of Right- and Left-Ventricular Filling Pressures in Patients With Heart Failure by the Clinical Examination. Circ Heart Fail 2021; 14:e008779. [PMID: 34503353 DOI: 10.1161/circheartfailure.121.008779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
BACKGROUND In ≈25% of patients with heart failure and reduced left-ventricular ejection fraction, right-ventricular (RV), and left-ventricular (LV) filling pressures are discordant (ie, one is elevated while the other is not). Whether clinical assessment allows detection of this discordance is unknown. We sought to determine the agreement of clinically versus invasively determined patterns of ventricular congestion. METHODS In 156 heart failure and reduced LV ejection fraction subjects undergoing invasive hemodynamic assessment, we categorized patterns of ventricular congestion (no congestion, RV only, LV only, or both) based on clinical findings of RV (jugular venous distention) or LV (hepatojugular reflux, orthopnea, or bendopnea) congestion. Agreement between clinically and invasively determined (RV congestion if right atrial pressure [RAP] ≥10 mm Hg and LV congestion if pulmonary capillary wedge pressure [PCWP] ≥22 mm Hg) categorizations was the primary end point. RESULTS The frequency of clinical patterns of congestion was: 51% no congestion, 24% both RV and LV, 21% LV only, and 4% RV only. Jugular venous distention had excellent discrimination for elevated RAP (C=0.88). However, agreement between clinical and invasive congestion patterns was poor, к=0.44 (95% CI, 0.34-0.55). While those with no clinical congestion usually had low RAP and PCWP (67/79, 85%), over one-half (24/38, 64%) with isolated LV clinical congestion had PCWP <22 mm Hg, most (5/7, 71%) with isolated RV clinical congestion had PCWP ≥22 mm Hg, and ≈one-third (10/32, 31%) with both RV and LV clinical congestion had elevated RAP but PCWP <22 mm Hg. CONCLUSIONS While clinical examination allows accurate detection of elevated RAP, it does not allow accurate detection of discordant RV and LV filling pressures.
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Affiliation(s)
- David D Pham
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Mark H Drazner
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Justin L Grodin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth A Hardin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Sonia Garg
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Pradeep P A Mammen
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Alpesh Amin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Faris G Araj
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Robert M Morlend
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Jennifer T Thibodeau
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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13
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Neeland IJ, Marso SP, Ayers CR, Lewis B, Oslica R, Francis W, Rodder S, Pandey A, Joshi PH. Effects of liraglutide on visceral and ectopic fat in adults with overweight and obesity at high cardiovascular risk: a randomised, double-blind, placebo-controlled, clinical trial. Lancet Diabetes Endocrinol 2021; 9:595-605. [PMID: 34358471 DOI: 10.1016/s2213-8587(21)00179-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 05/24/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Visceral and ectopic fat are key drivers of adverse cardiometabolic outcomes in obesity. We aimed to evaluate the effects of injectable liraglutide 3·0 mg daily on body fat distribution in adults with overweight or obesity without type 2 diabetes at high cardiovascular disease risk. METHODS In this randomised, double-blind, placebo-controlled, phase 4, single centre trial, we enrolled community-dwelling adults, recruited from the University of Texas Southwestern Medical Center, with BMI of at least 30 kg/m2 or BMI of at least 27 kg/m2 with metabolic syndrome but without diabetes and randomly assigned them, in a 1:1 ratio, to 40 weeks of treatment with once-daily subcutaneous liraglutide 3·0 mg or placebo, in addition to a 500 kcal deficient diet and guideline-recommended physical activity counselling. The primary endpoint was percentage reduction in visceral adipose tissue (VAT) measured with MRI. All randomly assigned participants with a follow-up imaging assessment were included in efficacy analyses and all participants who received at least one dose of study drug were included in the safety analyses. The trial is registered on ClinicalTrials.gov: NCT03038620. FINDINGS Between July 20, 2017 and Feb 21, 2020 from 235 participants assessed for eligibility, 185 participants were randomly assigned (n=92 liraglutide, n=93 placebo) and 128 (n=73 liraglutide, n=55 placebo) were included in the final analysis (92% female participants, 37% Black participants, 24% Hispanic participants, mean age 50·2 years (SD 9·4), mean BMI 37·7 kg/m2). Mean change in VAT over median 36·2 weeks was -12·49% (SD 9·3%) with liraglutide compared with -1·63% (SD 12·3%) with placebo, estimated treatment difference -10·86% (95% CI -6·97 to -14·75, p<0·0001). Effects seemed consistent across subgroups of age, sex, race-ethnicity, BMI, and baseline prediabetes. The most frequently reported adverse events were gastrointestinal-related (43 [47%] of 92 with liraglutide and 12 [13%] of 93 with placebo) and upper respiratory tract infections (10 [11%] of 92 with liraglutide and 14 [15%] of 93 with placebo). INTERPRETATION In adults with overweight or obesity at high cardiovascular disease risk, once-daily liraglutide 3·0 mg plus lifestyle intervention significantly lowered visceral adipose tissue over 40 weeks of treatment. Visceral fat reduction may be one mechanism to explain the benefits seen on cardiovascular outcomes in previous trials with liraglutide among patients with type 2 diabetes. FUNDING NovoNordisk.
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Affiliation(s)
- Ian J Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bienka Lewis
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert Oslica
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wynona Francis
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Rodder
- 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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14
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Khan SS, Agarwal A, Ayers CR, Jin E, Neeland IJ. Effects of Empagliflozin Treatment on Cardiac Biomarkers in Adults With Metabolically Healthy Obesity: Results From a Randomized, Placebo-Controlled Clinical Trial. Mayo Clin Proc 2021; 96:2282-2284. [PMID: 34353477 PMCID: PMC8446809 DOI: 10.1016/j.mayocp.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anubha Agarwal
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eunsook Jin
- Advanced Imaging Research Center and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian J Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH
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15
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Michelis KC, Grodin JL, Zhong L, Pandey A, Toto K, Ayers CR, Thibodeau JT, Drazner MH. Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing. J Am Heart Assoc 2021; 10:e019864. [PMID: 34180246 PMCID: PMC8403334 DOI: 10.1161/jaha.120.019864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/09/2023]
Abstract
Background Patient‐reported outcomes may be discordant to severity of illness as assessed by objective parameters. The frequency of this discordance and its influence on clinical outcomes in patients with heart failure is unknown. Methods and Results In HF‐ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), participants (N=2062) had baseline assessment of health‐related quality of life via the Kansas City Cardiomyopathy Clinical Summary score (KCCQ‐CS) and objective severity by cardiopulmonary stress testing (minute ventilation [VE]/carbon dioxide production [VCO2] slope). We defined 4 groups by median values: 2 concordant (lower severity: high KCCQ‐CS and low VE/VCO2 slope; higher severity: low KCCQ‐CS and high VE/VCO2 slope) and 2 discordant (symptom minimizer: high KCCQ‐CS and high VE/VCO2 slope; symptom magnifier: low KCCQ‐CS and low VE/VCO2 slope). The association of group assignment with mortality was assessed in adjusted Cox models. Symptom magnification (23%) and symptom minimization (23%) were common. Despite comparable KCCQ‐CS scores, the risk of all‐cause mortality in symptom minimizers versus concordant–lower severity participants was increased significantly (hazard ratio [HR], 1.79; 95% CI, 1.27–2.50; P<0.001). Furthermore, despite symptom magnifiers having a KCCQ‐CS score 28 points lower (poorer QOL) than symptom minimizers, their risk of mortality was not increased (HR, 0.79; 95% CI, 0.57–1.1; P=0.18, respectively). Conclusions Severity of illness by patient report versus cardiopulmonary exercise testing was frequently discordant. Mortality tracked more closely with the objective data, highlighting the importance of relying not only on patient report, but also objective data when risk stratifying patients with heart failure.
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Affiliation(s)
- Katherine C Michelis
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Justin L Grodin
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Lin Zhong
- Division of Bioinformatics Department of Clinical Sciences 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
| | - Kathleen Toto
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Colby R Ayers
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Jennifer T Thibodeau
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Mark H Drazner
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
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16
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Ajufo E, Rao S, Navar AM, Pandey A, Ayers CR, Khera A. Corrigendum to U.S. Population at Increased Risk of Severe Illness from COVID-19. Am J Prev Cardiol 2021; 6:100195. [PMID: 34131652 PMCID: PMC8192061 DOI: 10.1016/j.ajpc.2021.100195] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.ajpc.2021.100156.].
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Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX
| | - Shreya Rao
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
| | - Ann Marie Navar
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX.,Department of Clinical Sciences, UT Southwestern Medical Center; Dallas, TX
| | - Ambarish Pandey
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
| | - Colby R Ayers
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
| | - Amit Khera
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
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17
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Ajufo E, Rao S, Navar AM, Pandey A, Ayers CR, Khera A. U.S. population at increased risk of severe illness from COVID-19. Am J Prev Cardiol 2021; 6:100156. [PMID: 33615285 PMCID: PMC7880833 DOI: 10.1016/j.ajpc.2021.100156] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background The U.S. Centers for Disease Control and Prevention (CDC) recognizes that older adults and individuals with certain medical conditions are at increased risk of severe COVID-19 infection. Understanding the proportion of the population at risk of severe infection, including among those with heart disease, could assist current vaccine strategy efforts. Methods Using data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), we estimated the weighted prevalence of any of eight of eleven increased-risk conditions (including age ≥65) in U.S. adults aged ≥18 (N = 10,581) and extrapolated these results to a population of 233.8 million U.S. adults ≥18, and subgroups from the overall population defined by race/ethnicity, education, income and history of heart disease. Results An estimated 176.1 million individuals representing 75.4% of U.S. adults had at least one increased-risk condition, 40.3% ≥2 and, 18.5% ≥3 conditions. Approximately 129 million adults aged <65 (69.2%) were also estimated to be at increased-risk. Compared to Whites, similar proportions of Blacks in the overall population (78.0 vs. 75.6%, p>0.05) and Hispanics in the younger population (70.8 vs 68.4%) were estimated to be at increased-risk. Conversely, a greater proportion of individuals with lower education and income levels were estimated to be at increased-risk both in the overall and younger population. In addition, an estimated 6.2 million individuals (14.5%) had heart disease. Among these, virtually all had at least one additional CDC risk factor (97.9%) and most had ≥2 or ≥3 risk factors (83.8% and 58.5%, respectively). Conclusions As vaccination strategies are being explored, these results demonstrate that >75% of adults in the U.S. would be considered at increased-risk for severe COVID-19 infection by CDC criteria. Risk factor prevalence alone may not adequately capture the totality of risk, particularly among Black and Hispanic racial/ethnic groups and those with heart disease.
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Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Shreya Rao
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ann Marie Navar
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Colby R Ayers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Amit Khera
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
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Ajufo E, Ayers CR, Vigen R, Joshi PH, Rohatgi A, de Lemos JA, Khera A. Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease. JAMA Cardiol 2021; 6:179-187. [PMID: 33112372 DOI: 10.1001/jamacardio.2020.4939] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance Higher coronary artery calcium (CAC) identifies individuals at increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether it can also identify individuals likely to derive net benefit from aspirin therapy is unclear. Objective To examine the association between CAC, bleeding, and ASCVD and explore the net estimated effect of aspirin at different CAC thresholds. Design, Setting, and Participants Prospective population-based cohort study of Dallas Heart Study participants, free from ASCVD and not taking aspirin at baseline. Data were analyzed between February 1, 2020, and July 15, 2020. Exposures Coronary artery calcium score in the following categories: 0, 1-99, and 100 or higher. Main Outcomes and Measures Major bleeding and ASCVD events were identified from International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. Meta-analysis-derived aspirin effect estimates were applied to observed ASCVD and bleeding rates to model the net effect of aspirin at different CAC thresholds. Results A total of 2191 participants (mean [SD], age 44 [9.1] years, 1247 women [57%], and 1039 black individuals [47%]) had 116 major bleeding and 123 ASCVD events over a median follow-up of 12.2 years. Higher CAC categories (CAC 1-99 and ≥100 vs CAC 0) were associated with both ASCVD and bleeding events (hazard ratio [HR], 1.6; 95% CI, 1.1-2.4; HR, 2.6; 95% CI, 1.5-4.3; HR, 4.8; 95% CI, 2.8-8.2; P < .001; HR, 5.3; 95% CI, 3.6-7.9; P < .001), but the association between CAC and bleeding was attenuated after multivariable adjustment. Applying meta-analysis estimates, irrespective of CAC, aspirin use was estimated to result in net harm in individuals at low (<5%) and intermediate (5%-20%) 10-year ASCVD risk and net benefit in those at high (≥20%) ASCVD risk. Among individuals at lower bleeding risk, a CAC score of at least 100 identified individuals who would experience net benefit, but only in those at borderline or higher (≥5%) 10-year ASCVD risk. In individuals at higher bleeding risk, there would be net harm from aspirin irrespective of CAC and ASCVD risk. Conclusions and Relevance Higher CAC is associated with both ASCVD and bleeding events, with a stronger association with ASCVD. A high CAC score identifies individuals estimated to derive net benefit from primary prevention aspirin therapy from those who would not, but only in the setting of lower bleeding risk and estimated ASCVD risk that is not low.
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Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Rebecca Vigen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Parag H Joshi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Anand Rohatgi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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Kelly SA, Schesing KB, Thibodeau JT, Ayers CR, Drazner MH. Feasibility of Remote Video Assessment of Jugular Venous Pressure and Implications for Telehealth. JAMA Cardiol 2020; 5:1194-1195. [PMID: 32609293 DOI: 10.1001/jamacardio.2020.2339] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Samuel A Kelly
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Kevin B Schesing
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jennifer T Thibodeau
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Mark H Drazner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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20
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Khera R, Pandey A, Ayers CR, Carnethon MR, Greenland P, Ndumele CE, Nambi V, Seliger SL, Chaves PHM, Safford MM, Cushman M, Xanthakis V, Ramachandran VS, Mentz RJ, Correa A, Lloyd-Jones DM, Berry JD, de Lemos JA, Neeland IJ. Performance of the Pooled Cohort Equations to Estimate Atherosclerotic Cardiovascular Disease Risk by Body Mass Index. JAMA Netw Open 2020; 3:e2023242. [PMID: 33119108 PMCID: PMC7596579 DOI: 10.1001/jamanetworkopen.2020.23242] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Obesity is a global health challenge and a risk factor for atherosclerotic cardiovascular disease (ASVCD). Performance of the pooled cohort equations (PCE) for ASCVD risk by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is unknown. OBJECTIVE To assess performance of the PCE across clinical BMI categories. DESIGN, SETTING, AND PARTICIPANTS This cohort study used pooled individual-level data from 8 community-based, prospective, longitudinal cohort studies with 10-year ASCVD event follow-up from 1996 to 2016. We included all adults ages 40 to 79 years without baseline ASCVD or statin use, resulting in a sample size of 37 311 participants. Data were analyzed from August 2017 to July 2020. EXPOSURES Participant BMI category: underweight (<18.5), normal weight (18.5 to <25), overweight (25 to <30), mild obesity (30 to <35), and moderate to severe obesity (≥35). MAIN OUTCOMES AND MEASURES Discrimination (Harrell C statistic) and calibration (Nam-D'Agostino χ2 goodness-of-fit test) of the PCE across BMI categories. Improvement in discrimination and net reclassification with addition of BMI, waist circumference, and high-sensitivity C-reactive protein (hsCRP) to the PCE. RESULTS Among 37 311 participants (mean [SD] age, 58.6 [11.8] years; 21 897 [58.7%] women), 380 604 person-years of follow-up were conducted. Mean (SD) baseline BMI was 29.0 (6.2), and 360 individuals (1.0%) were in the underweight category, 9937 individuals (26.6%) were in the normal weight category, 13 601 individuals (36.4%) were in the overweight category, 7783 individuals (20.9%) were in the mild obesity category, and 5630 individuals (15.1%) were in the moderate to severe obesity category. Median (interquartile range [IQR]) 10-year estimated ASCVD risk was 7.1% (2.5%-15.4%), and 3709 individuals (9.9%) developed ASCVD over a median (IQR) 10.8 [8.5-12.6] years. The PCE overestimated ASCVD risk in the overall cohort (estimated/observed [E/O] risk ratio, 1.22; 95% CI, 1.18-1.26) and across all BMI categories except the underweight category. Calibration was better near the clinical decision threshold in all BMI groups but worse among individuals with moderate or severe obesity (E/O risk ratio, 1.36; 95% CI, 1.25-1.47) and among those with the highest estimated ASCVD risk ≥20%. The PCE C statistic overall was 0.760 (95% CI, 0.753-0.767), with lower discrimination in the moderate or severe obesity group (C statistic, 0.742; 95% CI, 0.721-0.763) compared with the normal-range BMI group (C statistic, 0.785; 95% CI, 0.772-0.798). Waist circumference (hazard ratio, 1.07 per 1-SD increase; 95% CI, 1.03-1.11) and hsCRP (hazard ratio, 1.07 per 1-SD increase; 95% CI, 1.05-1.09), but not BMI, were associated with increased ASCVD risk when added to the PCE. However, these factors did not improve model performance (C statistic, 0.760; 95% CI, 0.753-0.767) with or without added metrics. CONCLUSIONS AND RELEVANCE These findings suggest that the PCE had acceptable model discrimination and were well calibrated at clinical decision thresholds but overestimated risk of ASCVD for individuals in overweight and obese categories, particularly individuals with high estimated risk. Incorporation of the usual clinical measures of obesity did not improve risk estimation of the PCE. Future research is needed to determine whether incorporation of alternative high-risk obesity markers (eg, weight trajectory or measures of visceral or ectopic fat) into the PCE may improve risk prediction.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Colby R. Ayers
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chiadi E Ndumele
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vijay Nambi
- Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas
| | - Stephen L. Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Paulo H. M. Chaves
- Benjamin Leon Center for Geriatric Research and Education, Florida International University, Miami
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington
| | - Vanessa Xanthakis
- Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Vasan S. Ramachandran
- Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jarett D. Berry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - James A. de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Ian J. Neeland
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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21
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Mehta A, Pandey A, Ayers CR, Khera A, Sperling LS, Szklo MS, Gottesman RF, Budoff MJ, Blaha MJ, Blumenthal RS, Nasir K, Joshi PH. Predictive Value of Coronary Artery Calcium Score Categories for Coronary Events Versus Strokes: Impact of Sex and Race: MESA and DHS. Circ Cardiovasc Imaging 2020; 13:e010153. [PMID: 32806939 DOI: 10.1161/circimaging.119.010153] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) predicts atherosclerotic cardiovascular disease (ASCVD) events, inclusive of coronary heart disease (CHD) and stroke, and is a decision-making aid for primary prevention. The predictive value of CAC categories for CHD and stroke separately and across sex and race groups of an asymptomatic population is unclear. METHODS White, Black, and Hispanic participants of MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) underwent CAC measurement at enrollment and were followed for incident ASCVD events. Ten-year CHD-to-stroke incidence ratios across CAC score categories 0, 1 to 99, and ≥100 were assessed. Associations of CAC with incident CHD and stroke events were evaluated using multivariable-adjusted Cox models and multiplicative interactions of CAC with sex/race were tested. RESULTS Among 7042 participants (mean age, 57 years, 54% women, 36% Black, 23% Hispanic, 49% CAC=0, 19% CAC ≥100), 574 incident ASCVD events (333 CHD and 241 stroke) were observed over 12.3-year follow-up. Ten-year CHD-to-stroke incidence ratio increased significantly across CAC categories in men, women, Whites, Blacks, and Hispanics (all P<0.001). High CAC burden (score ≥100) was independently associated with ASCVD and CHD risk in all groups and with stroke risk in the overall cohort and Blacks. No sex- or race-based CAC interactions for ASCVD, CHD, and stroke events were observed. Adding CAC to a traditional risk factor model improved risk discrimination and reclassification for CHD but not for stroke events. CONCLUSIONS In 2 population-based cohorts of asymptomatic individuals, 10-year CHD-to-stroke incidence ratio was higher with increasing CAC score categories across sex and race groups, and CAC was consistently a better predictor of CHD than stroke. High CAC burden comparably associated with ASCVD risk across sex and race groups.
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.M., L.S.S.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine (A.P., A.K., P.H.J.), University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Department of Clinical Sciences (C.R.A.), University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine (A.P., A.K., P.H.J.), University of Texas Southwestern Medical Center, Dallas
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.M., L.S.S.)
| | - Moyses S Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.S.S.)
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.)
| | - Mathew J Budoff
- Lundquist Institute at Harbor-University of California Los Angeles Medical Center, Torrance (M.J. Budoff)
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J. Blaha, R.J.B., K.N.)
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J. Blaha, R.J.B., K.N.)
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J. Blaha, R.J.B., K.N.).,Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (K.N.)
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine (A.P., A.K., P.H.J.), University of Texas Southwestern Medical Center, Dallas
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22
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Gore MO, Ayers CR, Khera A, deFilippi CR, Wang TJ, Seliger SL, Nambi V, Selvin E, Berry JD, Hundley WG, Budoff M, Greenland P, Drazner MH, Ballantyne CM, Levine BD, de Lemos JA. Combining Biomarkers and Imaging for Short-Term Assessment of Cardiovascular Disease Risk in Apparently Healthy Adults. J Am Heart Assoc 2020; 9:e015410. [PMID: 32698652 PMCID: PMC7792258 DOI: 10.1161/jaha.119.015410] [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] [Received: 11/21/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022]
Abstract
Background Current strategies for cardiovascular disease (CVD) risk assessment focus on 10-year or longer timeframes. Shorter-term CVD risk is also clinically relevant, particularly for high-risk occupations, but is under-investigated. Methods and Results We pooled data from participants in the ARIC (Atherosclerosis Risk in Communities study), MESA (Multi-Ethnic Study of Atherosclerosis), and DHS (Dallas Heart Study), free from CVD at baseline (N=16 581). Measurements included N-terminal pro-B-type natriuretic peptide (>100 pg/mL prospectively defined as abnormal); high-sensitivity cardiac troponin T (abnormal >5 ng/L); high-sensitivity C-reactive protein (abnormal >3 mg/L); left ventricular hypertrophy by ECG (abnormal if present); carotid intima-media thickness, and plaque (abnormal >75th percentile for age and sex or presence of plaque); and coronary artery calcium (abnormal >10 Agatston U). Each abnormal test result except left ventricular hypertrophy by ECG was independently associated with increased 3-year risk of global CVD (myocardial infarction, stroke, coronary revascularization, incident heart failure, or atrial fibrillation), even after adjustment for traditional CVD risk factors and the other test results. When a simple integer score counting the number of abnormal tests was used, 3-year multivariable-adjusted global CVD risk was increased among participants with integer scores of 1, 2, 3, and 4, by ≈2-, 3-, 4.5- and 8-fold, respectively, when compared with those with a score of 0. Qualitatively similar results were obtained for atherosclerotic CVD (fatal or non-fatal myocardial infarction or stroke). Conclusions A strategy incorporating multiple biomarkers and atherosclerosis imaging improved assessment of 3-year global and atherosclerotic CVD risk compared with a standard approach using traditional risk factors.
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Affiliation(s)
- Maria Odette Gore
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
- Department of MedicineDenver Health and Hospital AuthorityDenverCO
- Community Health DepartmentColorado Prevention CenterAuroraCO
| | - Colby R. Ayers
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Amit Khera
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | | | - Thomas J. Wang
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Stephen L. Seliger
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Vijay Nambi
- Department of MedicineBaylor College of MedicineHoustonTX
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
- Department of MedicineMichael E. DeBakey Veterans Affairs HospitalHoustonTX
| | - Elizabeth Selvin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Jarett D. Berry
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - W. Gregory Hundley
- Departments of Medicine and Radiological SciencesWake Forest Health SciencesWinston‐SalemNC
| | | | - Philip Greenland
- Department of Preventive MedicineFeinberg School of Medicine, Northwestern UniversityChicagoIL
| | - Mark H. Drazner
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Christie M. Ballantyne
- Department of MedicineBaylor College of MedicineHoustonTX
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | - Benjamin D. Levine
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - James A. de Lemos
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
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23
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Mehta A, Virani SS, Ayers CR, Sun W, Hoogeveen RC, Rohatgi A, Berry JD, Joshi PH, Ballantyne CM, Khera A. Lipoprotein(a) and Family History Predict Cardiovascular Disease Risk. J Am Coll Cardiol 2020; 76:781-793. [DOI: 10.1016/j.jacc.2020.06.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/24/2022]
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24
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Neeland IJ, Rocha NDA, Hughes C, Ayers CR, Malloy CR, Jin ES. Effects of Empagliflozin Treatment on Glycerol-Derived Hepatic Gluconeogenesis in Adults with Obesity: A Randomized Clinical Trial. Obesity (Silver Spring) 2020; 28:1254-1262. [PMID: 32568464 PMCID: PMC7316140 DOI: 10.1002/oby.22854] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 03/09/2020] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effects of empagliflozin on glycerol-derived hepatic gluconeogenesis in adults with obesity without type 2 diabetes mellitus (T2DM) using oral carbon 13 (13 C)-labeled glycerol. METHODS A randomized, double-blind, placebo-controlled trial was performed in participants with magnetic resonance imaging assessment of body fat and measurement of glycerol-derived 13 C enrichment in plasma glucose by nuclear magnetic resonance spectroscopy following ingestion of [U-13 C3 ]glycerol. Participants were randomized to oral empagliflozin 10 mg once daily or placebo for 3 months. Glycerol-derived 13 C enrichment studies were repeated, and treatment differences in the mean percentage of 13 C glycerol enrichment in glucose were compared using mixed linear models. RESULTS Thirty-five participants completed the study. Empagliflozin increased glycerol-derived 13 C enrichment between baseline and follow-up by 6.5% (P = 0.005), consistent with less glycerol from visceral adipose tissue (VAT). No difference was found with placebo. Glycerol-derived 13 C enrichment was lower in participants with high VAT compared with low VAT by 12.6% (P = 0.04), but there was no heterogeneity of the treatment effect by baseline VAT. Glycerol-derived 13 C enrichment was inversely correlated with VAT but was not correlated with weight loss. CONCLUSIONS VAT is associated with endogenous glycerol-derived hepatic gluconeogenesis, and empagliflozin reduces endogenous glycerol gluconeogenesis in adults with obesity without T2DM. These findings suggest a mechanism by which sodium-glucose cotransporter 2 inhibitors may prevent T2DM in obesity.
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Affiliation(s)
- Ian J. Neeland
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Natalia de Albuquerque Rocha
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Connor Hughes
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby R. Ayers
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig R. Malloy
- Advanced Imaging Research Center and Departments of Internal Medicine and Radiology, University of Texas Southwestern Medical Center and VA North Texas Healthcare System, Dallas, TX, USA
| | - Eunsook S. Jin
- Advanced Imaging Research Center and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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25
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Singh K, Chandra A, Sperry T, Joshi PH, Khera A, Virani SS, Ballantyne CM, Otvos JD, Dullaart RPF, Gruppen EG, Connelly MA, Ayers CR, Rohatgi A. Associations Between High-Density Lipoprotein Particles and Ischemic Events by Vascular Domain, Sex, and Ethnicity: A Pooled Cohort Analysis. Circulation 2020; 142:657-669. [PMID: 32804568 PMCID: PMC7425196 DOI: 10.1161/circulationaha.120.045713] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: 02/02/2023]
Abstract
Supplemental Digital Content is available in the text. Background: High-density lipoprotein (HDL) cholesterol concentration (HDL-C) is an established atheroprotective marker, in particular for coronary artery disease; however, HDL particle concentration (HDL-P) may better predict risk. The associations of HDL-C and HDL-P with ischemic stroke and myocardial infarction (MI) among women and Blacks have not been well studied. We hypothesized that HDL-P would consistently be associated with MI and stroke among women and Blacks compared with HDL-C. Methods: We analyzed individual-level participant data in a pooled cohort of 4 large population studies without baseline atherosclerotic cardiovascular disease: DHS (Dallas Heart Study; n=2535), ARIC (Atherosclerosis Risk in Communities; n=1595), MESA (Multi-Ethnic Study of Atherosclerosis; n=6632), and PREVEND (Prevention of Renal and Vascular Endstage Disease; n=5022). HDL markers were analyzed in adjusted Cox proportional hazard models for MI and ischemic stroke. Results: In the overall population (n=15 784), HDL-P was inversely associated with the combined outcome of MI and ischemic stroke, adjusted for cardiometabolic risk factors (hazard ratio [HR] for quartile 4 [Q4] versus quartile 1 [Q1], 0.64 [95% CI, 0.52–0.78]), as was HDL-C (HR for Q4 versus Q1, 0.76 [95% CI, 0.61–0.94]). Adjustment for HDL-C did not attenuate the inverse relationship between HDL-P and atherosclerotic cardiovascular disease, whereas adjustment for HDL-P attenuated all associations between HDL-C and events. HDL-P was inversely associated with the individual end points of MI and ischemic stroke in the overall population, including in women. HDL-P was inversely associated with MI among White participants but not among Black participants (HR for Q4 versus Q1 for Whites, 0.49 [95% CI, 0.35–0.69]; for Blacks, 1.22 [95% CI, 0.76–1.98]; Pinteraction=0.001). Similarly, HDL-C was inversely associated with MI among White participants (HR for Q4 versus Q1, 0.53 [95% CI, 0.36–0.78]) but had a weak direct association with MI among Black participants (HR for Q4 versus Q1, 1.75 [95% CI, 1.08–2.83]; Pinteraction<0.0001). Conclusions: Compared with HDL-C, HDL-P was consistently associated with MI and ischemic stroke in the overall population. Differential associations of both HDL-C and HDL-P for MI by Black ethnicity suggest that atherosclerotic cardiovascular disease risk may differ by vascular domain and ethnicity. Future studies should examine individual outcomes separately.
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Affiliation(s)
- Kavisha Singh
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Alvin Chandra
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Thomas Sperry
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Amit Khera
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.)
| | | | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC (J.D.O., M.A.C.)
| | - Robin P F Dullaart
- University of Groningen and University Medical Center Groningen, The Netherlands (R.P.F.D., E.G.G.)
| | - Eke G Gruppen
- University of Groningen and University Medical Center Groningen, The Netherlands (R.P.F.D., E.G.G.)
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC (J.D.O., M.A.C.)
| | - Colby R Ayers
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Anand Rohatgi
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
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Jackson CL, Keeton JZ, Eason SJ, Ahmad ZA, Ayers CR, Gore MO, McGuire DK, Sayers MH, Khera A. Identifying Familial Hypercholesterolemia Using a Blood Donor Screening Program With More Than 1 Million Volunteer Donors. JAMA Cardiol 2020; 4:685-689. [PMID: 31116347 DOI: 10.1001/jamacardio.2019.1518] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Familial hypercholesterolemia is an autosomal-dominant disorder that often causes premature coronary artery disease. Unfortunately, familial hypercholesterolemia remains largely undiagnosed. Objective To estimate the prevalence of familial hypercholesterolemia in a population of blood donors. Design This analysis of deidentified data from blood donors 16 years and older who donated to Carter BloodCare, one of the largest independent blood programs in the United States, between January 2002 and December 2016. Carter BloodCare, which serves a population of about 8 million in Texas, routinely measures total nonfasting serum cholesterol levels as part of a donor health screening program. Data analysis occurred from October 2017 to March 2019. Exposure Blood donation. Main Outcomes and Measures Familial hypercholesterolemia was defined using the Make Early Diagnosis to Prevent Early Death general population criteria, with total nonfasting serum cholesterol thresholds of 270, 290, 340, and 360 mg/dL for donors younger than 20 years, 20 to 29 years, 30 to 39 years, and 40 years or older, respectively (to convert cholesterol values to mmol/L, multiply by 0.0259). For repeated donors, the maximum observed total cholesterol level was used for analyses. Results The study included 1 178 102 individual donors with a total of 3 038 420 blood donations. Of all individual donors (median total cholesterol level, 183 [interquartile range (IQR), 157-212] mg/dL; median age, 32 [IQR, 19-47] years; 619 583 [52.6%] women), a total of 3473 individuals (or 1 in every 339) met criteria for familial hypercholesterolemia. This group had a median (IQR) total cholesterol of 332 (297-377) mg/dL. Estimated prevalence was higher at younger ages (<30 years: 1:257) compared with older ages (≥30 years: 1:469; P < .001) and in men (1:327) compared with women (1:351; P = .03). Among 2219 repeated donors who met familial hypercholesterolemia criteria at least once, 3116 of 10 833 total donations (28.8%) met FH criteria. Conclusions and Relevance The prevalence of familial hypercholesterolemia using the Make Early Diagnosis to Prevent Early Death criteria in a large cohort of blood donors was similar to the estimated prevalence of this disorder in the general population. The blood donor screening program could be a novel strategy to detect and notify individuals with potential familial hypercholesterolemia, particularly younger individuals in whom early detection and treatment is especially helpful, as well as guide cascade screening.
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Affiliation(s)
- Candace L Jackson
- University of Texas Southwestern Medical Center, Dallas.,Now with Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Zahid A Ahmad
- Division of Nutrition and Metabolic Diseases, University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - M Odette Gore
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora.,Division of Cardiology, Denver Health and Hospital Authority, Denver, Colorado
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Merlyn H Sayers
- Carter BloodCare, Bedford, Texas.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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Lewis AA, Ayers CR, Selvin E, Neeland I, Ballantyne CM, Nambi V, Pandey A, Powell-Wiley TM, Drazner MH, Carnethon MR, Berry JD, Seliger SL, DeFilippi CR, de Lemos JA. Racial Differences in Malignant Left Ventricular Hypertrophy and Incidence of Heart Failure: A Multicohort Study. Circulation 2020; 141:957-967. [PMID: 31931608 PMCID: PMC7093253 DOI: 10.1161/circulationaha.119.043628] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A malignant subphenotype of left ventricular hypertrophy (LVH) has been described, in which minimal elevations in cardiac biomarkers identify individuals with LVH at high risk for developing heart failure (HF). We tested the hypothesis that a higher prevalence of malignant LVH among blacks may contribute to racial disparities in HF risk. METHODS Participants (n=15 710) without prevalent cardiovascular disease were pooled from 3 population-based cohort studies, the ARIC Study (Atherosclerosis Risk in Communities), the DHS (Dallas Heart Study), and the MESA (Multi-Ethnic Study of Atherosclerosis). Participants were classified into 3 groups: those without ECG-LVH, those with ECG-LVH and normal biomarkers (hs-cTnT (high sensitivity cardiac troponin-T) <6 ng/L and NT-proBNP (N-terminal pro-B-type natriuretic peptide) <100 pg/mL), and those with ECG-LVH and abnormal levels of either biomarker (malignant LVH). The outcome was incident HF. RESULTS Over the 10-year follow-up period, HF occurred in 512 (3.3%) participants, with 5.2% in black men, 3.8% in white men, 3.2% in black women, and 2.2% in white women. The prevalence of malignant LVH was 3-fold higher among black men and women versus white men and women. Compared with participants without LVH, the adjusted hazard ratio for HF was 2.8 (95% CI, 2.1-3.5) in those with malignant LVH and 0.9 (95% CI, 0.6-1.5) in those with LVH and normal biomarkers, with similar findings in each race/sex subgroup. Mediation analyses indicated that 33% of excess hazard for HF among black men and 11% of the excess hazard among black women was explained by the higher prevalence of malignant LVH in blacks. Of black men who developed HF, 30.8% had malignant LVH at baseline, with a corresponding population attributable fraction of 0.21. The proportion of HF cases occurring among those with malignant LVH, and the corresponding population attributable fraction, were intermediate and similar among black women and white men and lowest among white women. CONCLUSIONS A higher prevalence of malignant LVH may in part explain the higher risk of HF among blacks versus whites. Strategies to prevent development or attenuate risk associated with malignant LVH should be investigated as a strategy to lower HF risk and mitigate racial disparities.
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Affiliation(s)
- Alana A Lewis
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (A.A.L., C.R.A., I.N., A.P., M.H.D., J.D.B., J.A.d.L.)
| | - Colby R Ayers
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (A.A.L., C.R.A., I.N., A.P., M.H.D., J.D.B., J.A.d.L.)
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S.)
| | - Ian Neeland
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (A.A.L., C.R.A., I.N., A.P., M.H.D., J.D.B., J.A.d.L.)
| | | | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, TX (C.M.B., V.N.)
- Houston Methodist DeBakey Heart and Vascular Center, TX (V.N.)
- Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.N.)
| | - Ambarish Pandey
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (A.A.L., C.R.A., I.N., A.P., M.H.D., J.D.B., J.A.d.L.)
| | - Tiffany M Powell-Wiley
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (T.M.P.-W.)
| | - Mark H Drazner
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (A.A.L., C.R.A., I.N., A.P., M.H.D., J.D.B., J.A.d.L.)
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.R.C.)
| | - Jarett D Berry
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (A.A.L., C.R.A., I.N., A.P., M.H.D., J.D.B., J.A.d.L.)
| | - Stephen L Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore (S.L.S.)
| | | | - James A de Lemos
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (A.A.L., C.R.A., I.N., A.P., M.H.D., J.D.B., J.A.d.L.)
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Riggs KA, Joshi PH, Khera A, Singh K, Akinmolayemi O, Ayers CR, Rohatgi A. Impaired HDL Metabolism Links GlycA, A Novel Inflammatory Marker, with Incident Cardiovascular Events. J Clin Med 2019; 8:jcm8122137. [PMID: 31817053 PMCID: PMC6947609 DOI: 10.3390/jcm8122137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/30/2022] Open
Abstract
High-density lipoproteins (HDL) exert anti-atherosclerotic effects via reverse cholesterol transport, yet this salutary property is impaired in the setting of inflammation. GlycA, a novel integrated glycosylation marker of five acute phase reactants, is linked to cardiovascular (CV) events. We assessed the hypothesis that GlycA is associated with measures of impaired HDL function and that dysfunctional HDL may contribute to the association between GlycA and incident CV events. Baseline measurements of HDL cholesterol (HDL-C), HDL particle concentration (HDL-P), apoliprotein A1 (Apo A1), cholesterol efflux capacity, GlycA and high-sensitivity C-reactive protein (hs-CRP) were obtained from the Dallas Heart Study, a multi-ethnic cohort of 2643 adults (median 43 years old; 56% women, 50% black) without cardiovascular disease (CVD). GlycA was derived from nuclear magnetic resonance imaging. Participants were followed for first nonfatal MI, nonfatal stroke, coronary revascularization, or CV death over a median of 12.4 years (n = 197). The correlation between GlycA and hs-CRP was 0.58 (p < 0.0001). In multivariate models with HDL-C, GlycA was directly associated with HDL-P and Apo A1 and inversely associated with cholesterol efflux (standardized beta estimates: 0.08, 0.29, -0.06, respectively; all p ≤ 0.0004) GlycA was directly associated with incident CV events (adjusted hazard ratio (HR) for Q4 vs. Q1: 3.33, 95% confidence interval (CI) 1.99, 5.57). Adjustment for cholesterol efflux mildly attenuated this association (HR for Q4 vs. Q1: 3.00, 95% CI 1.75 to 5.13). In a multi-ethnic cohort, worsening inflammation, as reflected by higher GlycA levels, is associated with higher HDL-P and lower cholesterol efflux. Impaired cholesterol efflux likely explains some of the association between GlycA and incident CV events. Further studies are warranted to investigate the impact of inflammation on HDL function and CV disease.
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Affiliation(s)
- Kayla A. Riggs
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (K.A.R.); (O.A.)
| | - Parag H. Joshi
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.H.J.); (A.K.); (K.S.); (C.R.A.)
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.H.J.); (A.K.); (K.S.); (C.R.A.)
| | - Kavisha Singh
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.H.J.); (A.K.); (K.S.); (C.R.A.)
| | - Oludamilola Akinmolayemi
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (K.A.R.); (O.A.)
| | - Colby R. Ayers
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.H.J.); (A.K.); (K.S.); (C.R.A.)
| | - Anand Rohatgi
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (P.H.J.); (A.K.); (K.S.); (C.R.A.)
- Correspondence: ; Tel.: +1-214-645-7500
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Berry JD, Mehta A, Lin K, Ayers CR, Carroll T, Pandey A, Garside DB, Daviglus ML, Yuan C, Lloyd-Jones DM. Association of Long-Term Risk Factor Levels With Carotid Atherosclerosis: The Chicago Healthy Aging Magnetic Resonance Imaging Plaque Study (CHAMPS). Circ Cardiovasc Imaging 2019; 12:e009226. [PMID: 31522549 DOI: 10.1161/circimaging.119.009226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Absence of cardiovascular risk factors (RF) in young adulthood is associated with a lower risk for cardiovascular disease. However, it is unclear if low RF burden in young adulthood decreases the quantitative burden and qualitative features of atherosclerosis. METHODS Multi-contrast carotid magnetic resonance imaging was performed on 440 Chicago Healthy Aging Study participants in 2009 to 2011, whose RF (total cholesterol, blood pressure, diabetes mellitus, and smoking) were measured in 1967 to 1973. Participants were divided into 4 groups: low-risk (with total cholesterol <200 mg/dL and no treatment, blood pressure <120/80 mm Hg and no treatment, no smoking, and no diabetes mellitus), 0 high RF but some RF unfavorable (≥1 RF above low-risk threshold but below high-risk threshold), 1 high RF (total cholesterol ≥240 mg/dL or treated, blood pressure ≥140/90 or treated, diabetes mellitus, or smoking), and 2 or more high RF. Association of baseline RF status with carotid atherosclerosis (overall mean carotid wall thickness and lipid-rich necrotic core) at follow-up was assessed. RESULTS Among 424 participants with evaluable carotid magnetic resonance images, the mean age was 32 years at baseline and 73 years at follow-up; 67% were male, 86% white, and 36% were low-risk at baseline. Two or more high RF status was associated with higher carotid wall thickness (0.99±0.11 mm) and lipid-rich necrotic core prevalence (30%), as compared with low-risk group (0.94±0.09 mm and 17%, respectively). Each increment in baseline RF status was associated with higher carotid wall thickness (β-coefficient, 0.015; 95% CI, 0.004-0.026) and with higher lipid-rich necrotic core prevalence at older age (odds ratio, 1.26; 95% CI, 1.00-1.58) in models adjusted for baseline RF and demographics. CONCLUSIONS RF status in young adulthood is associated with the burden and quality of carotid atherosclerosis in older age suggesting that the decades-long protective effect of low-risk status might be mediated through a lower burden of quantitative and qualitative features of atherosclerotic plaque.
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Affiliation(s)
- Jarett D Berry
- Division of Cardiology, Department of Internal Medicine (J.D.B., A.P.), UT Southwestern Medical Center, Dallas, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.M.)
| | - Kai Lin
- Department of Radiology (K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Colby R Ayers
- Department of Clinical Sciences (C.R.A.), UT Southwestern Medical Center, Dallas, TX
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine (J.D.B., A.P.), UT Southwestern Medical Center, Dallas, TX
| | - Daniel B Garside
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago (D.B.G., M.L.D.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago (D.B.G., M.L.D.)
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Seattle (C.Y.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine (D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Hackler E, Lew J, Gore MO, Ayers CR, Atzler D, Khera A, Rohatgi A, Lewis A, Neeland I, Omland T, de Lemos JA. Racial Differences in Cardiovascular Biomarkers in the General Population. J Am Heart Assoc 2019; 8:e012729. [PMID: 31514563 PMCID: PMC6817997 DOI: 10.1161/jaha.119.012729] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 01/07/2023]
Abstract
Background The incidence and clinical manifestations of cardiovascular disease (CVD) differ between blacks and whites. Biomarkers that reflect important pathophysiological pathways may provide a window to allow deeper understanding of racial differences in CVD. Methods and Results The study included 2635 white and black participants from the Dallas Heart Study who were free from existing CVD. Cross‐sectional associations between race and 32 biomarkers were evaluated using multivariable linear regression adjusting for age, traditional CVD risk factors, imaging measures of body composition, renal function, insulin resistance, left ventricular mass, and socioeconomic factors. In fully adjusted models, black women had higher lipoprotein(a), leptin, d‐dimer, osteoprotegerin, antinuclear antibody, homoarginine, suppression of tumorigenicity‐2, and urinary microalbumin, and lower adiponectin, soluble receptor for advanced glycation end products and N‐terminal pro‐B‐type natriuretic peptide versus white women. Black men had higher lipoprotein(a), leptin, d‐dimer, high‐sensitivity C‐reactive protein, antinuclear antibody, symmetrical dimethylarginine, homoarginine, high‐sensitivity cardiac troponin T, suppression of tumorigenicity‐2, and lower adiponectin, soluble receptor for advanced glycation end products, and N‐terminal pro‐B‐type natriuretic peptide versus white men. Adjustment for biomarkers that were associated with higher CVD risk, and that differed between blacks and whites, attenuated the risk for CVD events in black women (unadjusted hazard ratio 2.05, 95% CI 1.32, 3.17 and adjusted hazard ratio 1.15, 95% CI 0.69, 1.92) and black men (unadjusted hazard ratio 2.39, 95% CI 1.64, 3.46, and adjusted hazard ratio 1.21, 95% CI 0.76, 1.95). Conclusions Significant racial differences were seen in biomarkers reflecting lipids, adipokines, and biomarkers of endothelial function, inflammation, myocyte injury, and neurohormonal stress, which may contribute to racial differences in the development and complications of CVD. See Editorial Suzuki et al
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Affiliation(s)
- Eddie Hackler
- Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Jeanney Lew
- Department of Cardiovascular Disease Baylor St. Luke's Medical Center Houston TX
| | - M Odette Gore
- Department of Medicine University of Colorado Anschutz Medical Campus and Denver Health and Hospital Authority Denver CO
| | - Colby R Ayers
- Department of Medicine UT Southwestern Medical Center Dallas TX.,Department of Clinical Sciences UT Southwestern Medical Center Dallas TX
| | - Dorothee Atzler
- Institute for Cardiovascular Prevention Ludwig-Maximilians-University Munich Germany
| | - Amit Khera
- Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Anand Rohatgi
- Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Alana Lewis
- Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Ian Neeland
- Department of Medicine UT Southwestern Medical Center Dallas TX
| | - Torbjorn Omland
- Department of Medicine Akershus University Hospital Lørenskog Norway.,University of Oslo Norway
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Chindhy S, Joshi P, Khera A, Ayers CR, Hedayati SS, Rohatgi A. Impaired Renal Function on Cholesterol Efflux Capacity, HDL Particle Number, and Cardiovascular Events. J Am Coll Cardiol 2019; 72:698-700. [PMID: 30072004 DOI: 10.1016/j.jacc.2018.05.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 11/25/2022]
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Aagaard P, Sharma S, McNamara DA, Joshi P, Ayers CR, de Lemos JA, Lincoln AE, Baranowski B, Mandsager K, Hill E, Castle L, Gentry J, Lang R, Dunn RE, Alexander K, Tucker AM, Phelan D. Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players. J Am Heart Assoc 2019; 8:e010401. [PMID: 31337251 PMCID: PMC6761649 DOI: 10.1161/jaha.118.010401] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Habitual high‐intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength‐type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population‐based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results This cross‐sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population‐based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study‐2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1–15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA2DS2‐VASc score ≥1. Former NFL players also had an 8‐fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first‐degree atrioventricular block (18% versus 9%, P<0.001). Conclusions Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population‐based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.
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Affiliation(s)
- Philip Aagaard
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - Shishir Sharma
- Division of Cardiology UT Southwestern Medical Center Dallas TX
| | | | - Parag Joshi
- Division of Cardiology UT Southwestern Medical Center Dallas TX.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore MD
| | - Colby R Ayers
- Division of Cardiology UT Southwestern Medical Center Dallas TX
| | | | | | - Bryan Baranowski
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - Kyle Mandsager
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | | | - Lon Castle
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - James Gentry
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - Richard Lang
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | | | | | | | - Dermot Phelan
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
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Chandra A, Ayers CR, Neeland IJ. Temporal Changes in Body Fat Distribution and Hypertension. J Am Coll Cardiol 2019; 73:3357-3359. [DOI: 10.1016/j.jacc.2019.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
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Jarvie JL, Pandey A, Ayers CR, McGavock JM, Sénéchal M, Berry JD, Patel KV, McGuire DK. Aerobic Fitness and Adherence to Guideline-Recommended Minimum Physical Activity Among Ambulatory Patients With Type 2 Diabetes Mellitus. Diabetes Care 2019; 42:1333-1339. [PMID: 31221698 PMCID: PMC6609956 DOI: 10.2337/dc18-2634] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 12/26/2018] [Accepted: 04/19/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lifestyle intervention remains the cornerstone of management of type 2 diabetes mellitus (T2DM). However, adherence to physical activity (PA) recommendations and the impact of that adherence on cardiorespiratory fitness in this population have been poorly described. We sought to investigate adherence to PA recommendations and its association with cardiorespiratory fitness in a population of patients with T2DM. RESEARCH DESIGN AND METHODS A cross-sectional analysis of baseline data from a randomized clinical trial (NCT00424762) was performed. A total of 150 individuals with medically treated T2DM and atherosclerotic cardiovascular disease (ASCVD) or risk factors for ASCVD were recruited from outpatient clinics at a single academic medical center. All individuals underwent a graded maximal exercise treadmill test to exhaustion with breath-by-breath gas exchange analysis to determine VO2peak. PA was estimated using a structured 7-Day Physical Activity Recall interview. RESULTS Participants had a mean ± SD age of 54.9 ± 9.0 years; 41% were women, 40% were black, and 21% were Hispanic. The mean HbA1c was 7.7 ± 1.8% and the mean BMI, 34.5 ± 7.2 kg/m2. A total of 72% had hypertension, 73% had hyperlipidemia, and 35% had prevalent ASCVD. The mean ± SD reported daily PA was 34.3 ± 4 kcal/kg, only 7% above a sedentary state; 47% of the cohort failed to achieve the minimum recommended PA. Mean ± SD VO2peak was 27.4 ± 6.5 mL/kg fat-free mass/min (18.8 ± 5.0 mL/kg/min). CONCLUSIONS On average, patients with T2DM who have or are at risk for ASCVD report low levels of PA and have low measured cardiopulmonary fitness. This underscores the importance of continued efforts to close this therapeutic gap.
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Affiliation(s)
- Jennifer L Jarvie
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Martin Sénéchal
- Cardio-Metabolic Exercise and Lifestyle Laboratory, Fredericton, New Brunswick, Canada.,Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Jarett D Berry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kershaw V Patel
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX .,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
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Eades MT, Paixao ARM, Mehta A, Ayers CR, Joshi PH, Berry JD, de Lemos JA, Khera A. Characterization and Trajectory of Coronary Artery Calcium Percentiles: The Dallas Heart Study. JACC Cardiovasc Imaging 2019; 12:1290-1292. [PMID: 31005534 DOI: 10.1016/j.jcmg.2019.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/09/2019] [Accepted: 02/13/2019] [Indexed: 11/19/2022]
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de Lemos JA, Oliver W, Matthews G, Ayers CR, Garg S, Gupta S, Neeland IJ, Drazner MH, Berry JD, Matulevicius S. Response by de Lemos et al to Letter Regarding Article "Factors Associated With Left Atrial Remodeling in the General Population". Circ Cardiovasc Imaging 2019; 10:CIRCIMAGING.117.006627. [PMID: 28611122 DOI: 10.1161/circimaging.117.006627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James A de Lemos
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Walter Oliver
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Gwendolyn Matthews
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Cardiovascular Division, Department of Medicine and Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas
| | - Sonia Garg
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Sachin Gupta
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Ian J Neeland
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Mark H Drazner
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Jarett D Berry
- Cardiovascular Division, Department of Medicine and Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas
| | - Susan Matulevicius
- Cardiovascular Division, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
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Wrobel CA, Drazner MH, Ayers CR, Pham DD, La Hoz RM, Grodin JL, Garg S, Mammen PPA, Morlend RM, Araj F, Amin AA, Cornwell WK, Thibodeau JT. Delayed febrile response with bloodstream infections in patients with continuous-flow left ventricular assist devices. J Investig Med 2019; 67:653-658. [PMID: 30696751 DOI: 10.1136/jim-2018-000893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2018] [Indexed: 11/03/2022]
Abstract
Bloodstream infections (BSIs) are common in patients with continuous-flow left ventricular assist devices (CF-LVADs). Whether CF-LVADs modulate the febrile response to BSIs is unknown. We retrospectively compared the febrile response to BSIs in patients with heart failure (HF) with CF-LVADs versus a control population of patients with HF receiving inotropic infusions. BSIs were adjudicated using the Centers for Disease Control and Prevention and the National Healthcare Safety Network criteria. Febrile status (temperature ≥38°C, 100.4 °F), temperature at presentation with BSI, and the highest temperature within 72 hours (Tmax) were collected. We observed 59 BSIs in LVAD patients and 45 BSIs in controls. LVAD patients were more likely to be afebrile and to have a lower temperature at presentation than control (88% vs 58%, p=0.002, and 37°C ±0.7 vs 37.7°C ±1.0, p=0.0009, respectively). By 72 hours, the difference in afebrile status diminished (53% vs 44%, p=0.42), and the Tmax was similar between the LVAD and control groups (37.9°C±0.9 vs 38.2°C±0.8, respectively, p=0.10). In conclusion, at presentation with a BSI, the vast majority of CF-LVAD patients were afebrile, an event which occurred at a higher frequency when compared with patients with advanced HF on chronic inotropes via an indwelling venous catheter. These data alert clinicians to have a very low threshold to obtain blood cultures in CF-LVAD patients even in the absence of fever. Further study is needed to determine whether a delayed or diminished febrile response represents another pathophysiological consequence of CF-LVADs.
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Affiliation(s)
- Christopher A Wrobel
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark H Drazner
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colby R Ayers
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David D Pham
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ricardo M La Hoz
- Department of Internal Medicine, Division of Infectious Disease, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Justin L Grodin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sonia Garg
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pradeep P A Mammen
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert M Morlend
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Faris Araj
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alpesh A Amin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William K Cornwell
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer T Thibodeau
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Sulistio MS, Khera A, Squiers K, Sanghavi M, Ayers CR, Weng W, Kazi S, de Lemos J, Johnson DH, Kirk L. Effects of gender in resident evaluations and certifying examination pass rates. BMC Med Educ 2019; 19:10. [PMID: 30616651 PMCID: PMC6322320 DOI: 10.1186/s12909-018-1440-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/28/2017] [Accepted: 12/26/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Though the proportion of female Internal Medicine (IM) residents and faculty has increased, there is minimal large scale modern data comparing resident performance by gender. This study sought to examine the effects of resident and faculty gender on resident evaluations. METHODS Retrospective observational study over 5 years in a single IM program. IM certifying examination pass rates were obtained from the American Board of IM. RESULTS Four hundred eighty-eight residents (195 women, 293 men), evaluated by 430 attending physicians (163 women, 270 men) were included. Twelve thousand six hundred eighty-one evaluations between 2007 and 2012 were analyzed. Female residents scored higher in two domains (Medical Interviewing, and Interpersonal and Communication Skills) (p < 0.01 for each), with no significant difference between genders for the other domains (Medical Knowledge, Overall Patient Care, Physical Examination, Procedural Skills, Professionalism, Practice Based Learning and Improvement, System Based Practices and Overall score). There were no differences in scoring between female and male attending physicians. There were no differences in certifying examination scores between women and men among graduating residents. National pass rates for women were not statistically different to pass rates for men from 1987 to 2015. CONCLUSIONS Data from one large academic medical center demonstrate higher ratings for female residents on performance domains reflecting bedside care and interpersonal skills, with similar scores for medical knowledge and remaining domains. No significant difference was seen locally in certifying examination scores, nor in recent national pass rates, an objective measure of medical knowledge. Despite imbalanced female representation in areas of medicine, our data suggest that gender-based disparities in Internal Medicine resident medical knowledge and physician competency are no longer present.
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Affiliation(s)
- Melanie S. Sulistio
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830 USA
- Division of Cardiology, Dallas, USA
| | - Amit Khera
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830 USA
- Division of Cardiology, Dallas, USA
| | - Kathryn Squiers
- University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Monika Sanghavi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830 USA
- Division of Cardiology, Dallas, USA
| | - Colby R. Ayers
- Division of Cardiology, Dallas, USA
- Department of Clinical Sciences, Dallas, USA
| | - Weifeng Weng
- American Board of Internal Medicine, Philadelphia, PA USA
| | - Salahuddin Kazi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830 USA
| | - James de Lemos
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830 USA
- Division of Cardiology, Dallas, USA
| | - David H. Johnson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830 USA
| | - Lynne Kirk
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830 USA
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Dominguez-Rodriguez A, Thibodeau JT, Ayers CR, Jimenez-Sosa A, Garrido P, Montoto J, Prada-Arrondo PC, Abreu-Gonzalez P, Drazner MH. Impact of bendopnea on postoperative outcomes in patients with severe aortic stenosis undergoing aortic valve replacement. Interact Cardiovasc Thorac Surg 2018; 27:808-812. [DOI: 10.1093/icvts/ivy174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Alberto Dominguez-Rodriguez
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Spain
| | - Jennifer T Thibodeau
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Pilar Garrido
- Department of Cardiothoracic Surgery, Hospital Universitario de Canarias, Tenerife, Spain
| | - Javier Montoto
- Department of Cardiothoracic Surgery, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pablo C Prada-Arrondo
- Department of Cardiothoracic Surgery, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pedro Abreu-Gonzalez
- Departmento de Ciencias Médicas Básicas (Unidad de Fisiología), Universidad de La Laguna, Tenerife, Spain
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hoeting N, Ayers CR, Rohatgi A. Abstract 170: Deep Phenotyping of HDL Particles: Characterization of Seven HDL Species and Their Relationship to Cardiometabolic Phenotypes in a Multi-Ethnic Population (Dallas Heart Study). Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Size-based HDL particle analysis based on small, medium, and large categories has led to inconsistent associations with cardiovascular disease (CVD). A new algorithm expands characterization of HDL-P from three to seven species, but the clinical significance remains unknown. We investigated the relationships between the seven HDL species and traditional risk factors, lipids, and cardiometabolic phenotypes in the Dallas Heart Study, a multiethnic, probability-based, population cohort of Dallas county adults.
Methods:
This study included 2,996 DHS participants (56% women, 50% Black), excluding those with prior CVD and statin users. HDL species were determined by nuclear magnetic resonance using the LP4 algorithm, with increasing size from H1P to H7P. Insulin resistance was determined by homeostatic model assessment index (HOMA-IR). Visceral fat was measured by MRI.
Results:
The largest HDL species were most directly associated with HDL cholesterol (HDL-C) (H6P: r = 0.61, p < 0.0001; H7P: r = 0.66, p < 0.0001). H2P was inversely associated with all HDL species including H1P (r = -0.19, p < 0.0001) and HDL-C (r = -0.18, p < 0.0001), but was directly associated with total cholesterol, triglycerides, and LDL-C (p < 0.0001). Female gender and Black ethnicity were associated with lower H2P levels (p < 0.0001). H2P alone was directly associated with diabetes, hypertension, waist circumference, insulin resistance, and visceral fat (Figure, p < 0.0001 for all values)
Conclusion:
Our study of a novel 7-species designation of HDL particles revealed that the smallest HDL particle species (H1P and H2P) confer differential associations with cardiometabolic phenotypes. These findings suggest further investigation specifically into the role of H2P and CVD.
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Mehta A, Patel J, Al Rifai M, Ayers CR, Neeland IJ, Kanaya AM, Kandula N, Blaha MJ, Nasir K, Blumenthal RS, Joshi PH. Inflammation and coronary artery calcification in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Atherosclerosis 2018; 270:49-56. [PMID: 29407888 DOI: 10.1016/j.atherosclerosis.2018.01.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/13/2017] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory biomarkers and adipocytokines (IBA) may contribute to atherosclerosis by promoting vascular inflammation. The association between IBA and coronary artery calcium (CAC), a marker of subclinical atherosclerosis, is not well defined in South Asians (SA). We hypothesized that IBA (high sensitivity C-reactive protein [hsCRP], tumor necrosis factor alpha [TNF-α], adiponectin, and leptin) were independently associated with and improved discrimination of CAC among SA. METHODS We analyzed IBA and CAC among participants in the prospective Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. We used logistic regression models to examine cross-sectional associations of IBA with CAC presence (CAC >0) and severity (CAC >100), and C-statistics to assess the incremental contribution of each IBA to traditional risk factors (TRF) from the AHA/ACC Pooled Cohort Equations (PCE) for discrimination of CAC. RESULTS Among 906 participants in the MASALA study, women (n = 420) had significantly higher levels of hsCRP, adiponectin, and leptin but lower levels of TNF-α than men (p < .01 for all). There was no significant association between any of the four IBA and either CAC category in multivariable-adjusted models, respectively. Lastly, none of the four IBA improved discrimination of CAC presence or severity when added to elements of the PCE. CONCLUSIONS IBA were not associated with CAC presence or severity in the MASALA population. IBA did not help identify SA at risk of subclinical atherosclerosis, although associations with ASCVD events remain unclear. In SA, CAC may have a distinct pathophysiology independent of inflammation as measured by IBA.
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Affiliation(s)
- Anurag Mehta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jaideep Patel
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - Mahmoud Al Rifai
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Department of Medicine, University of Kansas School of Medicine, Wichita, KS, United States
| | - Colby R Ayers
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Namratha Kandula
- Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, United States; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Parag H Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States.
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Gentry JL, Carruthers D, Joshi PH, Maroules CD, Ayers CR, de Lemos JA, Aagaard P, Hachamovitch R, Desai MY, Roselli EE, Dunn RE, Alexander K, Lincoln AE, Tucker AM, Phelan DM. Ascending Aortic Dimensions in Former National Football League Athletes. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006852. [PMID: 29122845 DOI: 10.1161/circimaging.117.006852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 06/28/2017] [Accepted: 09/26/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ascending aortic dimensions are slightly larger in young competitive athletes compared with sedentary controls, but rarely >40 mm. Whether this finding translates to aortic enlargement in older, former athletes is unknown. METHODS AND RESULTS This cross-sectional study involved a sample of 206 former National Football League (NFL) athletes compared with 759 male subjects from the DHS-2 (Dallas Heart Study-2; mean age of 57.1 and 53.6 years, respectively, P<0.0001; body surface area of 2.4 and 2.1 m2, respectively, P<0.0001). Midascending aortic dimensions were obtained from computed tomographic scans performed as part of a NFL screening protocol or as part of the DHS. Compared with a population-based control group, former NFL athletes had significantly larger ascending aortic diameters (38±5 versus 34±4 mm; P<0.0001). A significantly higher proportion of former NFL athletes had an aorta of >40 mm (29.6% versus 8.6%; P<0.0001). After adjusting for age, race, body surface area, systolic blood pressure, history of hypertension, current smoking, diabetes mellitus, and lipid profile, the former NFL athletes still had significantly larger ascending aortas (P<0.0001). Former NFL athletes were twice as likely to have an aorta >40 mm after adjusting for the same parameters. CONCLUSIONS Ascending aortic dimensions were significantly larger in a sample of former NFL athletes after adjusting for their size, age, race, and cardiac risk factors. Whether this translates to an increased risk is unknown and requires further evaluation.
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Affiliation(s)
- James L Gentry
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - David Carruthers
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Parag H Joshi
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Christopher D Maroules
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Colby R Ayers
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - James A de Lemos
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Philip Aagaard
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Rory Hachamovitch
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Milind Y Desai
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Eric E Roselli
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Reginald E Dunn
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Kezia Alexander
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Andrew E Lincoln
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Andrew M Tucker
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Dermot M Phelan
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.).
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Yingling LR, Mitchell V, Ayers CR, Peters-Lawrence M, Wallen GR, Brooks AT, Troendle JF, Adu-Brimpong J, Thomas S, Henry J, Saygbe JN, Sampson DM, Johnson AA, Graham AP, Graham LA, Wiley KL, Powell-Wiley T. Adherence with physical activity monitoring wearable devices in a community-based population: observations from the Washington, D.C., Cardiovascular Health and Needs Assessment. Transl Behav Med 2017; 7:719-730. [PMID: 28097627 PMCID: PMC5684058 DOI: 10.1007/s13142-016-0454-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Wearable mobile health (mHealth) technologies offer approaches for targeting physical activity (PA) in resource-limited, community-based interventions. We sought to explore user characteristics of PA tracking, wearable technology among a community-based population within a health and needs assessment. In 2014-2015, we conducted the Washington, D.C., Cardiovascular Health and Needs Assessment in predominantly African-American churches among communities with higher obesity rates and lower household incomes. Participants received a mHealth PA monitor and wirelessly uploaded PA data weekly to church data collection hubs. Participants (n = 99) were 59 ± 12 years, 79% female, and 99% African-American, with a mean body mass index of 33 ± 7 kg/m2. Eighty-one percent of participants uploaded PA data to the hub and were termed "PA device users." Though PA device users were more likely to report lower household incomes, no differences existed between device users and non-users for device ownership or technology fluency. Findings suggest that mHealth systems with a wearable device and data collection hub may feasibly target PA in resource-limited communities.
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Grants
- HHSN268201400023C NHGRI NIH HHS
- ZIA HL006168 Intramural NIH HHS
- ZIA HL006168 Intramural NIH HHS
- ZIA HL006168 Intramural NIH HHS
- Division of Intramural Research, National Heart, Lung, and Blood Insitute, USA
- Division of Intramural Research, National Heart, Lung, and Blood Institute, USA
- Office of Intramural Training and Education, National Institutes of Health, USA
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Affiliation(s)
- Leah R Yingling
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Valerie Mitchell
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Colby R Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlene Peters-Lawrence
- Office of the Clinical Director, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - James F Troendle
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Adu-Brimpong
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Samantha Thomas
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - JaWanna Henry
- Office of the National Coordinator for Health Information Technology, Washington, DC, USA
| | - Johnetta N Saygbe
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Dana M Sampson
- Office of Minority Health, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Allan A Johnson
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Avis P Graham
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Lennox A Graham
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Kenneth L Wiley
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany Powell-Wiley
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA.
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Khera R, Pandey A, Ayers CR, Agusala V, Pruitt SL, Halm EA, Drazner MH, Das SR, de Lemos JA, Berry JD. Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004402. [PMID: 29129828 DOI: 10.1161/circheartfailure.117.004402] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 07/12/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND To assess the current landscape of the heart failure (HF) epidemic and provide targets for future health policy interventions in Medicare, a contemporary appraisal of its epidemiology across inpatient and outpatient care settings is needed. METHODS AND RESULTS In a national 5% sample of Medicare beneficiaries from 2002 to 2013, we identified a cohort of 2 331 939 unique fee-for-service Medicare beneficiaries ≥65-years-old followed for all inpatient and outpatient encounters over a 10-year period (2004-2013). Preexisting HF was defined by any HF encounter during the first year, and incident HF with either 1 inpatient or 2 outpatient HF encounters. Mean age of the cohort was 72 years; 57% were women, and 86% and 8% were white and black, respectively. Within this cohort, 518 223 patients had preexisting HF, and 349 826 had a new diagnosis of HF during the study period. During 2004 to 2013, the rates of incident HF declined 32%, from 38.7 per 1000 (2004) to 26.2 per 1000 beneficiaries (2013). In contrast, prevalent (preexisting + incident) HF increased during our study period from 162 per 1000 (2004) to 172 per 1000 beneficiaries (2013) (Ptrend <0.001 for both). Finally, the overall 1-year mortality among patients with incident HF is high (24.7%) with a 0.4% absolute decline annually during the study period, with a more pronounced decrease among those diagnosed in an inpatient versus outpatient setting (Pinteraction <0.001) CONCLUSIONS: In recent years, there have been substantial changes in the epidemiology of HF in Medicare beneficiaries, with a decline in incident HF and a decrease in 1-year HF mortality, whereas the overall burden of HF continues to increase.
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Affiliation(s)
- Rohan Khera
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Vijay Agusala
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Sandi L Pruitt
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Ethan A Halm
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Mark H Drazner
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Sandeep R Das
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas
| | - Jarett D Berry
- From the Division of Cardiology (R.K., A.P., C.R.A., V.A., M.H.D., S.R.D., J.A.d.L., J.D.B.) and Division of General Internal Medicine (S.L.P., E.A.H.), Department of Internal Medicine and Department of Clinical Sciences (E.H., J.D.B.), University of Texas Southwestern Medical Center, Dallas.
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Mani P, Ren HY, Neeland IJ, McGuire DK, Ayers CR, Khera A, Rohatgi A. The association between HDL particle concentration and incident metabolic syndrome in the multi-ethnic Dallas Heart Study. Diabetes Metab Syndr 2017; 11 Suppl 1:S175-S179. [PMID: 27993539 PMCID: PMC6190917 DOI: 10.1016/j.dsx.2016.12.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Abstract
AIMS Metabolic syndrome (MetS) increases atherosclerotic cardiovascular disease (ASCVD) risk. Low HDL cholesterol (HDL-C) is a diagnostic criterion of MetS and a major ASCVD risk factor. HDL particle concentration (HDL-P) associates with incident ASCVD independent of HDL-C, but its association with incident MetS has not been studied. We hypothesized that HDL-P would be inversely associated with incident metabolic syndrome independent of HDL-C and markers of adiposity and insulin resistance. MATERIALS AND METHODS HDL-P was measured by NMR and visceral fat by MRI in participants of the Dallas Heart Study, a probability-based population sample of adults age 30-65. Participants with prevalent MetS, DM, CVD, and any systemic illlness were excluded. Incident MetS as defined by NCEP ATPIII criteria was determined in all participants after median follow-up period of 7.0 years. RESULTS Among 1120 participants without DM or MetS at baseline (57% women, 45% Black, mean age 43), 22.8% had incident MetS at follow-up. HDL-P and HDL-C were modestly correlated (r=0.54, p<0.0001). In models adjusted for traditional risk factors and MetS risk factors including visceral fat, HS-CRP, triglyceride to HDL-C ratio, and HOMA-IR, the lowest quartile of HDL-P was associated with a 2-fold increased risk of incident MetS (OR 2.1, 95%CI 1.4-3.1; p=0.0003). CONCLUSIONS Low HDL-P is independently associated with incident MetS after adjustment for traditional risk factors, lipid parameters, adiposity, inflammation, and markers of insulin resistance. Further studies are warranted to validate these findings and elucidate the mechanisms underpinning this association.
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Affiliation(s)
- Preethi Mani
- Department of Internal Medicine, UT Southwestern Medical Center, United States
| | - Hao-Yu Ren
- Department of Internal Medicine, UT Southwestern Medical Center, United States
| | - Ian J Neeland
- Department of Cardiology, UT Southwestern Medical Center, United States
| | - Darren K McGuire
- Department of Cardiology, UT Southwestern Medical Center, United States
| | - Colby R Ayers
- Department of Cardiology, UT Southwestern Medical Center, United States
| | - Amit Khera
- Department of Cardiology, UT Southwestern Medical Center, United States
| | - Anand Rohatgi
- Department of Cardiology, UT Southwestern Medical Center, United States.
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Mirfakhraee S, Ayers CR, McGuire DK, Maalouf NM. Longitudinal changes in serum 25-hydroxyvitamin D in the Dallas Heart Study. Clin Endocrinol (Oxf) 2017; 87:242-248. [PMID: 28502105 PMCID: PMC5561481 DOI: 10.1111/cen.13374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/22/2017] [Revised: 04/03/2017] [Accepted: 04/25/2017] [Indexed: 01/14/2023]
Abstract
CONTEXT While the prevalence of vitamin D deficiency is well described in various populations, limited data are available regarding longitudinal variation in serum 25-hydroxyvitamin D concentrations. OBJECTIVES To evaluate the temporal trends in serum 25(OH)D, prevalence of vitamin D deficiency and factors influencing these trends. PARTICIPANTS, DESIGN AND SETTING Adults enrolled in the Dallas Heart Study, a longitudinal, probability-based, multiethnic, population study in Dallas, Texas, USA. MAIN OUTCOME MEASURES Prevalence of vitamin D deficiency and predictors of change in serum 25(OH)D. RESULTS A total of 2045 participants had serum 25(OH)D measured on two occasions (2000-2002 and 2007-2009) at a median interval of 7 years. Serum 25(OH)D decreased (42.7-39.4 nmol/L, P<.001) and the prevalence of vitamin D deficiency [25(OH)D <50 nmol/L] increased significantly (60.6%-66.4%, P<.0001) despite vitamin D supplementation increasing over the interval (7.2%-23.0%; P<.0001). In a multivariable model adjusting for sex, race, BMI, age, season of blood draw, smoking and exercise, a greater decline in serum 25(OH)D was noted in men compared with women (-8.0 vs -3.5 nmol/L, P<.0001), in participants of Hispanic ethnicity vs White and Black ethnicity (P<.0001), in nonobese vs obese participants (-7.2 vs -4.0 nmol/L, P=.005) and in nonusers vs users of vitamin D supplements (-5.7 vs -1.7 nmol/L, P=.032). CONCLUSIONS Despite increased vitamin D supplementation, serum 25(OH)D decreased in an ethnically diverse cohort of Dallas County residents between 2000-2002 and 2007-2009. Features most predictive of a decline in serum 25(OH)D include male sex, Hispanic ethnicity and weight gain.
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Affiliation(s)
- Sasan Mirfakhraee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby R Ayers
- Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darren K McGuire
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Naim M. Maalouf
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ren HY, Khera A, de Lemos JA, Ayers CR, Rohatgi A. Soluble endothelial cell-selective adhesion molecule and incident cardiovascular events in a multiethnic population. Am Heart J 2017; 191:55-61. [PMID: 28888270 DOI: 10.1016/j.ahj.2017.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 06/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cell adhesion molecules are key regulators of atherosclerotic plaque development, but circulating levels of soluble fragments, such as intercellular adhesion molecule (sICAM-1) and vascular cell adhesion molecule (sVCAM-1), have yielded conflicting associations with atherosclerotic cardiovascular disease (ASCVD). Endothelial cell-selective adhesion molecule (ESAM) is expressed exclusively in platelets and endothelial cells, and soluble ESAM (sESAM) levels have been associated with prevalent subclinical atherosclerosis. We therefore hypothesized that sESAM would be associated with incident ASCVD. METHODS sESAM, sICAM-1, and sVCAM-1 were measured in 2,442 participants without CVD in the Dallas Heart Study, a probability-based population sample aged 30-65 years enrolled between 2000 and 2002. ASCVD was defined as first myocardial infarction, stroke, coronary revascularization, or CV death. A total of 162 ASCVD events were analyzed over 10.4 years. RESULTS Increasing sESAM was associated with ASCVD, independent of risk factors (HR Q4 vs Q1: 2.7, 95% CI 1.6-4.6). Serial adjustment for renal function, sICAM-1, VCAM-1, and prevalent coronary calcium did not attenuate these associations. Continuous ESAM demonstrated similar findings (HR 1.31, 95% CI 1.2-1.4). Addition of sESAM to traditional risk factors improved discrimination and reclassification (delta c-index: P = .009; integrated-discrimination-improvement index P = .001; net reclassification index = 0.42, 95% CI 0.15-0.68). Neither sICAM-1 nor sVCAM-1 was independently associated with ASCVD. CONCLUSIONS sESAM but not sICAM-1 or sVCAM-1 levels are associated with incident ASCVD. Further studies are warranted to investigate the role of sESAM in ASCVD.
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Affiliation(s)
- Hao-Yu Ren
- 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
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
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Wilner B, Garg S, Ayers CR, Maroules CD, McColl R, Matulevicius SA, de Lemos JA, Drazner MH, Peshock R, Neeland IJ. Dynamic Relation of Changes in Weight and Indices of Fat Distribution With Cardiac Structure and Function: The Dallas Heart Study. J Am Heart Assoc 2017; 6:JAHA.117.005897. [PMID: 28724650 PMCID: PMC5586303 DOI: 10.1161/jaha.117.005897] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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 Obesity may increase heart failure risk through cardiac remodeling. Cross-sectional associations between adiposity and cardiac structure and function have been elucidated, but the impact of longitudinal changes in adiposity on cardiac remodeling is less well understood. METHODS AND RESULTS Participants in the Dallas Heart Study without cardiovascular disease or left ventricular dysfunction underwent assessment of body weight, anthropometrics, and cardiac magnetic resonance imaging at baseline and 7 years later. Associations between changes in indices of generalized and central adiposity with changes in left ventricular mass, volume, mass/volume ratio (concentricity), wall thickness, and ejection fraction were assessed using multivariable linear regression. The study cohort (n=1262) mean age was 44 years with 57% women, 44% black, and 36% obese participants. At follow-up, 41% had ≥5% weight gain, and 15% had ≥5% weight loss. Greater weight gain was associated with younger age, lower risk factor burden, and lower body mass index at baseline. In multivariable models adjusting for age, sex, race, comorbid conditions at baseline and follow-up, baseline adiposity, and cardiac measurement, increasing weight was associated with increases in left ventricular mass (β=0.10, P<0.0001), wall thickness (β=0.10, P<0.0001), and concentricity (β=0.06, P=0.002), with modest effects on end-diastolic volume (β=0.04, P=0.044) and ejection fraction (β=0.05, P=0.046). Similar results were seen with other adiposity indices. CONCLUSIONS Concentric left ventricular remodeling is the predominant phenotype linked to increasing adiposity in middle age. Our findings support the importance of weight management to prevent secular changes in adiposity, concentric remodeling, and eventual heart failure over time.
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Affiliation(s)
- Bryan Wilner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sonia Garg
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Roderick McColl
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Susan A Matulevicius
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mark H Drazner
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ronald Peshock
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian J Neeland
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
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Paixao ARM, Neeland IJ, Ayers CR, Xing F, Berry JD, de Lemos JA, Abbara S, Peshock RM, Khera A. Defining coronary artery calcium concordance and repeatability - Implications for development and change: The Dallas Heart Study. J Cardiovasc Comput Tomogr 2017; 11:347-353. [PMID: 28732689 DOI: 10.1016/j.jcct.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 11/16/2016] [Revised: 05/14/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Development and change of coronary artery calcium (CAC) are associated with coronary heart disease. Interpretation of serial CAC measurements will require better understanding of changes in CAC beyond the variability in the test itself. METHODS Dallas Heart Study participants (2888) with duplicate CAC scans obtained minutes apart were analyzed to determine interscan concordance and 95% confidence bounds (ie: repeatability limits) for each discrete CAC value. These data derived cutoffs were then used to define change above measurement variation and determine the frequency of CAC development and change among 1779 subjects with follow up CAC scans performed 6.9 years later. RESULTS Binary concordance (0 vs. >0) was 91%. The value of CAC denoting true development of CAC by exceeding the 95% confidence bounds for a single score of 0 was 2.7 Agatston units (AU). Among those with scores >0, the 95% confidence bounds for CAC change were determined by the following formulas: for CAC≤100AU: 5.6√CAC + 0.3*CAC - 3.1; for CAC>100AU: 12.4√CAC - 67.7. Using these parameters, CAC development occurred in 15.0% and CAC change occurred in 48.9%. Although 225 individuals (24.9%) had a decrease in CAC over follow up, only 1 (0.1%) crossed the lower confidence bound. Compared with prior reported definition of CAC development (ie: >0), the novel threshold of 2.7AU resulted in better measures of model performance. In contrast, for CAC change, no consistent differences in performance metrics were observed compared with previously reported definitions. CONCLUSION There is significant interscan variability in CAC measurement, including around scores of 0. Incorporating repeatability estimates may help discern true differences from those due to measurement variability, an approach that may enhance determination of CAC development and change.
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Affiliation(s)
- Andre R M Paixao
- Arkansas Heart Hospital, Little Rock, AR, USA; University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ian J Neeland
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby R Ayers
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Frank Xing
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jarett D Berry
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A de Lemos
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ronald M Peshock
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Mody P, Joshi PH, Khera A, Ayers CR, Rohatgi A. Beyond Coronary Calcification, Family History, and C-Reactive Protein: Cholesterol Efflux Capacity and Cardiovascular Risk Prediction. J Am Coll Cardiol 2017; 67:2480-7. [PMID: 27230043 DOI: 10.1016/j.jacc.2016.03.538] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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] [Received: 10/19/2015] [Revised: 03/04/2016] [Accepted: 03/15/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cholesterol efflux capacity (CEC), which is a key step in the reverse cholesterol transport pathway, is independently associated with atherosclerotic cardiovascular disease (ASCVD). However, whether it predicts ASCVD beyond validated novel risk markers is unknown. OBJECTIVES This study assessed if CEC improved ACSVD risk prediction beyond using coronary artery calcium (CAC), family history (FH), and high-sensitivity C-reactive protein (hs-CRP). METHODS CEC, CAC, self-reported FH, and hs-CRP were assessed among participants without baseline ASCVD who were enrolled in the Dallas Heart Study (DHS). ASCVD was defined as a first nonfatal myocardial infarction (MI) or stroke, coronary revascularization, or cardiovascular death, assessed over a median 9.4 years. Risk prediction was assessed using various modeling techniques and improvements in the c-statistic, the integrated discrimination index (IDI), and the net reclassification index (NRI). RESULTS The mean age of the population (N = 1,972) was 45 years, 52% had CAC (>0), 31% had FH, and 58% had elevated hs-CRP (≥2 mg/l). CEC greater than the median was associated with a 50% reduced incidence of ASCVD in those with CAC (5.4% vs. 10.5%; p = 0.003), FH (5.8% vs. 10%; p = 0.05), and elevated hs-CRP (3.8% vs. 7.9%; p = 0.004). CEC improved all metrics of discrimination and reclassification when added to CAC (c-statistic, p = 0.004; IDI, p = 0.02; NRI: 0.38; 95% confidence interval [CI]: 0.13 to 0.53), FH (c-statistic, p = 0.006; IDI, p = 0.008; NRI: 0.38; 95% CI: 0.13 to 0.55), or elevated hs-CRP (c-statistic p = 0.008; IDI p = 0.02; NRI: 0.36; 95% CI 0.12 to 0.52). CONCLUSIONS CEC improves ASCVD risk prediction beyond using CAC, FH, and hs-CRP and warrants consideration as a novel ASCVD risk marker.
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Affiliation(s)
- Purav Mody
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
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