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Razavi AC, Kohli P, McGuire DK, Martin SS, Polonsky TS, McEvoy JW, Whelton SP, Blumenthal RS. PREVENT Equations: A New Era in Cardiovascular Disease Risk Assessment. Circ Cardiovasc Qual Outcomes 2024; 17:e010763. [PMID: 38506044 DOI: 10.1161/circoutcomes.123.010763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Alexander C Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.C.R.)
| | - Payal Kohli
- Department of Cardiology, University of Colorado Anschutz, Aurora (P.K.)
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC (P.K.)
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Tamar S Polonsky
- Section of Cardiology, Division of Medicine, University of Chicago Pritzker School of Medicine, IL (T.S.P.)
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
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Al Rifai M, Al-Mallah MH, Blaha MJ, Patel J, McEvoy JW, Nasir K, Shahid I, Patel KV, Sharma G, Marrugat J, Tizon-Marcos H, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Blumenthal RS, Virani SS, Nambi V, Cainzos-Achirica M. Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes: A Multicohort Study. Diabetes Care 2024; 47:698-706. [PMID: 38329795 DOI: 10.2337/dc23-1864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To describe the epidemiology and prognostic value of coronary artery calcium (CAC) in individuals with prediabetes. RESEARCH DESIGN AND METHODS We pooled participants free of clinical atherosclerotic cardiovascular disease (ASCVD) from four prospective cohorts: the Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, and Jackson Heart Study. Two definitions were used for prediabetes: inclusive (fasting plasma glucose [FPG] ≥100 to <126 mg/dL and hemoglobin A1c [HbA1c] ≥5.7% to <6.5%, if available, and no glucose-lowering medications) and restrictive (FPG ≥110 to <126 mg/dL and HbA1c ≥5.7% to <6.5%, if available, among participants not taking glucose-lowering medications). RESULTS The study included 13,376 participants (mean age 58 years; 54% women; 57% White; 27% Black). The proportions with CAC ≥100 were 17%, 22%, and 37% in those with euglycemia, prediabetes, and diabetes, respectively. Over a median (25th-75th percentile) follow-up time of 14.6 (interquartile range 7.8-16.4) years, individuals with prediabetes and CAC ≥100 had a higher unadjusted 10-year incidence of ASCVD (13.4%) than the overall group of those with diabetes (10.6%). In adjusted analyses, using the inclusive definition of prediabetes, compared with euglycemia, the hazard ratios (HRs) for ASCVD were 0.79 (95% CI 0.62, 1.01) for prediabetes and CAC 0, 0.70 (0.54, 0.89) for prediabetes and CAC 1-99, 1.54 (1.27, 1.88) for prediabetes and CAC ≥100, and 1.64 (1.39, 1.93) for diabetes. Using the restrictive definition, the HR for ASCVD was 1.63 (1.29, 2.06) for prediabetes and CAC ≥100. CONCLUSIONS CAC ≥100 is frequent among individuals with prediabetes and identifies a high ASCVD risk subgroup in which the adjusted ASCVD risk is similar to that in individuals with diabetes.
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Affiliation(s)
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Johns Hopkins Heart Center, Greater Baltimore Medical Center, Baltimore, MD
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Houston Methodist Academic Institute, Houston, TX
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Izza Shahid
- Houston Methodist Academic Institute, Houston, TX
| | - Kershaw V Patel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Houston Methodist Academic Institute, Houston, TX
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Inova Women's Cardiovascular Health, Fairfax, VA
| | - Jaume Marrugat
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Helena Tizon-Marcos
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Houston, TX
- Baylor College of Medicine, Houston, TX
| | - Vijay Nambi
- Section of Cardiology, Baylor College of Medicine, Houston, TX
- Center for Cardiometabolic Disease Prevention, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
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McEvoy JW, Wang D, Tang O, Fang M, Ndumele CE, Coresh J, Christenson RH, Selvin E. Four high sensitivity troponin assays and mortality in US adults with cardiovascular disease: The national health and nutrition examination survey, 1999-2004. Am J Prev Cardiol 2024; 17:100631. [PMID: 38304389 PMCID: PMC10832369 DOI: 10.1016/j.ajpc.2023.100631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024] Open
Abstract
Objective High sensitivity cardiac troponin (hs-cTn) may be useful to monitor residual risk in secondary prevention. Our objective was to study the correlations and comparative associations with mortality of four hs-cTn assays in US adults with known cardiovascular disease (CVD). Methods We studied 1,211 adults with a history of CVD who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Using stored samples, we measured hs-cTnT (Roche) and three hs-cTnI assays (Abbott, Siemens, and Ortho). Outcomes were all-cause and CVD mortality, with follow-up through December 31, 2019. Results Mean age was 64 years, 48 % were female, and 80 % identified as non-Hispanic White. Pearson's correlation coefficients between hs-cTn assays ranged from 0.67 to 0.85. There were 848 deaths (365 from CVD). Among adults with a history of prior non-fatal CVD, each hs-cTn assay (log-transformed, per 1-SD) was independently associated with CVD death (HRs ranging from 1.55 to 2.16 per 1-SD, all p-values <0.05) and with all-cause death (HRs ranging from 1.31 to 1.62 per 1-SD, all p-values <0.05). Associations of hs-cTnT and all-cause and CVD death remained significant after adjusting for hs-cTnI (and vice versa). Associations between hs-cTnI and CVD death remained significant after mutually adjusting for other individual hs-cTnI assays: e.g., HR 2.21 (95 % CI 1.60, 3.05) for Ortho (hs-cTnI) after adjustment for Siemens (hs-cTnI) and HR 1.81 (95 % CI 1.35, 2.43) for Ortho (hs-cTnI) after adjustment for Abbott (hs-cTnI). Conclusion In US adults with a history of CVD, we found modest correlations between 4 hs-cTn assays. All assays were associated with all-cause and CVD mortality. The hs-cTnT assay was associated with mortality independent of the hs-cTnI assays. Hs-cTnI assays also appeared to be independent of each other. Thus, hs-cTn assays may provide distinct information for residual risk in secondary prevention adults.
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Affiliation(s)
- John W. McEvoy
- Department of Cardiology & National Institute for Prevention & Cardiovascular Health, University of Galway, Ireland
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dan Wang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olive Tang
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Fang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chiadi E. Ndumele
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore,aryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kenny E, Coyne R, McEvoy JW, McSharry J, Taylor RS, Byrne M. Behaviour change techniques and intervention characteristics in digital cardiac rehabilitation: a systematic review and meta-analysis of randomised controlled trials. Health Psychol Rev 2024; 18:189-228. [PMID: 36892523 DOI: 10.1080/17437199.2023.2185653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023]
Abstract
Evidence suggests that digitally delivered cardiac rehabilitation (CR) is likely to be an effective alternative to centre-based CR. However, there is limited understanding of the behaviour change techniques (BCTs) and intervention characteristics included in digital CR programmes. This systematic review aimed to identify the BCTs and intervention characteristics that have been used in digital CR programmes, and to study those associated with effective programmes. Twenty-five randomised controlled trials were included in the review. Digital CR was associated with significant improvements in daily steps, light physical activity, medication adherence, functional capacity, and low-density lipoprotein-cholesterol when compared to usual care, and produced effects on these outcomes comparable to centre-based CR. The evidence for improved quality of life was mixed. Interventions that were effective at improving behavioural outcomes frequently employed BCTs relating to feedback and monitoring, goals and planning, natural consequences, and social support. Completeness of reporting on the TIDieR checklist across studies ranged from 42% to 92%, with intervention material descriptions being the most poorly reported item. Digital CR appears effective at improving outcomes for patients with cardiovascular disease. The integration of certain BCTs and intervention characteristics may lead to more effective interventions, however better intervention reporting is required.
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Affiliation(s)
- Eanna Kenny
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Rory Coyne
- School of Psychology, University of Galway, Galway, Republic of Ireland
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, University of Galway, Galway, Republic of Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
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Campbell R, Nelson MR, McNeill JJ, McEvoy JW. Outcomes After Aspirin Discontinuation Among Baseline Users in Contemporary Primary Prevention Aspirin Trials: A Meta-Analysis. Circulation 2024; 149:722-724. [PMID: 38408145 PMCID: PMC10901451 DOI: 10.1161/circulationaha.123.065420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Ruth Campbell
- National Institute for Prevention and Cardiovascular Health and School of Medicine, University of Galway, Ireland (R.C., J.W.M.E.)
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.R.N.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (M.R.N., J.J.M.N.)
| | - John J McNeill
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (M.R.N., J.J.M.N.)
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health and School of Medicine, University of Galway, Ireland (R.C., J.W.M.E.)
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Kenny E, Byrne M, McEvoy JW, Connolly S, McSharry J. Exploring patient experiences of participating in digital cardiac rehabilitation: A qualitative study. Br J Health Psychol 2024; 29:149-164. [PMID: 37722874 DOI: 10.1111/bjhp.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Digital cardiac rehabilitation (CR) has emerged as a promising alternative to in-person CR. Understanding patients' experiences and perceptions can provide valuable insights into what makes these programmes successful and identify opportunities for improvement. This study aimed to explore patients' experiences of digital CR and to understand the factors that make these programmes successful. DESIGN A qualitative approach was taken. METHODS From March to August 2022, we conducted semi-structured interviews with patients who were referred to one of two digital CR programmes offered on the island of Ireland. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. A public and patient involvement panel guided the recruitment strategy and assisted with data analysis. RESULTS Eleven patients, predominantly male (82%) and with a mean age of 64 (range 50-75), participated in the study. Five themes were developed: (1) Empowered patients; (2) Controlling the recovery; (3) At home but not alone; (4) The world at your (digital) doorstep and; (5) Challenges of interacting online. Participants reported that digital CR equipped them with the necessary tools and support to modify their lifestyle and effectively manage their recovery. However, the opportunities for social interaction were limited and communicating online was not always straightforward. CONCLUSIONS Participants reported that digital CR guided them towards recovery and improved their sense of empowerment and control. However, the limited opportunities for social interaction may represent a challenge for patients seeking social support.
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Affiliation(s)
- Eanna Kenny
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - John W McEvoy
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Susan Connolly
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
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Nolan P, McEvoy JW. Salt restriction for treatment of hypertension - current state and future directions. Curr Opin Cardiol 2024; 39:61-67. [PMID: 38078601 DOI: 10.1097/hco.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE OF REVIEW Given the adverse effects of excess dietary sodium chloride (also known as table salt) on blood pressure (BP) and cardiovascular disease (CVD), restriction of dietary sodium is recommended by numerous guidelines. The strictest of these recommend no more than 1.5 g/day of dietary sodium among hypertensive persons. However, average dietary sodium intake in the population is closer to 5 g/day and there is debate about whether too much sodium restriction may be associated with increased CVD risk. Herein, we aim to provide a balanced update on this topic. RECENT FINDINGS In 2021, the Salt Substitute and Stroke Study (SSaSS) demonstrated a significant reduction in BP, CVD, and death among Chinese adults randomized to a low sodium salt-substitute supplemented with potassium. This trial largely puts to rest any remaining debate about the benefits of dietary sodium restriction among persons with excess baseline intake (dietary sodium intake fell from approximately 5 down to 4 g/day in the active arm of SSaSS). However, whether achieving and maintaining a dietary sodium of less than1.5 g/day is feasible in real-world settings and whether this low an intake is harmful remain open questions. SUMMARY Aiming for sodium intakes of 2--3 g/day in the general population and as low as 2 g/day in persons with hypertension or CVD seems most reasonable, but there is some uncertainty around lower targets.
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Affiliation(s)
- Philip Nolan
- University Hospital Galway and SAOLTA University Healthcare Group
- School of Medicine, University of Galway
| | - John W McEvoy
- University Hospital Galway and SAOLTA University Healthcare Group
- School of Medicine, University of Galway
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
- Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lunardi M, Muhammad F, Shahzad A, Nadeem A, Combe L, Simpkin AJ, Sharif F, Wijns W, McEvoy JW. Performance of wearable watch-type home blood pressure measurement devices in a real-world clinical sample. Clin Res Cardiol 2023:10.1007/s00392-023-02353-7. [PMID: 38112747 DOI: 10.1007/s00392-023-02353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Independent testing of home blood pressure (BP) measurement (HBPM) devices is often lacking, particularly among older and multi-morbid patients. METHODS We studied the Bpro G2 (using tonometry), Omron HeartGuide (using occlusive oscillometric technology), and Heartisans (using photoplethysmography) wrist watch HBPM devices against a gold standard brachial sphygmomanometer. To test device performance, we used the ISO81060-2 protocol (though this protocol cannot formally validate cuffless devices). We also used linear mixed models to compare adjusted longitudinal BP measurements between devices. Finally, as a surrogate for usability, we recorded instances of device failure where no BP measurement was returned. RESULTS We enrolled 128 participants (median [Q1-Q3] age 53 [40-65] years, 51% male, 46% on antihypertensive drugs), of whom 100 were suitable for the primary analysis. All three devices had mean BP values within 5 mmHg of sphygmomanometry. However, due to insufficient reliability (e.g., wider than accepted standard deviations of mean BP), none of the three devices passed all criteria required by the ISO81060-2 protocol. In adjusted longitudinal analyses, the Omron device also systematically underestimated systolic and diastolic BP (- 8.46 mmHg; 95% CI 6.07, 10.86; p < 0.001; and - 2.53 mmHg; 95% CI - 4.03, - 1.03; p = 0.001; respectively). Nevertheless, compared to the Omron device, BPro and Heartisans devices had increased odds of failure (BPro: odds ratio [OR] 5.24; p < 0.0001; Heartisans: OR 5.61; p < 0.001). CONCLUSIONS While we could not formally validate the cuffless devices, our results show that wearable technologies will require improvements to offer reliable BP assessment. This study also highlights the need for validation protocols specifically designed for cuffless BP measurement technologies.
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Affiliation(s)
- Mattia Lunardi
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and University of Galway, Galway, H91 TK33, Ireland
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
- Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Farooq Muhammad
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Atif Shahzad
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Asma Nadeem
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Lisa Combe
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, University of Galway, Galway, Ireland
- Insight Centre for Data Analytics, University of Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and University of Galway, Galway, H91 TK33, Ireland
| | - William Wijns
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - John W McEvoy
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and University of Galway, Galway, H91 TK33, Ireland.
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Yang P, Rooney MR, Wallace AS, Kim H, Echouffo-Tcheugui JB, McEvoy JW, Ndumele C, Christenson RH, Selvin E, Rebholz CM. Associations between diet quality and NT-proBNP in U.S. adults, NHANES 1999-2004. Am J Prev Cardiol 2023; 16:100528. [PMID: 37601625 PMCID: PMC10432600 DOI: 10.1016/j.ajpc.2023.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Objective N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is a marker of cardiac wall stress and is a predictor of cardiovascular disease. Higher diet quality is associated with lower risk of cardiovascular disease. The association between diet quality and subclinical cardiovascular disease assessed by NT-proBNP is uncharacterized. We investigated the associations between diet quality, using Healthy Eating Index-2015 (HEI-2015), and NT-proBNP from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Methods We included 9,782 adults from NHANES 1999-2004 without self-reported cardiovascular disease. The HEI-2015 ranges from 0 to 100, with higher scores indicating better diet quality. The HEI-2015 was categorized into sex-specific quintiles. Regression models were used to quantify associations between the overall HEI-2015 score and its 13 components with log-transformed NT-proBNP. The beta coefficients were converted to percent differences. Results Among 9,782 participants, mean age was 45 years, 48% were men, and 72% were non-Hispanic White adults. After adjusting for sociodemographic characteristics, lifestyle factors, and medical history, those in the highest vs. lowest HEI-2015 quintile had an 8.5% (95% CI: -14.6% to -2.0%) lower NT-proBNP level. There was a dose-response association between HEI-2015 and NT-proBNP (P value for trend = 0.01). Each 1-unit higher in sodium and added sugars score indicating lower intake was associated with lower NT-proBNP by 7.7% (95% CI: -12.8% to -2.2%) and 6.5% (95% CI: -12.0% to -0.7%), respectively. Conclusion Higher diet quality, especially lower intakes of sodium and added sugars, was associated with lower serum levels of NT-proBNP.
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Affiliation(s)
- Ping Yang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary R. Rooney
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amelia S. Wallace
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hyunju Kim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John W. McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Chiadi Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Casey M. Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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McEvoy JW, Leahy N, Parati G. The Apples and Oranges of Blood Pressure Variability. Hypertension 2023; 80:2556-2558. [PMID: 37967158 DOI: 10.1161/hypertensionaha.123.21927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- John W McEvoy
- National Institute for Prevention and Cardiovascular Health and University of Galway, Galway, Ireland. (J.W.M., N.L.)
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD. (J.W.M.)
| | - Niall Leahy
- National Institute for Prevention and Cardiovascular Health and University of Galway, Galway, Ireland. (J.W.M., N.L.)
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.)
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11
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Creegan D, McEvoy JW. Selected highlights in the updated treatment of hypertension. Trends Cardiovasc Med 2023:S1050-1738(23)00097-X. [PMID: 37981201 DOI: 10.1016/j.tcm.2023.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/30/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023]
Abstract
Hypertension remains the leading international risk factor for cardiovascular disease and premature death but, despite effective treatments, hypertension remains significantly underdiagnosed and undertreated. In the present review paper, we provide a selected update on recent developments of interest in the management of hypertension. We focus on summarizing four topics that we believe are worth highlighting to a clinical audience: (1) the evidence and strong motivation for new lower systolic BP treatment targets; (2) new studies reporting on the efficacy of renal denervation in the management of hypertension; (3) interesting new data to inform the great salt debate; and (4), perhaps most importantly, pioneering new work highlighting the huge potential of multi-disciplinary care in the management of hypertension.
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Affiliation(s)
- Daniel Creegan
- University Hospital Galway and SAOLTA University Health Care Group, Galway, Ireland; School of Medicine, University of Galway, Ireland
| | - John W McEvoy
- University Hospital Galway and SAOLTA University Health Care Group, Galway, Ireland; School of Medicine, University of Galway, Ireland; National Institute for Prevention and Cardiovascular Health, Moyola Lane, Galway, H91 FF68, Ireland; Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA.
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12
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Burger PM, Savarese G, Tromp J, Adamson C, Jhund PS, Benson L, Hage C, Tay WT, Solomon SD, Packer M, Rossello X, McEvoy JW, De Bacquer D, Timmis A, Vardas P, Graham IM, Di Angelantonio E, Visseren FLJ, McMurray JJV, Lam CSP, Lund LH, Koudstaal S, Dorresteijn JAN, Mosterd A. Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: The LIFE-HF model. Eur J Heart Fail 2023; 25:1962-1975. [PMID: 37691140 DOI: 10.1002/ejhf.3028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. METHODS AND RESULTS Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65-0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor, and angiotensin receptor-neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7-3.7) and 3.7 (IQR 2.4-5.5) additional years of overall and HF hospitalization-free survival, respectively. CONCLUSION The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.
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Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- National University Health System Singapore, Singapore, Singapore
| | - Carly Adamson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lina Benson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Hage
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Adam Timmis
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Ian M Graham
- School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin, Ireland
| | | | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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13
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Daya NR, McEvoy JW, Christenson RH, Tang O, Foti K, Juraschek SP, Selvin E, Echouffo-Tcheugui JB. Prevalence of Elevated NT-proBNP and its Prognostic Value by Blood Pressure Treatment and Control. Am J Hypertens 2023; 36:602-611. [PMID: 37458697 PMCID: PMC10570660 DOI: 10.1093/ajh/hpad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The prognostic utility of NT-proBNP in the setting of hypertension has not been well-characterized in the general US adult population. METHODS We measured NT-proBNP in stored blood samples collected from participants 1 year or older who participated in the 1999-2004 National Health and Nutrition Examination Survey. In adults 20 years or older without a history of cardiovascular disease, we assessed the prevalence of elevated NT-pro-BNP by blood pressure (BP) treatment and control categories. We examined the extent to which NT-proBNP identifies participants at higher risk for mortality across BP treatment and control categories. RESULTS Among US adults without CVD, the prevalence of elevated NT-proBNP (≥125 pg/ml) was 27.2% among those with untreated hypertension, 24.9% among those with treated controlled hypertension, and 43.3% among those with treated uncontrolled hypertension. Over a median follow-up of 17.3 years and after adjusting for demographic and clinical risk factors, US adults with treated controlled hypertension and elevated NT-proBNP had increased risk of all-cause mortality (HR 2.29, 95% CI 1.79, 2.95) and cardiovascular mortality (HR 3.83, 95% CI 2.34, 6.29), compared to adults without hypertension and with low levels of NT-proBNP (<125 pg/ml). Across all levels of SBP and irrespective of antihypertensive medication use, elevated NT-proBNP was associated with an increased risk of mortality, compared to low levels of NT-proBNP. CONCLUSIONS Among a general population of adults free of CVD, NT-proBNP can provide additional prognostic information within and across categories of BP. Measurement of NT-proBNP may have potential for clinical use to optimize hypertension treatment.
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Affiliation(s)
- Natalie R Daya
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John W McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Olive Tang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathryn Foti
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Justin B Echouffo-Tcheugui
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Echouffo-Tcheugui JB, Zhang S, McEvoy JW, Juraschek SP, Fang M, Ndumele CE, Christenson RH, Selvin E. Insulin Resistance and N-Terminal Pro-B-Type Natriuretic Peptide Among Healthy Adults. JAMA Cardiol 2023; 8:989-995. [PMID: 37672260 PMCID: PMC10483384 DOI: 10.1001/jamacardio.2023.2758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/07/2023] [Indexed: 09/07/2023]
Abstract
Importance It is unclear to what extent insulin resistance is associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the general population after accounting for body composition. Objective To characterize the association of insulin resistance with NT-proBNP independently of measures of body composition in US adults. Design, Setting, and Participants In a cross-sectional design, data on participants aged 20 years or older were obtained from the 1999-2004 National Health and Nutrition Examination Survey with measures of NT-pro-BNP, body mass index (BMI), and dual energy x-ray absorptiometry (DEXA)-derived measures of body composition (fat and lean masses). Linear and logistic regression was used to characterize the associations of measures of body mass and composition (BMI, waist circumference, fat mass, and lean mass) with NT-proBNP, adjusting for cardiovascular risk factors. Linear regression was used to characterize the associations of homeostasis model assessment of insulin resistance [HOMA-IR] and NT-proBNP after adjusting for cardiovascular risk factors and body composition measures. The quantitative insulin sensitivity check index [QUICKI], triglyceride-glucose index [TyG index], insulin to glucose ratio [IGR], fasting insulin, and homeostasis model assessment of β-cell function (HOMA-β) were also examined. Data for this study were analyzed from August 10, 2022, to June 30, 2023. Main Outcomes and Measures Adjusted changes in NT-proBNP by insulin resistance levels. Results A total of 4038 adults without diabetes or cardiovascular disease were included (mean [SD] age, 44 years; 51.2% female; and 74.3% White). In sex-specific analyses, insulin resistance measures were inversely associated with NT-pro-BNP. After adjustment including cardiovascular risk factors, BMI, waist circumference, and DEXA-derived fat mass and lean mass, the percent change in NT-proBNP associated with an SD increase in HOMA-IR was -16.84% (95% CI, -21.23% to -12.21%) in women and -19.04% (95% CI, -24.14 to -13.59) in men. Similar associations were observed for other indices of insulin resistance, including QUICKI (women: 17.27; 95% CI, 10.92-23.99 vs men: 22.17; 95% CI, 15.27 to 29.48), TyG index women: -11.47; 95% CI, -16.12 to -6.57 vs men: -15.81; 95% CI, -20.40 to -10.95), IGR women: -15.15; 95% CI, -19.35 to -10.74 vs men: -16.61; 95% CI, -21.63 to -11.26), and fasting insulin (women: -16.32; 95% CI, -20.63 to -11.78 vs men: -18.22; 95% CI, -23.30 to -12.79), as well as HOMA-β (women: -10.71; 95% CI, -14.71 to -6.52 vs men: -11.72; 95% CI, -16.35 to -6.85). Conclusions and Relevance In a national sample of US adults, insulin resistance was inversely associated with NT-proBNP, even after rigorously accounting for multiple measures of fat mass and lean mass. These results suggest that the mechanisms linking NT-proBNP to insulin resistance are partially independent of excess adiposity and may be associated with hyperinsulinemia.
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Affiliation(s)
- Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sui Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John W. McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Stephen P. Juraschek
- Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael Fang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Wang MC, Petito LC, Pool LR, Foti K, Juraschek SP, McEvoy JW, Nambi V, Carnethon MR, Michos ED, Khan SS. The 2017 American College of Cardiology/American Heart Association Hypertension Guideline and Blood Pressure in Older Adults. Am J Prev Med 2023; 65:640-648. [PMID: 37105448 PMCID: PMC10524146 DOI: 10.1016/j.amepre.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION The 2017 American College of Cardiology/American Heart Association blood pressure guideline redefined hypertension and lowered the blood pressure treatment target. Empirical data on the guideline's impact are needed. METHODS Data were analyzed from Atherosclerosis Risk in Communities study participants who attended baseline pre-guideline (2016-2017) and post-guideline (2018-2019) visits with baseline systolic blood pressure between 120 and 159 mmHg. Participants were grouped according to baseline systolic blood pressure by change in classification under the new guideline as follows: not reclassified (120-129 mmHg), reclassified to Stage 1 hypertension (130-139 mmHg), and reclassified to Stage 2 hypertension (140-159 mmHg). Means and 95% CIs for systolic blood pressure changes between baseline and follow-up, changes in antihypertensive use, and percentages that achieved the post-guideline recommendation (systolic blood pressure <130 mmHg) were calculated. Analyses were performed in 2021-2022. RESULTS Among 2,193 community-dwelling Atherosclerosis Risk in Communities participants aged 71-95 years at baseline, systolic blood pressure changes between baseline and follow-up visits differed among participants not reclassified (+4.1 mmHg, 95% CI=3.0, 5.3 mmHg), reclassified to Stage 1 hypertension (-1.1 mmHg, 95% CI= -2.2, 0.1 mmHg), and reclassified to Stage 2 hypertension (-5.7 mmHg, 95% CI= -6.8, -4.7 mmHg). Antihypertensive use changed from 77.3% to 78.4% (p=0.25) among participants reclassified to Stage 1 hypertension and from 78.3% to 81.4% (p<0.01) among participants reclassified to Stage 2 hypertension. At follow-up, 41.8% of the Stage 1 and 22.4% of the Stage 2 hypertension groups reached the systolic blood pressure <130 mmHg goal. CONCLUSIONS There were small decreases in systolic blood pressure and increases in antihypertensive therapy among older adults reclassified to Stage 2 hypertension but not among those reclassified to Stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association guideline.
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Affiliation(s)
- Michael C Wang
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lucia C Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn Foti
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephen P Juraschek
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, University of Galway School of Medicine, Galway, Ireland; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hital, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Ozkan B, Grams ME, Coresh J, McEvoy JW, Echouffo-Tcheugui JB, Mu SZ, Tang O, Daya NR, Kim H, Christenson RH, Ndumele CE, Selvin E. Associations of N-terminal pro-B-type natriuretic peptide, estimated glomerular filtration rate, and mortality in US adults. Am Heart J 2023; 264:49-58. [PMID: 37290699 PMCID: PMC10526685 DOI: 10.1016/j.ahj.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/11/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND NT-proBNP is an important predictor of mortality but is inversely related to estimated glomerular filtration rate (eGFR). Whether the prognostic value of NT-proBNP is similar at different levels of kidney function is unknown. AIMS We evaluated the association of NT-proBNP with eGFR and its implications for all-cause and cardiovascular mortality risk in the general population. METHODS We included adults without prior cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. We used linear regression to characterize the cross-sectional associations of NT-proBNP with eGFR. We used Cox regression to assess the prospective associations of NT-proBNP with mortality across categories of eGFR. RESULTS Among 11,456 participants (mean age 43 years, 48% female, 71% White, 11% Black), there was an inverse association between NT-proBNP and eGFR, which was stronger in those with more impaired kidney function. Per 15-unit decrease in eGFR, NT-proBNP was 4.3-fold higher for eGFR<30; 1.7-fold higher for eGFR 30 to 60, 1.4-fold higher for eGFR 61 to 90, 1.1-fold higher for eGFR 91 to 120 mL/min/1.73 m2. Over a median 17.6 years of follow-up, 2,275 deaths (622 cardiovascular) occurred. Higher NT-proBNP was associated with higher all-cause (HR per doubling of NT-proBNP: 1.20, 95% CI: 1.16-1.25) and cardiovascular mortality (HR: 1.34, 95% CI 1.25-1.44). Associations were similar across eGFR categories (P-interaction >.10). Adults with NT-proBNP≥450 pg/mL and eGFR<60 mL/min/1.73m2 had 3.4-fold higher all-cause mortality and 5.5-fold higher cardiovascular mortality risk, compared to those with NT-proBNP<125 pg/mL and eGFR>90 mL/min/1.73m2. CONCLUSION Despite its strong inverse association with eGFR, NT-proBNP has robust associations with mortality across the full range of kidney function in the general US adult population.
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Affiliation(s)
- Bige Ozkan
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Morgan E Grams
- Division of Precision Medicine Research, New York University Grossman School of Medicine, New York, NY
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John W McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Scott Z Mu
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Olive Tang
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Natalie R Daya
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hyunju Kim
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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17
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Echouffo-Tcheugui JB, Zhang S, McEvoy JW, Juraschek SP, Coresh J, Christenson RH, Ndumele CE, Selvin E. Body Composition Measures and N-terminal pro-B-type Natriuretic Peptide (NT-pro-BNP) in US Adults. Clin Chem 2023; 69:901-914. [PMID: 37477552 PMCID: PMC10478300 DOI: 10.1093/clinchem/hvad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/10/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The associations of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with dual energy x-ray absorptiometry (DEXA)-derived measures of body mass and composition are largely unknown. METHODS We included participants aged ≥20 years from the 1999-2004 National Health and Nutrition Examination Survey with NT-pro-BNP and DEXA-derived body composition (fat and lean mass) measures. We used linear and logistic regression to characterize the associations of measures of body mass and composition (body mass index [BMI], waist circumference [WC], fat mass, and lean mass) with NT-pro-BNP, adjusting for cardiovascular risk factors. RESULTS We conducted sex-specific analyses among 9134 adults without cardiovascular disease (mean age 44.4 years, 50.8% women, and 72% White adults). The adjusted mean NT-proBNP values were lowest in the highest quartiles of BMI, WC, fat mass, and lean mass. There were large adjusted absolute differences in NT-pro-BNP between the highest and lowest quartiles of DEXA-derived lean mass, -6.26 pg/mL (95% confidence interval [CI], -8.99 to -3.52) among men and -22.96 pg/mL (95% CI, -26.83 to -19.09) among women. Lean mass exhibited a strong inverse association with elevated NT-pro-BNP ≥ 81.4 pg/mL (highest quartile) - odds ratio (OR) 0.58 (95% CI, 0.39-0.86) in men and OR 0.59 (95% CI, 0.47-0.73) in women for highest lean mass quartile vs. lowest quartile. Further adjustment for fat mass, BMI, or WC did not appreciably alter the inverse association of lean mass with NT-pro-BNP. CONCLUSIONS In a national sample of US adults, lean mass was inversely associated with NT-pro-BNP.
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Affiliation(s)
- Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sui Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - John W. McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Stephen P. Juraschek
- Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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18
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Hicks CW, Wang D, McDermott K, Matsushita K, Tang O, Echouffo-Tcheugui JB, McEvoy JW, Christenson RH, Selvin E. Associations of Cardiac Biomarkers With Peripheral Artery Disease and Peripheral Neuropathy in US Adults Without Prevalent Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2023; 43:1583-1591. [PMID: 37317848 PMCID: PMC10526698 DOI: 10.1161/atvbaha.122.318774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity cardiac troponin T (hs-troponin T), and high-sensitivity cardiac troponin I (hs-troponin I) are increasingly being recommended for risk stratification for a variety of cardiovascular outcomes. The aims of our study were to establish the prevalence and associations of elevated NT-proBNP, hs-troponin T, and hs-troponin I with lower extremity disease, including peripheral artery disease (PAD) and peripheral neuropathy (PN), in the US general adult population without known cardiovascular disease. We also assessed whether the combination of PAD or PN and elevated cardiac biomarkers was associated with an increased risk of all-cause and cardiovascular mortality. METHODS We conducted a cross-sectional analysis of the associations of NT-proBNP, hs-troponin T, and hs-troponin I with PAD (based on ankle-brachial index <0.90) and PN (diagnosed by monofilament testing) in adult participants aged ≥40 years of age without prevalent cardiovascular disease in NHANES (National Health and Nutrition Examination Survey) 1999 to 2004. We calculated the prevalence of elevated cardiac biomarkers among adults with PAD and PN and used multivariable logistic regression to assess the associations of each cardiac biomarker, modeled using clinical cut points, with PAD and PN separately. We used multivariable Cox proportional hazards models to assess the adjusted associations of cross categories of clinical categories of each cardiac biomarker and PAD or PN with all-cause and cardiovascular mortality. RESULTS In US adults aged ≥40 years, the prevalence (±SE) of PAD was 4.1±0.2% and the prevalence of PN was 12.0±0.5%. The prevalence of elevated NT-proBNP (≥125 ng/L), hs-troponin T (≥6 ng/L), and hs-troponin I (≥6 ng/L for men and ≥4 ng/L for women) was 54.0±3.4%, 73.9±3.5%, and 32.3±3.7%, respectively, among adults with PAD and 32.9±1.9%, 72.8±2.0%, and 22.7±1.9%, respectively, among adults with PN. There was a strong, graded association of higher clinical categories of NT-proBNP with PAD after adjusting for cardiovascular risk factors. Clinical categories of elevated hs-troponin T and hs-troponin I were strongly associated with PN in adjusted models. After a maximum follow-up of 21 years, elevated NT-proBNP, hs-troponin T, and hs-troponin I were each associated with all-cause and cardiovascular mortality, with higher risks of death observed among adults with elevated cardiac biomarkers plus PAD or PN compared with elevated biomarkers alone. CONCLUSIONS Our study establishes a high burden of subclinical cardiovascular disease defined by cardiac biomarkers in people with PAD or PN. Cardiac biomarkers provided prognostic information for mortality within and across PAD and PN status, supporting the use of these biomarkers for risk stratification among adults without prevalent cardiovascular disease.
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Affiliation(s)
- Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Dan Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Katherine McDermott
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Olive Tang
- Johns Hopkins University School of Medicine, Baltimore MD
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - John W. McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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McEvoy JW, Daya N, Tang O, Fang M, Ndumele CE, Coresh J, Christenson RH, Selvin E. High-sensitivity troponins and mortality in the general population. Eur Heart J 2023; 44:2595-2605. [PMID: 37264651 PMCID: PMC10361011 DOI: 10.1093/eurheartj/ehad328] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 12/06/2022] [Revised: 03/29/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS Cardiac troponin T and I can be measured using a number of high-sensitivity (hs) assays. This study aimed to characterize correlations between four such assays and test their comparative associations with mortality. METHODS AND RESULTS Among adults without cardiovascular disease in the 1999-2004 National Health and Nutrition Examination Survey, hs-troponin T was measured using one assay (Roche) and hs-troponin I using three assays (Abbott, Siemens, and Ortho). Cox regression was used to estimate associations with all-cause and cardiovascular mortality. Pearson's correlation coefficients comparing concentrations from each assay ranged from 0.53 to 0.77. There were 2188 deaths (488 cardiovascular) among 9810 participants. Each hs-troponin assay [log-transformed, per 1 standard deviation (SD)] was independently associated with all-cause mortality: hazard ratio (HR) 1.20 [95% confidence interval (CI) 1.13-1.28] for Abbott hs-troponin I; HR 1.10 (95% CI 1.02-1.18) for Siemens hs-troponin I; HR 1.23 (95% CI 1.14-1.33) for Ortho hs-troponin I; and HR 1.31 (95% CI 1.21-1.42) for Roche hs-troponin T. Each hs-troponin assay was also independently associated with cardiovascular mortality (HR 1.44 to 1.65 per 1 SD). Associations of hs-troponin T and all-cause and cardiovascular mortality remained significant after adjusting for hs-troponin I. Furthermore, associations of hs-troponin I remained significant after mutually adjusting for hs-troponin I from the other individual assays: e.g. cardiovascular mortality HR 1.46 (95% CI 1.19-1.79) for Abbott after adjustment for the Siemens assay and HR 1.29 (95% CI 1.09-1.53) for Abbott after adjustment for the Ortho assay. CONCLUSION This study demonstrates only modest correlations between hs-troponin T and three hs-troponin I assays and that hs-troponin I assays can provide distinct risk information for mortality in the general population.
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Affiliation(s)
- John W McEvoy
- University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91-FF68, Connacht, Ireland
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Natalie Daya
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Olive Tang
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Chiadi E Ndumele
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
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Echouffo‐Tcheugui JB, Zhang S, Daya N, McEvoy JW, Tang O, Juraschek SP, Ndumele CE, Coresh J, Christenson RH, Selvin E. NT-proBNP and All-Cause and Cardiovascular Mortality in US Adults: A Prospective Cohort Study. J Am Heart Assoc 2023; 12:e029110. [PMID: 37232235 PMCID: PMC10382006 DOI: 10.1161/jaha.122.029110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 05/27/2023]
Abstract
Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle-aged and older populations, have suggested that NT-proBNP has prognostic value in ambulatory adults. Methods and Results We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT-proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT-proBNP with all-cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self-reported history of CVD). There were 3155 deaths (1009 CVD-related) over a median 17.3 years of follow-up. Among individuals without prior CVD, elevated NT-proBNP (≥75th percentile [81.5 pg/mL] versus <25th percentile [20.5 pg/mL]) was associated with a significantly higher risk of all-cause (hazard ratio [HR], 1.67 [95% CI, 1.39-2.00]) and CVD mortality (HR, 2.87 [95% CI, 1.61-5.11]). Associations of NT-proBNP with all-cause and CVD mortality were generally similar across subgroups defined by age, sex, race and ethnicity, or body mass index (all P interaction >0.05). Conclusions In a representative sample of the US adult population, NT-proBNP was an important independent risk factor for all-cause and CVD mortality. NT-proBNP may be useful for monitoring risk in the general adult population.
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Affiliation(s)
- Justin B. Echouffo‐Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Sui Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Natalie Daya
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - John W. McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland
| | - Olive Tang
- Johns Hopkins School of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Selvin E, Wang D, Tang O, Fang M, Christenson RH, McEvoy JW. Elevated Cardiac Biomarkers, Erectile Dysfunction, and Mortality in U.S. Men: NHANES 2001 to 2004. JACC Adv 2023; 2:100380. [PMID: 37427147 PMCID: PMC10328217 DOI: 10.1016/j.jacadv.2023.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND The prevalence of elevated cardiac biomarkers and their link to mortality in men with erectile dysfunction in the U.S. population are unknown. OBJECTIVES The purpose of this study was to evaluate the prevalence of elevations in N-terminal prohormone B-type natriuretic peptide, high sensitivity troponin (hs-troponin) T, and 3 hs-troponin I assays and their associations with mortality in U.S. men with and without erectile dysfunction. METHODS We conducted cross-sectional analyses using logistic regression to examine associations of elevated cardiac biomarkers (>90th percentile) with erectile dysfunction in 2,971 male participants aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. We conducted prospective analyses using Cox regression to examine the mortality implications of elevations in cardiac biomarkers in the setting of erectile dysfunction. RESULTS Elevations in hs-troponin T and the 3 hs-troponin I assays were associated with erectile dysfunction, with the strongest association for hs-troponin T (adjusted OR: 2.01; 95% CI: 1.22-3.30). Elevated N-terminal prohormone B-type natriuretic peptide was not significantly associated with erectile dysfunction (OR: 1.22; 95% CI: 0.74-2.03). There were 673 deaths during a median of 16 years of follow-up. Men with erectile dysfunction were at an elevated risk of death (adjusted HR: 1.23; 95% CI: 1.04-1.46). Those men with elevated cardiac biomarkers in the setting of erectile dysfunction were at highest risk of all-cause and cardiovascular mortality (adjusted HRs ranging from ~1.5 to 2.4). CONCLUSIONS In this national study, the association of erectile dysfunction with elevated hs-troponin and excess mortality risk suggests that men with erectile dysfunction should be evaluated and targeted for intensive cardiovascular risk management.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dan Wang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olive Tang
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Fang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John W. McEvoy
- Division of Cardiology & National Institute for Prevention & Cardiovascular Health, National University of Ireland, Galway, Ireland
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McEvoy JW, Tang O, Wang D, Ndumele CE, Coresh J, Christenson RH, Selvin E. Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in U.S. Adults. J Am Coll Cardiol 2023; 81:2028-2039. [PMID: 37197846 DOI: 10.1016/j.jacc.2023.03.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Myocardial injury is currently defined as a cardiac troponin above the sex-specific 99th percentile of a healthy reference population (upper reference limit [URL]). OBJECTIVES The purpose of this study was to estimate high-sensitivity (hs) troponin URLs in a representative sample of the U.S. adult population; overall and by sex, race/ethnicity, and age group. METHODS Among adults participating in the 1999-2004 National Health and Nutrition Examination Survey (NHANES), we measured hs-troponin T using 1 assay (Roche) and hs-troponin I using 3 assays (Abbott, Siemens, and Ortho). In a strictly defined healthy reference subgroup, we estimated 99th percentile URLs for each assay using the recommended nonparametric method. RESULTS Of 12,545 participants, 2,746 met criteria for the healthy subgroup (mean age 37 years, 50% men). The NHANES 99th percentile URL for hs-troponin T (19 ng/L) matched the manufacturer-reported URL (19 ng/L). NHANES URLs were 13 ng/L (95% CI: 10-15 ng/L) for Abbott hs-troponin I (manufacturer: 28 ng/L), 5 ng/L (95% CI: 4-7 ng/L) for Ortho hs-troponin I (manufacturer: 11 ng/L), and 37 ng/L (95% CI: 27-66 ng/L) for Siemens hs-troponin I (manufacturer: 46.5 ng/L). There were significant differences in URLs by sex, but none by race/ethnicity. Furthermore, the 99th percentile URLs for all 4 hs-troponin assays were statistically significantly lower in healthy adults aged <40 years compared with healthy adults ≥60 years (all P < 0.001 by rank sum testing). CONCLUSIONS We found URLs for hs-troponin I assays that were substantially lower than currently listed 99th percentile URLs. There were significant differences in hs-troponin T and I URLs by sex and by age group in healthy U.S. adults but none by race/ethnicity.
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Affiliation(s)
- John W McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, University of Galway, Galway, Ireland; Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Olive Tang
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dan Wang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiadi E Ndumele
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Gibson WO, McEvoy JW. Letter by Gibson and McEvoy Regarding Article, "Influence of Age on the Diagnosis of Myocardial Infarction". Circulation 2023; 147:1312-1313. [PMID: 37093972 DOI: 10.1161/circulationaha.122.062836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- William O Gibson
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway
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McEvoy JW, Wang D, Brady T, Tang O, Ndumele C, Coresh J, Christenson RH, Selvin E. Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in a Population-Based Sample of US Children and Adolescents. Circulation 2023. [PMID: 37078280 DOI: 10.1161/circulationaha.122.063281] [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] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Myocardial injury is an important pediatric diagnosis. Establishing normative data from a representative pediatric sample is vital to provide accurate upper reference limits (URLs) for defining myocardial injury using high-sensitivity cardiac troponin. METHODS Among participants 1 to 18 years of age in the 1999-2004 National Health and Nutrition Examination Survey, we measured high-sensitivity troponin T using one assay (Roche) and high-sensitivity troponin I using 3 assays (Abbott, Siemens, and Ortho). In a strictly defined healthy subgroup, we estimated 97.5th and 99th percentile URLs for each assay using the recommended nonparametric method. RESULTS Of 5695 pediatric participants, 4029 met criteria for the healthy subgroup (50% males; mean age 12.6 years). Our 99th percentile URL estimates for all 4 high-sensitivity troponin assays among children and adolescents were lower than the manufacturer-reported URLs (derived from adults). The 99th percentile URLs (95% CI) were 15 ng/L (95% CI, 12-17) for high-sensitivity troponin T, 16 ng/L (95% CI, 12-19) for high-sensitivity troponin I with the Abbott assay, 38 ng/L (95% CI, 25-46) for high-sensitivity troponin I with the Siemens assay, and 7 ng/L (95% CI, 5, 12) for high-sensitivity troponin I with the Ortho assay. The 95% CIs for age-, sex-, and race-specific 99th percentile URLs overlapped. However, the 97.5th percentile URL for each assay was measured with superior statistical precision (ie, tighter 95% CIs) and demonstrated differences by sex. For male compared with female children, 97.5th percentile URLs were 11 ng/L (95% CI, 10-12) versus 6 ng/L (95% CI, 6-7) for high-sensitivity troponin T, 9 ng/L (95% CI, 7-10) versus 5 ng/L (95% CI, 4-6) for high-sensitivity troponin I with the Abbott assay, 21 ng/L (95% CI, 18-25) versus 11 ng/L (95% CI, 9-13) for high-sensitivity troponin I with the Siemens assay, and 4 ng/L (95% CI, 3-5) versus 2 ng/L (95% CI, 1-3) for high-sensitivity troponin I with the Ortho assay. In contrast to the 99th percentiles, the point estimates of 97.5th percentile pediatric URLs for cardiac troponin were also much more stable to differences in the analytic approaches taken to estimate URLs. CONCLUSIONS Because myocardial infarction is rare in adolescents, the use of statistically more precise and reliable sex-specific 97.5th percentile URLs might be considered to define pediatric myocardial injury.
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Affiliation(s)
- John W McEvoy
- Division of Cardiology and National Institute for Prevention & Cardiovascular Health, University of Galway, Ireland (J.W.M.)
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.N., J.C., E.S.)
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD. (J.W.M. O.T., C.N.)
| | - Dan Wang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.N., J.C., E.S.)
| | - Tammy Brady
- Division of Nephrology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD. (T.B.)
| | - Olive Tang
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD. (J.W.M. O.T., C.N.)
| | - Chiadi Ndumele
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.N., J.C., E.S.)
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD. (J.W.M. O.T., C.N.)
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.N., J.C., E.S.)
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.)
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.N., J.C., E.S.)
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Daya NR, McEvoy JW, Christenson R, Tang O, Foti K, Juraschek SP, Selvin E, Tcheugui JBE. Prevalence of Elevated NT-proBNP and its Prognostic Value by Blood Pressure Treatment and Control- National Health and Nutrition Examination Survey, 1999-2004. medRxiv 2023:2023.02.20.23286211. [PMID: 36865209 PMCID: PMC9980258 DOI: 10.1101/2023.02.20.23286211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background The prognostic utility of NT-proBNP in the setting of hypertension has not been well-characterized in the general US adult population. Methods We measured NT-proBNP among adults aged 20 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. In adults without a history of cardiovascular disease, we assessed the prevalence of elevated NT-pro-BNP by blood pressure (BP) treatment and control categories. We examined the extent to which NT-proBNP identifies participants at higher risk for mortality across BP treatment and control categories. Results The number of US adults without CVD with elevated NT-proBNP (≥125 pg/ml) was 6.2 million among those with untreated hypertension, 4.6 million among those with treated controlled hypertension, and 5.4 million among those with treated uncontrolled hypertension. After adjusting for age, sex, body mass index, and race/ethnicity, participants with treated controlled hypertension and elevated NT-proBNP had increased risk of all-cause mortality (HR 2.29, 95% CI 1.79, 2.95) and increased risk of cardiovascular mortality (HR 3.83, 95% CI: 2.34, 6.29), compared to those without hypertension and with low levels of NT-proBNP (<125 pg/ml). Among those on antihypertensive medication, those with SBP 130-139 mm Hg and elevated NT-proBNP had increased risk of all-cause mortality, compared to those with SBP<120 mm Hg and low levels of NT-proBNP. Conclusions Among a general population of adults free of cardiovascular disease, NT-proBNP can provide additional prognostic information within and across categories of BP. Measurement of NT-proBNP may have potential for clinical use to optimize hypertension treatment.
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Affiliation(s)
- Natalie R. Daya
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John W. McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Olive Tang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Foti
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | | | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin B. Echouffo Tcheugui
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kaneko H, Yano Y, Okada A, Itoh H, Suzuki Y, Yokota I, Morita K, Fujiu K, Michihata N, Jo T, Yamaguchi S, Takeda N, Morita H, Node K, Yamauchi T, Nangaku M, Kadowaki T, McEvoy JW, Lam CSP, Yasunaga H, Komuro I. Age-Dependent Association Between Modifiable Risk Factors and Incident Cardiovascular Disease. J Am Heart Assoc 2023; 12:e027684. [PMID: 36628975 PMCID: PMC9939069 DOI: 10.1161/jaha.122.027684] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background There have been limited data examining the age-dependent relationship of wide-range risk factors with the incidence of each subtype of cardiovascular disease (CVD) event. We assessed age-related associations between modifiable risk factors and the incidence of CVD. Methods and Results We analyzed 3 027 839 participants without a CVD history enrolled in the JMDC Claims Database (mean age, 44.8±11.0 years; 57.6% men). Each participant was categorized as aged 20 to 49 years (n=2 008 559), 50 to 59 years (n=712 273), and 60 to 75 years (n=307 007). Using Cox proportional hazards models and the relative risk reduction, we identified associations between risk factors and incident CVD, consisting of myocardial infarction, angina pectoris, stroke, and heart failure (HF). We assessed whether the association of risk factors for developing CVD would be modified by age category. Over a mean follow-up of 1133 days, 6315 myocardial infarction, 56 447 angina pectoris, 28 079 stroke, and 56 369 HF events were recorded. The incidence of myocardial infarction, angina pectoris, stroke, and HF increased with age category. Hazard ratios of obesity, hypertension, and diabetes in the multivariable Cox regression analyses for myocardial infarction, angina pectoris, stroke, and HF decreased with age category. The relative risk reduction of obesity, hypertension, and diabetes for CVD events decreased with age category. For example, the relative risk reduction of hypertension for HF decreased from 59.2% in participants aged 20 to 49 years to 38.1% in those aged 60 to 75 years. Conclusions The contribution of modifiable risk factor to the development of CVD is greater in younger compared with older individuals. Preventive efforts for risk factor modification may be more effective in younger people.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular MedicineThe University of TokyoJapan,Department of Advanced CardiologyThe University of TokyoJapan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical TrialsYokohama City University HospitalYokohamaJapan,Department of Family Medicine and Community HealthDuke UniversityDurhamNC
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Hidetaka Itoh
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Yuta Suzuki
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Isao Yokota
- Department of Biostatistics, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineThe University of TokyoJapan,Department of Advanced CardiologyThe University of TokyoJapan
| | | | - Taisuke Jo
- Department of Health Services ResearchThe University of TokyoJapan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Norifumi Takeda
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Masaomi Nangaku
- Division of Nephrology and EndocrinologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineThe University of TokyoJapan,Toranomon HospitalTokyoJapan
| | - John W. McEvoy
- National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland,Johns Hopkins Ciccarone Center for Cardiovascular Disease PreventionJohns Hopkins University School of MedicineBaltimoreMD
| | - Carolyn S. P. Lam
- National Heart Centre SingaporeSingapore,Duke‐NUS Medical SchoolSingapore,Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineThe University of TokyoJapan
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Vela E, Cleries M, Bilal U, Banach M, McEvoy JW, Mortensen MB, Blaha MJ, Nasir K, Comin-Colet J, Mauri J, Cainzos-Achirica M. Implications of the 2021 ESC cardiovascular risk classification among 283,000 European immigrants living in a low-risk region: a population-based analysis in Catalonia. Arch Med Sci 2023; 19:35-45. [PMID: 36817660 PMCID: PMC9897087 DOI: 10.5114/aoms/144631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The ESC recently classified European countries into 4 cardiovascular risk regions. However, whether Europeans from higher-risk countries living in lower-risk regions may benefit from intensive cardiovascular prevention efforts is unknown. We described the burden of risk factors and cardiovascular disease (CVD) among European-born immigrants living in Catalonia, a low-risk region. MATERIAL AND METHODS A retrospective cohort study of 5.6 million adults of European origin living in Catalonia in 2019, including 282,789 European-born immigrants, was performed. We used the regionwide healthcare database and classified participants into 5 groups: low-, moderate-, high-, and very high-risk, and local-born. Age-standardized prevalence was estimated as of December 31st, 2019 and incidence was computed during 2019 among at-risk individuals. RESULTS The very high-risk group was the largest immigrant group (N = 136,910; 48.4%), while the high-risk group was the smallest (N = 15,739; 5.6%). These two had the highest burden of coronary heart disease across all groups evaluated, in both men and women. The very high-risk group also had the highest prevalence of hypertension and obesity at young-to-middle age, and the burden of risk factors newly diagnosed during 2019 was highest in high- and very high-risk participants. The mean age at first diagnosis of risk factors and CVD was lower in these groups. CONCLUSIONS In Catalonia, residents born in high- and very-high-risk European countries are at increased risk of coronary heart disease and newly diagnosed risk factors. Low-risk European countries may consider tailored prevention efforts, early screening of risk factors, and adequate healthcare resource planning to better address the health needs of men and women from higher-risk countries.
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Affiliation(s)
- Emili Vela
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Montse Cleries
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia (PA), USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz (MUL), Lodz, Poland
| | - John W. McEvoy
- National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
| | - Michael Joseph Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore (MD), USA
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston (TX), USA
- Center for Outcomes Research, Houston Methodist, Houston (TX), USA
| | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Pla Director de Malalties Cardiovasculars, Health Department of the Government of Catalonia, Catalonia, Spain
| | - Josepa Mauri
- Pla Director de Malalties Cardiovasculars, Health Department of the Government of Catalonia, Catalonia, Spain
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, Spain
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston (TX), USA
- Pla Director de Malalties Cardiovasculars, Health Department of the Government of Catalonia, Catalonia, Spain
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28
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Al Rifai M, Szklo M, Patel J, Blaha MJ, Ballantyne CM, Bittner V, Morris P, McEvoy JW, Shapiro MD, Al-Mallah MH, Greenland P, Virani SS. Statin Use and Risk of Diabetes by Subclinical Atherosclerosis Burden (from a Multi-Ethnic Study of Atherosclerosis Report). Am J Cardiol 2022; 184:7-13. [PMID: 36192199 PMCID: PMC10458502 DOI: 10.1016/j.amjcard.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/14/2022] [Accepted: 08/31/2022] [Indexed: 11/01/2022]
Abstract
Although there is a significant reduction in atherosclerotic cardiovascular disease risk with statins, a higher risk of diabetes mellitus has been demonstrated in randomized clinical trials. The risk of incident diabetes with statins may be heterogeneous by presence of coronary artery calcium (CAC). We evaluated participants without prevalent diabetes at baseline from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of subjects free of clinical cardiovascular disease at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between statin use and incident diabetes, adjusting for sociodemographic and cardiovascular risk factors, including time-varying statin use and stratifying by baseline CAC (0, 1 to 100, ≥100). The study population included 5,943 participants with a mean (SD) age of 62 (10) years, 54% women, 41% White, 26% Black, 12% Chinese-American, and 21% Hispanic. In the unadjusted analyses, statin use was associated with a higher risk of incident diabetes (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.27 to 2.06). After adjustment, this risk was no longer significant (HR 1.13, 95% CI 0.83 to 1.54). Although imprecise, the HR expressing the association of statins with diabetes was lower for those with CAC = 0 (HR 0.80, 95% CI 0.45 to 1.40) than for those with a higher CAC burden (HR 1.30, 95% CI 0.71 to 2.39 for CAC 1 to 100 and HR 1.39, 95% CI 0.85 to 2.28 for CAC ≥100), but this heterogeneity was not statistically significant. In conclusion, statin therapy was not significantly associated with incident diabetes mellitus in this observational study. The risk of incident diabetes did not significantly differ by baseline CAC.
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Affiliation(s)
- Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Greater Baltimore Medical Center (Johns Hopkins Heart Center at GBMC), Baltimore, Maryland
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | | | - Vera Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pamela Morris
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - John W McEvoy
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Michael D Shapiro
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Salim S Virani
- Section of Cardiology, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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29
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Levine GN, McEvoy JW, Fang JC, Ibeh C, McCarthy CP, Misra A, Shah ZI, Shenoy C, Spinler SA, Vallurupalli S, Lip GYH. Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e205-e223. [PMID: 36106537 DOI: 10.1161/cir.0000000000001092] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.
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30
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Brennan S, Costigan O, McEvoy JW. Impact of antihypertensive medication regimens on blood pressure control in individuals with established coronary heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Hypertension is a major risk factor for coronary heart disease (CHD) development and progression, with pharmacological control of blood pressure reducing the risk of CHD events and death [1].
Treatment and control of blood pressure in CHD is suboptimal, with many patients failing to achieve guideline-directed targets [1,2]. This study aims to assess the relationship between antihypertensive medication regimens and blood pressure control in patients with hypertension and established coronary heart disease.
Methods
The iASPIRE study recently evaluated secondary prevention in an Irish cohort with coronary heart disease [2]. Based on a method used in a similar study [3], we calculated the average percentage daily dose of each prescribed antihypertensive agent. We then assessed the relationship between dose and number of antihypertensive agents with blood pressure control.
Results
540 (75.5%) of iASPIRE participants had an underlying diagnosis of hypertension, and at the study examination, 56% of these had a blood pressure ≥140/90 mmHg, while 83% had a blood pressure ≥130/80 mmHg. The median number of antihypertensive agents prescribed was 2 (IQR 1–2), with 88% of those with hypertension on at least one blood pressure medication. In participants with hypertension on treatment, the median percentage daily medication dose was 29% (IQR 14–50). After adjustment for age and sex, the addition of further antihypertensive medications increased the odds of achieving a blood pressure target of <130/80 mmHg (OR 1.3, 95% CI 1.07–1.69, p=0.012). The average percentage daily dose of each antihypertensive agent was lower in both participants with a medication-controlled blood pressure of <130/80 mmHg and <140/90 mmHg compared to those without blood pressure control (30% versus 37% p=0.006 and 33% versus 38% p=0.028 respectively).
Conclusion
Many patients with hypertension and coronary heart disease currently fail to achieve blood pressure control. This analysis found that an increasing number of antihypertensive medications but not increasing dose was associated with better blood pressure control. Combination therapy is superior to sequential monotherapy in the treatment of hypertension [1], and an approach that emphasises the initiation of several antihypertensive agents would likely lead to better blood pressure control in individuals with coronary heart disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Brennan
- Royal Perth Hospital , Perth , Australia
| | - O Costigan
- Royal Perth Hospital , Perth , Australia
| | - J W McEvoy
- National Institute of Preventive Cardiology , Galway , Ireland
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31
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Suzuki Y, Kaneko H, Yano Y, Okada A, Itoh H, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Matsunaga A, Node K, McEvoy JW, Lam CSP, Oparil S, Yasunaga H, Komuro I. Association of Cardiovascular Health Metrics With Risk of Transition to Hypertension in Non-Hypertensive Young Adults. Am J Hypertens 2022; 35:858-866. [PMID: 35639507 DOI: 10.1093/ajh/hpac057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/25/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The risk of developing hypertension in young adults and its relationship to modifiable lifestyle factors are unclear. We aimed to examine the association of cardiovascular health (CVH) metrics with the risk of hypertension. METHODS We analyzed 66,876 participants aged 20-39 years, with available blood pressure (BP) data for 5 consecutive years, who had normal or elevated BP at the initial health check-up, enrolled in the JMDC Claims Database. Ideal CVH metrics included nonsmoking, body mass index <25 kg/m2, physical activity at goal, optimal dietary habits, untreated fasting glucose <100 mg/dL, and untreated total cholesterol <200 mg/dL. The primary endpoint was defined as stage 1 or stage 2 hypertension. We defined normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) BP guideline. RESULTS The median age was 35 years, and 62% were men. Number of non-ideal CVH metrics was associated with an increasing risk for the development of stage 1 and stage 2 hypertension. Non-ideal body mass index was most strongly associated with a risk for hypertension. This association was more pronounced in women. An annual increase in the number of non-ideal CVH metrics was associated with an elevated risk for the hypertension development. CONCLUSIONS CVH metrics can stratify the risk for hypertension in non-hypertensive adults aged 20-39 years. These findings have important public health implications for the screening and prevention of hypertension. Improving CVH metrics may prevent the risk of developing hypertension in young adults.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan.,The Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.,The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Johns Hopkins Ciccarone Center for Cardiovascular Disease Prevention, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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32
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Al Rifai M, McEvoy JW. Pulse Pressure Augmentation During Exercise: An Important Stress Test Parameter. JACC Heart Fail 2022; 10:695-696. [PMID: 36049820 DOI: 10.1016/j.jchf.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
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33
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Jacobsen AP, McKittrick M, Daya N, Al Rifai M, McEvoy JW. Response to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument. Hypertension 2022; 79:1570. [PMID: 35861746 DOI: 10.1161/hypertensionaha.122.19492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Jacobsen AP, McKittrick M, Daya N, Rifai MA, McEvoy JW. Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension-Con Side of the Argument. Hypertension 2022; 79:1571-1578. [PMID: 35861748 PMCID: PMC10949136 DOI: 10.1161/hypertensionaha.122.18458] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alan P. Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Myles McKittrick
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Natalie Daya
- Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mahmoud Al Rifai
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - John W. McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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35
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Juraschek SP, Wang D, McEvoy JW, Harrap S, Harris K, Mancia G, Marre M, Neal B, Patel A, Poulter NR, Williams B, Chalmers J, Woodward M, Selvin E. Effects of glucose and blood pressure reduction on subclinical cardiac damage: Results from ADVANCE. Int J Cardiol 2022; 358:103-109. [PMID: 35439582 PMCID: PMC9148188 DOI: 10.1016/j.ijcard.2022.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/25/2022] [Accepted: 04/13/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial. METHODS The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization. RESULTS Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95). CONCLUSIONS In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.
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Affiliation(s)
- Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Dan Wang
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John W McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Stephen Harrap
- The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Michel Marre
- Clinique Ambroise Paré, Diabétologie-Endocrinologie, Neuilly-sur-Seine, France; Cordeliers Research Centre, Paris, France
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; School of Public Health, Imperial College London, London, United Kingdom
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Neil R Poulter
- School of Public Health, Imperial College London, London, United Kingdom
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; The George Institute for Global Health, Imperial College London, United Kingdom
| | - Elizabeth Selvin
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hageman SHJ, McKay AJ, Ueda P, Gunn LH, Jernberg T, Hagström E, Bhatt DL, Steg PG, Läll K, Mägi R, Gynnild MN, Ellekjær H, Saltvedt I, Tuñón J, Mahíllo I, Aceña Á, Kaminski K, Chlabicz M, Sawicka E, Tillman T, McEvoy JW, Di Angelantonio E, Graham I, De Bacquer D, Ray KK, Dorresteijn JAN, Visseren FLJ. Estimation of recurrent atherosclerotic cardiovascular event risk in patients with established cardiovascular disease: the updated SMART2 algorithm. Eur Heart J 2022; 43:1715-1727. [PMID: 35165703 PMCID: PMC9312860 DOI: 10.1093/eurheartj/ehac056] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/30/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
AIMS The 10-year risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established ASCVD can be estimated with the Secondary Manifestations of ARTerial disease (SMART) risk score, and may help refine clinical management. To broaden generalizability across regions, we updated the existing tool (SMART2 risk score) and recalibrated it with regional incidence rates and assessed its performance in external populations. METHODS AND RESULTS Individuals with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms were included from the Utrecht Cardiovascular Cohort-SMART cohort [n = 8355; 1706 ASCVD events during a median follow-up of 8.2 years (interquartile range 4.2-12.5)] to derive a 10-year risk prediction model for recurrent ASCVD events (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality) using a Fine and Gray competing risk-adjusted model. The model was recalibrated to four regions across Europe, and to Asia (excluding Japan), Japan, Australia, North America, and Latin America using contemporary cohort data from each target region. External validation used data from seven cohorts [Clinical Practice Research Datalink, SWEDEHEART, the international REduction of Atherothrombosis for Continued Health (REACH) Registry, Estonian Biobank, Spanish Biomarkers in Acute Coronary Syndrome and Biomarkers in Acute Myocardial Infarction (BACS/BAMI), the Norwegian COgnitive Impairment After STroke, and Bialystok PLUS/Polaspire] and included 369 044 individuals with established ASCVD of whom 62 807 experienced an ASCVD event. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547-0.664] in BACS/BAMI to 0.772 (95% CI 0.659-0.886) in REACH Europe high-risk region. The clinical utility of the model was demonstrated across a range of clinically relevant treatment thresholds for intensified treatment options. CONCLUSION The SMART2 risk score provides an updated, validated tool for the prediction of recurrent ASCVD events in patients with established ASCVD across European and non-European populations. The use of this tool could allow for a more personalized approach to secondary prevention based upon quantitative rather than qualitative estimates of residual risk.
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Affiliation(s)
- Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Ailsa J McKay
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Laura H Gunn
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Public Health Sciences and School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Ph. Gabriel Steg
- French Alliance for Cardiovascular Trials, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, INSERM Unité, 1148 Paris, France
| | - Kristi Läll
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Mari Nordbø Gynnild
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
- Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
- Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatrics, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Autónoma University, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Ignacio Mahíllo
- Department of Epidemiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Autónoma University, Madrid, Spain
| | - Karol Kaminski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland
| | - Malgorzata Chlabicz
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland
- Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Emilia Sawicka
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Taavi Tillman
- Centre for Non-Communicable Disease, Institute for Global Health, University College London, London, UK
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
- Galway Campus, National University of Ireland Galway, Galway, Ireland
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ian Graham
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Corresponding author. Tel: +31 88 7555161, Fax: +31 30 2523741,
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Murphy E, McEvoy JW. Does Stopping Aspirin Differ Fundamentally From Not Starting Aspirin in the Primary Prevention of Cardiovascular Disease Among Older Adults? Ann Intern Med 2022; 175:757-758. [PMID: 35286142 DOI: 10.7326/m22-0550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/22/2022] Open
Affiliation(s)
- Ella Murphy
- University Hospital Galway, Saolta University Health Care Group, and National University of Ireland Galway, Galway, Ireland
| | - John W McEvoy
- University Hospital Galway, Saolta University Health Care Group, National University of Ireland Galway, and National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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Jacobsen AP, Lim ZL, Chang B, Lambeth KD, Das TM, Gorry C, McCague M, Sharif F, Mylotte D, Wijns W, Serruys PWJC, Blumenthal RS, Martin SS, McEvoy JW. Contextualizing National Policies Regulating Access to Low-Dose Aspirin in America and Europe Using the Full Report of a Transatlantic Patient Survey of Aspirin in Preventive Cardiology. J Am Heart Assoc 2022; 11:e023995. [PMID: 35411788 PMCID: PMC9238454 DOI: 10.1161/jaha.121.023995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Aspirin is widely administered to prevent cardiovascular disease (CVD). However, appropriate use of aspirin depends on patient understanding of its risks, benefits, and indications, especially where aspirin is available over the counter (OTC). Methods and Results We did a survey of patient-reported 10-year cardiovascular risk; aspirin therapy status; form of aspirin access (OTC versus prescription); and knowledge of the risks, benefits, and role of aspirin in CVD prevention. Consecutive adults aged ≥50 years with ≥1 cardiovascular risk factor attending outpatient clinics in America and Europe were recruited. We also systematically reviewed national policies regulating access to low-dose aspirin for CVD prevention. At each site, 150 responses were obtained (300 total). Mean±SD age was 65±10 years, 40% were women, and 41% were secondary prevention patients. More than half of the participants at both sites did not know (1) their own level of 10-year CVD risk, (2) the expected magnitude of reduction in CVD risk with aspirin, or (3) aspirin's bleeding risks. Only 62% of all participants reported that aspirin was routinely indicated for secondary prevention, whereas 47% believed it was routinely indicated for primary prevention (P=0.048). In America, 83.5% participants obtained aspirin OTC compared with 2.5% in Europe (P<0.001). Finally, our review of European national policies found only 2 countries where low-dose aspirin was available OTC. Conclusions Many patients have poor insight into their objectively calculated 10-year cardiovascular risk and do not know the risks, benefits, and role of aspirin in CVD prevention. Aspirin is mainly obtained OTC in America in contrast to Europe, where most countries restrict access to low-dose aspirin.
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Affiliation(s)
- Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins Medical Institutions Baltimore MD
| | - Zi Lun Lim
- National Institute for Prevention and Cardiovascular HealthNational University of Ireland Galway School of Medicine Galway Ireland
| | - Blair Chang
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins Medical Institutions Baltimore MD
| | - Kaleb D Lambeth
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins Medical Institutions Baltimore MD
| | - Thomas M Das
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins Medical Institutions Baltimore MD
| | - Colin Gorry
- National Institute for Prevention and Cardiovascular HealthNational University of Ireland Galway School of Medicine Galway Ireland
| | - Michael McCague
- Clinical Research Facility National University of Ireland Galway Galway Ireland
| | - Faisal Sharif
- School of Medicine National University of Ireland Galway Galway Ireland
| | - Darren Mylotte
- School of Medicine National University of Ireland Galway Galway Ireland
| | - William Wijns
- School of Medicine National University of Ireland Galway Galway Ireland
| | | | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins Medical Institutions Baltimore MD
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins Medical Institutions Baltimore MD
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins Medical Institutions Baltimore MD.,National Institute for Prevention and Cardiovascular HealthNational University of Ireland Galway School of Medicine Galway Ireland
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39
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Birrane JP, Foschi M, Sacco S, McEvoy JW. Another Nail in the Coffin of Causality for the Diastolic Blood Pressure J Curve. Hypertension 2022; 79:794-797. [PMID: 35263158 DOI: 10.1161/hypertensionaha.122.18997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John P Birrane
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway School of Medicine, Galway, Ireland (J.P.B., J.W.M.)
| | - Matteo Foschi
- Department of Neuroscience, Neurology Unit, S. Maria delle Croci Hospital of Ravenna, AUSL Romagna, Italy (M.F.).,Department of Medical and Surgical Sciences, University of Bologna, Italy (M.F.)
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (S.S.)
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway School of Medicine, Galway, Ireland (J.P.B., J.W.M.).,Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD (J.W.M.)
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40
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Almagal N, Cainzos-Achirica M, McEvoy JW. Mind the Gap: Primary Prevention Aspirin and the Danger of Suboptimal Implementation of Contemporary Guidelines Into Clinical Practice. Circ Cardiovasc Qual Outcomes 2022; 15:e008799. [PMID: 35098726 DOI: 10.1161/circoutcomes.121.008799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/01/2023]
Affiliation(s)
- Naeif Almagal
- Prince Mohammed bin Abdulaziz Medical City, Ministry of Health, Saudi Arabia (N.A.).,Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University Hospital Galway, Ireland (N.A., J.W.M.)
| | - Miguel Cainzos-Achirica
- Division of Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, TX (M.C.-A.).,Center for Outcomes Research, Houston Methodist, TX (M.C.-A.)
| | - John W McEvoy
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University Hospital Galway, Ireland (N.A., J.W.M.).,National Institute for Prevention and Cardiovascular Health, School of Medicine, National University of Ireland Galway (J.W.M.)
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41
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Hicks CW, Wang D, Matsushita K, McEvoy JW, Christenson R, Selvin E. Glycated albumin and HbA1c as markers of lower extremity disease inUS adults with and without diabetes. Diabetes Res Clin Pract 2022; 184:109212. [PMID: 35066057 PMCID: PMC8917067 DOI: 10.1016/j.diabres.2022.109212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/03/2023]
Abstract
AIM We evaluated the associations of two biomarkers of hyperglycemia-hemoglobin A1c(HbA1c) and glycated albumin-with lower extremity disease in US adultsoverall and by diabetes status. METHODS We conducted a cross-sectional study of adult participants aged ≥ 40 years who attended the National Health and Nutrition Examination Survey (NHANES) 1999-2004 (unweighted N = 5,785). We used logistic regression to evaluate the associations of HbA1c and glycated albumin with lower extremity disease: peripheral neuropathy (assessed by monofilament test), peripheral artery disease (assessed by ankle-brachial index), history of foot ulcer, or amputation. All analyses were weighted and accounted for the complex NHANES sample survey design. RESULTS The prevalence of lower extremity disease was 17.4% (15.9% in adults without diabetes and 33.2% in adults with diabetes). HbA1c and glycated albumin were not significantly associated with lower extremity disease in adults without diabetes. However, we observed significant associations of both HbA1c (OR 1.19 per 1-% point increase, 95 %CI 1.06-1.34) and glycated albumin (OR 1.06 per 1-% point increase, 95 %CI 1.02-1.10) with lower extremity disease in adults with diabetes after adjustment. The patterns of association were similar for HbA1c and glycated albumin (P-for-seemingly-unrelated-regression = 0.60), with strong linear associations observed at high (diabetic) levels of both biomarkers. CONCLUSIONS Our study suggests the importance of diabetes prevention and glycemic control in adults with diabetes to reduce the burden of lower extremity disease.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore MD, United States
| | - Dan Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, United States
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, United States
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore MD, United States
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, United States.
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42
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McGrath B, McEvoy JW. Isolated diastolic hypertension in the UK Biobank: correspondence regarding Isolated systolic and diastolic hypertension by the 2017 American College of Cardiology/American Heart Association guidelines and risk of cardiovascular disease: a large prospective cohort study. J Hypertens 2022; 40:409-410. [PMID: 34992200 DOI: 10.1097/hjh.0000000000003032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Brian McGrath
- National University of Ireland Galway, School of Medicine, and National Institute for Preventive Cardiology, Galway, Ireland
| | - John W McEvoy
- National University of Ireland Galway, School of Medicine, and National Institute for Preventive Cardiology, Galway, Ireland
- Ciccarone Center for the Prevention of Cardiovascular Disease, and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
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43
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Gaffney B, Jacobsen AP, Pallippattu AW, Leahy N, McEvoy JW. The Diastolic Blood Pressure J-Curve in Hypertension Management: Links and Risk for Cardiovascular Disease. Integr Blood Press Control 2021; 14:179-187. [PMID: 34938115 PMCID: PMC8685549 DOI: 10.2147/ibpc.s286957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose of Review The treatment of hypertension has changed dramatically over the last century, with recent trials informing clinical guidelines that recommend aiming for lower blood pressure (BP) targets than ever before. However, a “J”- or “U-shaped curve” in the association between diastolic BP and cardiovascular events has been observed in epidemiological studies, suggesting that both high diastolic BPs and diastolic BPs below a certain nadir are associated with higher risk of cardiovascular disease (CVD) events. Despite the potential for confounding and reverse causation, this association may caution against overly intensive BP lowering in some hypertensive adults who also have a low baseline diastolic BP. Recent Findings Recent post-hoc analyses of the landmark Systolic Blood Pressure Intervention Trial (SPRINT) appear to contradict these J-curve concerns, finding that the benefit of more intensive BP treatment did not differ based on baseline blood pressure. Similarly, sensitivity analyses of The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) randomized controlled trial found that patients experienced similar benefits from an intensive BP goal, regardless of whether their diastolic BP was above or below 60 mm Hg. Finally, several Mendelian randomization analyses, which are less susceptible to confounding and reverse causation, demonstrated a clear linear relationship between diastolic BP and cardiovascular events. These studies indicate that a potential reduction in CVD risk is possible, irrespective of baseline diastolic BP values. Summary Sufficient recent evidence indicates that low diastolic BP is not causal of worse cardiovascular outcomes but rather represents confounding or reverse causation. Therefore, while low diastolic BP can be considered a marker of CVD risk, this risk is not expected to increase with further BP lowering when necessary to control concomitant elevations of systolic BP. Indeed, BP reduction in this setting appears beneficial.
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Affiliation(s)
- Brian Gaffney
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, School of Medicine, Galway, Ireland
| | - Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Abhishek W Pallippattu
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, School of Medicine, Galway, Ireland
| | - Niall Leahy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, School of Medicine, Galway, Ireland
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, School of Medicine, Galway, Ireland
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44
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Thompson B, McEvoy JW. Establishing target systolic and diastolic blood pressure in diabetic patients with hypertension: what do we need to consider? Expert Rev Cardiovasc Ther 2021; 19:993-1003. [PMID: 34878361 DOI: 10.1080/14779072.2021.2013814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The optimum target for systolic and diastolic blood pressure remains divisive. In particular, the conflicting outcomes of the SPRINT and ACCORD trials have led to a divergence of guideline-recommended blood pressure targets for adults with diabetes. AREAS COVERED Here, we review the existing recommendations for blood pressure targets in diabetes, discussing the evidence base behind them and their limitations. We start by outlining the risks and benefits of lower systolic blood pressure targets among diabetics. We then follow with a separate appraisal of diastolic blood pressure targets, which necessitates examination of the 'J curve' and isolated diastolic hypertension. EXPERT OPINION Current and emerging evidence supports, on balance, a blood pressure therapeutic target of < 130/90 mmHg in adults at increased risk for cardiovascular disease, including diabetics. Whether certain diabetics with systolic BPs of 120-130 and/or diastolic BPs 80-90 mmHg require drug treatment to a target of <120/80 mmHg is less clear and requires more research.
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Affiliation(s)
- Brian Thompson
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - John W McEvoy
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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45
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Berry JD, Nambi V, Ambrosius WT, Chen H, Killeen AA, Taylor A, Toto RD, Soliman EZ, McEvoy JW, Pandey A, Joshi PH, Blankenberg S, Kitzman DW, Ballantyne CM, de Lemos JA. Associations of High-Sensitivity Troponin and Natriuretic Peptide Levels With Outcomes After Intensive Blood Pressure Lowering: Findings From the SPRINT Randomized Clinical Trial. JAMA Cardiol 2021; 6:1397-1405. [PMID: 34468696 PMCID: PMC8411355 DOI: 10.1001/jamacardio.2021.3187] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/04/2020] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
Importance Elevated high-sensitivity cardiac troponin T (hscTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) levels are associated with risk of heart failure (HF) and mortality among individuals in the general population. However, it is unknown if this risk is modifiable. Objective To test the hypothesis that elevated hscTnT and NTproBNP levels would identify individuals with the greatest risk for mortality and HF and the largest benefit associated with intensive systolic blood pressure (SBP) lowering. Design, Setting, and Participants This is a nonprespecified post hoc analysis of the multicenter, prospective, randomized clinical Systolic Blood Pressure Intervention Trial (SPRINT), conducted from October 20, 2010, to August 20, 2015. A total of 9361 patients without diabetes with increased risk for cardiovascular disease were randomized to receive intensive vs standard SBP lowering. Statistical analysis was performed on an intention-to-treat basis from September 30, 2019, to July 29, 2021. Interventions Participants were randomized to undergo intensive (<120 mm Hg) or standard (<140 mm Hg) SBP lowering. High-sensitivity cardiac troponin T and NTproBNP levels were measured from stored specimens collected at enrollment, with elevated levels defined as 14 ng/L or more for hscTnT (to convert to micrograms per liter, multiply by 0.001) and 125 pg/mL or more for NTproBNP (to convert to nanograms per liter, multiply by 1.0). Main Outcomes and Measures The primary outcome of this ancillary study was HF and mortality. Results Of the 9361 participants enrolled in SPRINT, 8828 (5578 men [63.2%]; mean [SD] age, 68.0 [9.5] years) had measured hscTnT levels and 8836 (5585 men [63.2%]; mean [SD] age, 68.0 [9.5] years) had measured NTproBNP levels; 2262 of 8828 patients (25.6%) had elevated hscTnT levels, 3371 of 8836 patients (38.2%) had elevated NTproBNP, and 1411 of 8828 patients (16.0%) had both levels elevated. Randomization to the intensive SBP group led to a 4.9% (95% CI, 1.7%-7.5%) absolute risk reduction (ARR) over 4 years in death and HF (421 events) for those with elevated hscTnT and a 1.7% (95% CI, 0.7%-2.5%) ARR for those without elevated levels. Similarly, for those with elevated NTproBNP, the ARR for death and HF over 4 years was 4.6% (95% CI, 2.3%-6.5%) vs 1.8% (95% CI, 0.9%-2.5%) in those without elevated levels. For those with elevated levels of both biomarkers, the ARR for death and HF over 4 years was 7.8% (95% CI, 3.3%-11.3%) vs 1.7% (95% CI, 0.8%-2.3%) in those with neither biomarker elevated. No significant treatment group by biomarker category interactions were detected. Conclusions and Relevance Intensive SBP control led to large absolute differences in death and HF among patients with abnormal hscTnT and NTproBNP levels. These findings demonstrate that risk associated with elevation of these biomarkers is modifiable with intensive BP control. A prospective, randomized clinical trial is needed to evaluate whether these biomarkers may help guide selection of patients for intensive SBP lowering. Trial Registration ClinicalTrials.gov Identifier: NCT01206062.
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Affiliation(s)
- Jarett D. Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
| | - Vijay Nambi
- Michael E. DeBakey Veterans Affairs Hospital, Baylor College of Medicine, Houston, Texas
| | - Walter T. Ambrosius
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Haiying Chen
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anthony A. Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Addison Taylor
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Robert D. Toto
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - John W. McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
| | - Parag H. Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, German Center for Cardiovascular Research, partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Dalane W. Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Section on Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christie M. Ballantyne
- Center for Cardiometabolic Disease Prevention, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - James A. de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
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46
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Murphy E, Curneen JMG, McEvoy JW. Aspirin in the Modern Era of Cardiovascular Disease Prevention. Methodist Debakey Cardiovasc J 2021; 17:36-47. [PMID: 34824680 PMCID: PMC8588762 DOI: 10.14797/mdcvj.293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/18/2021] [Indexed: 12/20/2022] Open
Abstract
Aspirin’s antithrombotic effects have a long-established place in the prevention of cardiovascular disease (CVD), and its traditional use as a core therapy for secondary prevention of CVD is well recognized. However, with the advent of newer antiplatelet agents and an increasing understanding of aspirin’s bleeding risks, its role across the full spectrum of modern CVD prevention has become less certain. As a consequence, recent trials have begun investigating aspirin-free strategies in secondary prevention. For example, a contemporary metanalysis of trials that assessed P2Y12 inhibitor monotherapy versus prolonged (≥ 12 months) dual antiplatelet therapy (which includes aspirin) after percutaneous coronary intervention reported a lower risk of major bleeding and no increase in stent thrombosis, all-cause mortality, myocardial infarction (MI), or stroke in the P2Y12 monotherapy group. In contrast to secondary prevention, aspirin’s role in primary prevention has always been more controversial. While historical trials reported a reduction in MI and stroke, more contemporary trials have suggested diminishing benefit for aspirin in this setting, with no reduction in hard outcomes, and some primary prevention trials have even indicated a potential for harm. In this review, we discuss how changing population demographics, enhanced control of lipids and blood pressure, changes in the definition of outcomes like MI, evolution of aspirin formulations, and updated clinical practice guidelines have all impacted the use of aspirin for primary and secondary CVD prevention.
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Affiliation(s)
- Ella Murphy
- National University of Ireland, Galway, Ireland
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47
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McEvoy JW, Yang WY, Thijs L, Zhang ZY, Melgarejo JD, Boggia J, Hansen TW, Asayama K, Ohkubo T, Dolan E, Stolarz-Skrzypek K, Malyutina S, Casiglia E, Lind L, Filipovský J, Maestre GE, Li Y, Wang JG, Imai Y, Kawecka-Jaszcz K, Sandoya E, Narkiewicz K, O'Brien E, Vanassche T, Staessen JA. Isolated Diastolic Hypertension in the IDACO Study: An Age-Stratified Analysis Using 24-Hour Ambulatory Blood Pressure Measurements. Hypertension 2021; 78:1222-1231. [PMID: 34601965 PMCID: PMC8516806 DOI: 10.1161/hypertensionaha.121.17766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- John W McEvoy
- National University of Ireland Galway, School of Medicine, and National Institute for Prevention and Cardiovascular Health, Ireland (J.W.M.)
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital (W.-Y.Y.), Shanghai Jiao Tong University School of Medicine, China
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium
| | - Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.)
| | - Tine W Hansen
- The Steno Diabetes Center Copenhagen, Gentofte, and Center for Health, Capital Region of Denmark, Copenhagen (T.W.H.)
| | - Kei Asayama
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.).,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.)
| | - Takayoshi Ohkubo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.).,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.)
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, Geriatric Medicine, Dublin, Ireland (E.D.)
| | - Katarzyna Stolarz-Skrzypek
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S., K.K.-J.)
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine and Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation (S.M.)
| | | | - Lars Lind
- Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Sweden (L.L.)
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.)
| | - Gladys E Maestre
- Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (G.E.M.).,Department of Biomedical Sciences, Division of Neuroscience and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.)
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital (Y.L., J.-G.W.), Shanghai Jiao Tong University School of Medicine, China
| | - Ji-Guang Wang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital (Y.L., J.-G.W.), Shanghai Jiao Tong University School of Medicine, China
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.)
| | - Kalina Kawecka-Jaszcz
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S., K.K.-J.)
| | - Edgardo Sandoya
- Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay (E.S.)
| | - Krzysztof Narkiewicz
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.)
| | - Eoin O'Brien
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland (E.O.)
| | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (T.V.), University of Leuven, Belgium
| | - Jan A Staessen
- Biomedical Sciences Group, Faculty of Medicine (J.A.S.), University of Leuven, Belgium.,Research Institute Alliance for the Promotion of Preventive Medicine, Mecehelen, Belgium (J.A.S)
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48
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Raber I, Al Rifai M, McCarthy CP, Vaduganathan M, Michos ED, Wood MJ, Smyth YM, Ibrahim NE, Asnani A, Mehran R, McEvoy JW. Gender Differences in Medicare Payments Among Cardiologists. JAMA Cardiol 2021; 6:1432-1439. [PMID: 34495296 DOI: 10.1001/jamacardio.2021.3385] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Women cardiologists receive lower salaries than men; however, it is unknown whether US Centers for Medicare & Medicaid Services (CMS) reimbursement also differs by gender and contributes to the lower salaries. Objective To determine whether gender differences exist in the reimbursements, charges, and reimbursement per charge from CMS. Design, Setting, and Participants This cross-sectional analysis used the CMS database to obtain 2016 reimbursement data for US cardiologists. These included reimbursements to cardiologists, charges submitted, and unique billing codes. Gender differences in reimbursement for evaluation and management and procedural charges from both inpatient and outpatient settings were also assessed. Analysis took place between April 2019 and December 2020. Main Outcomes and Measures Outcomes included median CMS payments received and median charges submitted in the inpatient and outpatient settings in 2016. Results In 2016, 17 524 cardiologists (2312 women [13%] and 15 212 men [87%]) received CMS payments in the inpatient setting, and 16 929 cardiologists (2151 women [13%] and 14 778 men [87%]) received CMS payments in the outpatient setting. Men received higher median payments in the inpatient (median [interquartile range], $62 897 [$30 904-$104 267] vs $45 288 [$21 371-$73 191]; P < .001) and outpatient (median [interquartile range], $91 053 [$34 820-$196 165] vs $51 975 [$15 622-$120 175]; P < .001) practice settings. Men submitted more median charges in the inpatient (median [interquartile range], 1190 [569-2093] charges vs 959 [569-2093] charges; P < .001) and outpatient settings (median [interquartile range], 1685 [644-3328] charges vs 870 [273-1988] charges; P < .001). In a multivariable-adjusted linear regression analysis, women received less CMS payments compared with men (log-scale β = -0.06; 95% CI, -0.11 to -0.02) after adjustment for number of charges, number of unique billing codes, complexity of patient panel, years since graduation of physicians, and physician subspecialty. Payment by billing codes, both inpatient and outpatient, did not differ by gender. Conclusions and Relevance There may be potential differences in CMS payments between men and women cardiologists, which appear to stem from gender differences in the number and types of charges submitted. The mechanisms behind these differences merit further research, both to understand why such gender differences exist and also to facilitate reductions in pay disparities.
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Affiliation(s)
- Inbar Raber
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yvonne M Smyth
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nasrien E Ibrahim
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Aarti Asnani
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
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49
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Matar A, McEvoy JW. Blood Pressure Limbo-How Low Can You Go? Diabetes Care 2021; 44:1910-1912. [PMID: 34417276 DOI: 10.2337/dci21-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Aishah Matar
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University Hospital Galway, Galway, Ireland
| | - John W McEvoy
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University Hospital Galway, Galway, Ireland .,National Institute for Prevention and Cardiovascular Health, School of Medicine, National University of Ireland, Galway, Galway, Ireland
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50
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Kenny E, McEvoy JW, McSharry J, Collins LM, Taylor RS, Byrne M. Are behaviour change techniques and intervention features associated with effectiveness of digital cardiac rehabilitation programmes? A systematic review protocol. HRB Open Res 2021; 4:88. [PMID: 35088032 PMCID: PMC8767424 DOI: 10.12688/hrbopenres.13355.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Cardiac rehabilitation (CR) is a complex intervention that aims to stabilise, slow, or reverse the progression of CVD and improve patients' functional status and quality of life. Digitally delivered CR has been shown to be effective and can overcome many of the access barriers associated with traditional centre-based delivered CR programmes. However, there is a limited understanding of the behaviour change techniques (BCTs) and intervention features that maximise the effectiveness of digital programmes. Therefore, this systematic review will aim to identify the BCTs that have been used in digital CR programmes and to determine which BCTs and intervention features are associated with programme effectiveness. Methods: PubMed, MEDLINE (Ovid), EMBASE, CINHAL, PsycINFO and Cochrane Central Register of Controlled Trials will be searched from inception to June 2021 for randomised controlled trials of digital CR with CVD patients. Screening, data extraction, intervention coding and risk of bias will be performed by one reviewer with a second reviewer independently verifying a random 20% of the articles. Intervention content will be coded using the behaviour change technique taxonomy v1 and the Template for Intervention Description and Replication (TIDieR) checklist and intervention features will be identified. A meta-analysis will be conducted to calculate the pooled effect size of each outcome, and meta-regression analyses will investigate whether intervention features and the presence and absence of individual BCTs in interventions are associated with intervention effectiveness. Discussion: The review will identify BCTs and intervention features that are associated with digital CR programmes and adopt a systematic approach to describe the content of these programmes using the BCT taxonomy (v1) and TIDieR checklist. The results will provide key insights into the content and design of successful digital CR programmes, providing a foundation for further development, testing and refinement.
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Affiliation(s)
- Eanna Kenny
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - John W. McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Linda M. Collins
- Departments of Social and Behavioral Sciences and Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
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