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Obisesan OH, Orimoloye OA, Wang FM, Dardari ZA, Selvin E, Boakye E, Osei AD, Honda Y, Dzaye O, Pankow J, Coresh J, Howard-Claudio CM, Nasir K, Matsushita K, Blaha MJ. Coronary Artery Calcium Scores in Older Adults With Diabetes and Their Association With Diabetes-Specific Risk Enhancers (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2023; 201:219-223. [PMID: 37385177 PMCID: PMC10526640 DOI: 10.1016/j.amjcard.2023.06.011] [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: 04/05/2023] [Revised: 05/12/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
Coronary artery calcium (CAC) is a validated marker of atherosclerotic cardiovascular disease (ASCVD) risk; however, it is not routinely incorporated in ASCVD risk prediction in older adults with diabetes. We sought to assess the CAC distribution among this demographic and its association with "diabetes-specific risk enhancers," which are known to be associated with increased ASCVD risk. We used the ARIC (Atherosclerosis Risk in Communities) study data, including adults aged >75 years with diabetes, who had their CAC measured at ARIC visit 7 (2018 to 2019). The demographic characteristics of participants and their CAC distribution were analyzed using descriptive statistics. Multivariable-adjusted logistic regression models were used to estimate the association between diabetes-specific risk enhancers (duration of diabetes, albuminuria, chronic kidney disease, retinopathy, neuropathy, and ankle-brachial index) and elevated CAC, adjusting for age, gender, race, education level, dyslipidemia, hypertension, physical activity, smoking status, and family history of coronary heart disease. The mean age in our sample was 79.9 (SD 3.97) years, with 56.6% women and 62.1% White. The CAC scores were heterogenous, and the median CAC score was higher in participants with a greater number of diabetes risk enhancers, regardless of gender. In the multivariable-adjusted logistic regression models, participants with ≥2 diabetes-specific risk enhancers had greater odds of elevated CAC than those with <2 (odds ratio 2.31, 95% confidence interval 1.34 to 3.98). In conclusion, the distribution of CAC was heterogeneous among older adults with diabetes, with the CAC burden associated with the number of diabetes risk-enhancing factors present. These data may have implications for prognostication in older patients with diabetes and supports the possible incorporation of CAC in the assessment of cardiovascular disease risk in this population.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland; Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Olusola A Orimoloye
- Division of Medicine, Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Frances M Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Zeina A Dardari
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen Boakye
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Albert D Osei
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Yasuyuki Honda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Omar Dzaye
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - James Pankow
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Josef Coresh
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Khurram Nasir
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael J Blaha
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland.
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Obisesan OH, Uddin SMI, Boakye E, Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, El Shahawy O, Stokes A, DeFilippis AP, Benjamin EJ, Blaha MJ. Pod-based e-cigarette use among US college-aged adults: A survey on the perception of health effects, sociodemographic correlates, and interplay with other tobacco products. Tob Induc Dis 2023; 21:34. [PMID: 36875734 PMCID: PMC9983309 DOI: 10.18332/tid/159177] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION E-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the US. Using an online survey, we explored the socio-behavioral correlates, predisposing factors, and addictive behaviors, among young adult pod-mod users within a University in Maryland, USA. METHODS In total, 112 eligible college students aged 18-24 years, recruited from a University in Maryland, who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past-30-day use. Descriptive statistics were used to analyze participants' responses. RESULTS The mean age of the survey participants was 20.5 ± 1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8 ± 1.4 years, while the mean age of regular use was 18.5 ± 1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of the current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were aged <21 years. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio, AOR=4.52; 95% CI: 1.76-11.64), JUUL use (AOR=2.56; 95% CI: 1.08-6.03), and menthol flavor (AOR=6.52; 95% CI: 1.38-30.89) were associated with reduced nicotine autonomy, a measure of addiction. CONCLUSIONS Our findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Medicine, Medstar Union Memorial Hospital, Baltimore, United States
| | - S. M. Iftekhar Uddin
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
| | - Ellen Boakye
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
| | - Albert D. Osei
- Department of Medicine, Medstar Union Memorial Hospital, Baltimore, United States
| | | | - Olusola A. Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, United States
| | - Omar Dzaye
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Population Health, New York University School of Medicine, New York, United States
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- School of Medicine, Boston University, Boston, United States
- School of Public Health, Boston University, Boston, United States
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, United States
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- School of Medicine, Boston University, Boston, United States
- School of Public Health, Boston University, Boston, United States
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
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Obisesan OH, Kou M, Wang FM, Boakye E, Honda Y, Uddin SMI, Dzaye O, Osei AD, Orimoloye OA, Howard‐Claudio CM, Coresh J, Blumenthal RS, Hoogeveen RC, Budoff MJ, Matsushita K, Ballantyne CM, Blaha MJ. Lipoprotein(a) and Subclinical Vascular and Valvular Calcification on Cardiac Computed Tomography: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2022; 11:e024870. [PMID: 35656990 PMCID: PMC9238743 DOI: 10.1161/jaha.121.024870] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Lipoprotein(a) (Lp(a)) is a potent causal risk factor for cardiovascular events and mortality. However, its relationship with subclinical atherosclerosis, as defined by arterial calcification, remains unclear. This study uses the ARIC (Atherosclerosis Risk in Communities Study) to evaluate the relationship between Lp(a) in middle age and measures of vascular and valvular calcification in older age. Methods and Results Lp(a) was measured at ARIC visit 4 (1996-1998), and coronary artery calcium (CAC), together with extracoronary calcification (including aortic valve calcium, aortic valve ring calcium, mitral valve calcification, and thoracic aortic calcification), was measured at visit 7 (2018-2019). Lp(a) was defined as elevated if >50 mg/dL and CAC/extracoronary calcification were defined as elevated if >100. Logistic and linear regression models were used to evaluate the association between Lp(a) and CAC/extracoronary calcification, with further stratification by race. The mean age of participants at visit 4 was 59.2 (SD 4.3) years, with 62.2% women. In multivariable adjusted analyses, elevated Lp(a) was associated with higher odds of elevated aortic valve calcium (adjusted odds ratio [aOR], 1.82; 95% CI, 1.34-2.47), CAC (aOR, 1.40; 95% CI, 1.08-1.81), aortic valve ring calcium (aOR, 1.36; 95% CI, 1.07-1.73), mitral valve calcification (aOR, 1.37; 95% CI, 1.06-1.78), and thoracic aortic calcification (aOR, 1.36; 95% CI, 1.05-1.77). Similar results were obtained when Lp(a) and CAC/extracoronary calcification were examined on continuous logarithmic scales. There was no significant difference in the association between Lp(a) and each measure of calcification by race or sex. Conclusions Elevated Lp(a) at middle age is significantly associated with vascular and valvular calcification in older age, represented by elevated CAC, aortic valve calcium, aortic valve ring calcium, mitral valve calcification, thoracic aortic calcification. Our findings encourage assessing Lp(a) levels in individuals with increased cardiovascular disease risk, with subsequent comprehensive vascular and valvular assessment where elevated.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Medstar Union Memorial HospitalBaltimoreMD
| | - Minghao Kou
- Tulane University School of Public Health and Tropical MedicineNew OrleansLA
| | | | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | - Yasuyuki Honda
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | | | | | - Josef Coresh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute at Harbor‐UCLA Medical CenterLos AngelesCA
| | - Kunihiro Matsushita
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
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Whelton SP, McAuley PA, Dardari Z, Orimoloye OA, Michos ED, Brawner CA, Ehrman JK, Keteyian SJ, Blaha MJ, Al-Mallah MH. Fitness and Mortality Among Persons 70 Years and Older Across the Spectrum of Cardiovascular Disease Risk Factor Burden: The FIT Project. Mayo Clin Proc 2021; 96:2376-2385. [PMID: 34366139 DOI: 10.1016/j.mayocp.2020.12.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine whether fitness could improve mortality risk stratification among older adults compared with cardiovascular disease (CVD) risk factors. METHODS We examined 6509 patients 70 years of age and older without CVD from the Henry Ford ExercIse Testing Project (FIT Project) cohort. Patients performed a physician-referred treadmill stress test between 1991 and 2009. Traditional categorical CVD risk factors (hypertension, hyperlipidemia, diabetes, and smoking) were summed from 0 to 3 or more. Fitness was grouped as low, moderate, and high (<6, 6 to 9.9, and ≥10 metabolic equivalents of task). All-cause mortality was ascertained through US Social Security Death Master files. We calculated age-adjusted mortality rates, multivariable adjusted Cox proportional hazards, and Kaplan-Meier survival models. RESULTS Patients had a mean age of 75±4 years, and 3385 (52%) were women; during a mean follow-up of 9.4 years, there were 2526 deaths. A higher fitness level (P<.001), not lower CVD risk factor burden (P=.31), was associated with longer survival. The age-adjusted mortality rate per 1000 person-years was 56.7 for patients with low fitness and 0 risk factors compared with 24.9 for high fitness and 3 or more risk factors. Among patients with 3 or more risk factors, the adjusted mortality hazard was 0.68 (95% CI, 0.61 to 0.76) for moderate and 0.51 (95% CI, 0.44 to 0.60) for high fitness compared with the least fit. CONCLUSION Among persons aged 70 years and older, there was no significant difference in survival of patients with 0 vs 3 or more risk factors, but a higher fitness level identified older persons with good long-term survival regardless of CVD risk factor burden.
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Paul A McAuley
- Department of Health, Physical Education, and Sport Studies, Winston-Salem State University, Winston-Salem, NC
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
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5
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Obisesan OH, Osei AD, Berman D, Dardari ZA, Uddin SMI, Dzaye O, Orimoloye OA, Budoff MJ, Miedema MD, Rumberger J, Mirbolouk M, Boakye E, Johansen MC, Rozanski A, Shaw LJ, Han D, Nasir K, Blaha MJ. Thoracic Aortic Calcium for the Prediction of Stroke Mortality (from the Coronary Artery Calcium Consortium). Am J Cardiol 2021; 148:16-21. [PMID: 33667445 DOI: 10.1016/j.amjcard.2021.02.038] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Thoracic aortic calcium(TAC) is an important marker of extracoronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium (CAC) score. The CAC Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no previous history of cardiovascular disease, baseline CAC scans for risk stratification, and follow-up for 12 ± 4 years. CAC scans capture the adjacent thoracic aorta, enabling assessment of TAC from the same images. TAC was available in 41,066 (62%), and was primarily analyzed as present or not present. To account for competing risks for nonstroke death, we utilized multivariable-adjusted Fine and Gray competing risk regression models adjusted for traditional cardiovascular risk factors and CAC score. The mean age of participants was 53.8 ± 10.3 years, with 34.4% female. There were 110 stroke deaths during follow-up. The unadjusted subdistribution hazard ratio (SHR) for stroke mortality in those who had TAC present compared with those who did not was 8.80 (95% confidence interval [CI]: 5.97, 12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21 (95% CI:1.39,3.49). In sex-stratified analyses, the fully adjusted SHR for females was 3.42 (95% CI: 1.74, 6.73) while for males it was 1.55 (95% CI: 0.83, 2.90). TAC was associated with stroke mortality independent of CAC and traditional risk factors, more so in women. The presence of TAC appears to be an independent risk marker for stroke mortality.
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Affiliation(s)
| | - Albert D Osei
- Medstar Union Memorial Hospital, Baltimore, Maryland
| | | | - Zeina A Dardari
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Omar Dzaye
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California
| | | | | | | | - Ellen Boakye
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, New York
| | | | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Michael J Blaha
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Blaha MJ, Naazie IN, Cainzos-Achirica M, Dardari ZA, DeFilippis AP, McClelland RL, Mirbolouk M, Orimoloye OA, Dzaye O, Nasir K, Page JH. Derivation of a Coronary Age Calculator Using Traditional Risk Factors and Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2021; 10:e019351. [PMID: 33663219 PMCID: PMC8174231 DOI: 10.1161/jaha.120.019351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The optimal method for communicating coronary heart disease (CHD) risk to individual patients is not yet clear. Recent research supports the concept of "coronary age" for more effective risk communication. We defined an individual's coronary age as the age at which an average healthy individual would have an equivalent estimated CHD risk as that calculated for the index individual, building on our previously validated MESA (Multi‐Ethnic Study of Atherosclerosis) 10‐year CHD Risk Score equations with and without coronary artery calcium (CAC). Methods and Results We derived a coronary age by (1) calculating the MESA 10‐year CHD risk; (2) mathematically setting this equal to an equation describing risk of an average healthy MESA participant, as a function of age; and (3) solving for age. The risk discrimination of the resultant coronary age was compared with that of chronological age, the MESA CHD Risk Score, and CAC alone. Approximately 95% of coronary age values ranged from 30 years less to 30 years higher than chronological age. Although the mean chronological age of individuals experiencing CHD events compared with those free of events was 67.4 versus 61.8 years, the difference in coronary age including CAC was larger (80.6 versus 62.8 years). Coronary age with CAC had identical predictive ability to that of MESA CHD Risk Score and outperformed chronological age and CAC alone. Conclusions The newly derived coronary age is a convenient transformation of MESA CHD Risk, retaining very good risk discrimination. This easy‐to‐communicate tool will be available for patients and clinicians, potentially facilitating risk communication in routine care.
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Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease Baltimore MD
| | - Isaac N Naazie
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease Baltimore MD
| | | | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease Baltimore MD
| | | | | | | | | | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease Baltimore MD
| | - Khurram Nasir
- Department of Medicine Yale New Haven Hospital New Haven CT.,Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart & Vascular Center, and Center for Outcomes Research (COR) Houston Methodist Houston TX
| | - John H Page
- Center for Observational Research Amgen Incorporated Thousand Oaks CA
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7
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Stokes AC, Xie W, Wilson AE, Yang H, Orimoloye OA, Harlow AF, Fetterman JL, DeFilippis AP, Benjamin EJ, Robertson RM, Bhatnagar A, Hamburg NM, Blaha MJ. Association of Cigarette and Electronic Cigarette Use Patterns With Levels of Inflammatory and Oxidative Stress Biomarkers Among US Adults: Population Assessment of Tobacco and Health Study. Circulation 2021; 143:869-871. [PMID: 33390037 PMCID: PMC8284843 DOI: 10.1161/circulationaha.120.051551] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew C. Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Wubin Xie
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anna E. Wilson
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Hanqi Yang
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Olusola A. Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyssa F. Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jessica L. Fetterman
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Andrew P. DeFilippis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emelia J. Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rose Marie Robertson
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Naomi M. Hamburg
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Michael J. Blaha
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
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8
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Reiter-Brennan C, Osei AD, Iftekhar Uddin SM, Orimoloye OA, Obisesan OH, Mirbolouk M, Blaha MJ, Dzaye O. ACC/AHA lipid guidelines: Personalized care to prevent cardiovascular disease. Cleve Clin J Med 2021; 87:231-239. [PMID: 32238379 DOI: 10.3949/ccjm.87a.19078] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The 2018 and 2019 guidelines from the American College of Cardiology and American Heart Association reflect the complexity of individualized cholesterol management. The documents address more detailed risk assessment, newer nonstatin cholesterol-lowering drugs, special attention to patient subgroups, and consideration of the value of therapy, all with the aim of creating personalized treatment plans for each patient. Overall, the guidelines recommend shared decision-making to meet the individual needs of each patient.
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Affiliation(s)
- Cara Reiter-Brennan
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD.,Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
| | - S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
| | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD.,Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD .,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD .,Department of Radiology and Neuroradiology, Charité, Berlin, Germany
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9
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Uddin SMI, Osei AD, Obisesan OH, El-Shahawy O, Dzaye O, Cainzos-Achirica M, Mirbolouk M, Orimoloye OA, Stokes A, Benjamin EJ, Bhatnagar A, DeFilippis AP, Henry TS, Nasir K, Blaha MJ. Prevalence, Trends, and Distribution of Nicotine and Marijuana use in E-cigarettes among US adults: The Behavioral Risk Factor Surveillance System 2016-2018. Prev Med 2020; 139:106175. [PMID: 32593733 PMCID: PMC8383272 DOI: 10.1016/j.ypmed.2020.106175] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 01/10/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/17/2022]
Abstract
Use of substances other than nicotine in e-cigarettes, especially marijuana, is becoming increasingly popular in the US. However, population-representative data on such poly-use (nicotine and marijuana) remains limited. We therefore conducted a cross-sectional logistic regression analysis of the 2018 Behavioral Risk Factor Surveillance System among 16 US states/territories with data on past 30-day marijuana use to describe the emerging dual nicotine and marijuana vaping population. We additionally examined trends in marijuana use, including marijuana vaping, from 2016 to 2018. Of the 131,807 participants studied, 3068 were current e-cigarette users, among whom 7.1% also vaped marijuana. Prevalence of nicotine-predominant, dual nicotine marijuana, and marijuana-predominant vaping was 3.36%, 0.38% and 1.09%, respectively. Compared to nicotine-predominant vapers, dual and marijuana-predominant vapers were older, had greater proportions of non-Whites, particularly Hispanics, and less likely to be current smokers (nicotine-predominant vs dual vs marijuana-predominant vaping: current tobacco use 44.7 vs 23.7 vs 11.1%). Proportion of dual vapers among current e-cigarette users was 8.6%, 2.6% and 7.1% for 2016, 2017 and 2018, respectively. Prevalence of marijuana use increased from 8.97% (2016) to 13.1% (2018) while no clear trend was observed for marijuana vaping. Dual nicotine and marijuana vaping is prevalent in the US, and compared to predominantly nicotine vapers such users have higher mean ages, and are more likely to be Blacks, Hispanics, and never cigarette smokers. Marijuana use overall increased from 2016 to 2018. Dual vapers represent a large and important emerging population that will require dedicated study of health effects and tailored regulatory strategies.
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Affiliation(s)
- S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; Johns Hopkins University, Baltimore, MD, United States of America
| | - Albert D Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; Johns Hopkins University, Baltimore, MD, United States of America
| | - Olufunmilayo H Obisesan
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; Johns Hopkins University, Baltimore, MD, United States of America
| | - Omar El-Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; New York University, New York City, NY, United States of America
| | - Omar Dzaye
- Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Mohammadhassan Mirbolouk
- Johns Hopkins University, Baltimore, MD, United States of America; Yale New Haven Hospital, New Haven, CT, United States of America
| | - Olusola A Orimoloye
- Johns Hopkins University, Baltimore, MD, United States of America; Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; Boston University, Boston, MA, United States of America
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; Boston University, Boston, MA, United States of America
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; University of Louisville, Louisville, KY, United States of America
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; University of Louisville, Louisville, KY, United States of America
| | - Travis S Henry
- University of California, San Francisco, San Francisco, CA, United States of America
| | - Khurram Nasir
- Johns Hopkins University, Baltimore, MD, United States of America; Houston Methodist Hospital, Houston, TX, United States of America
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America; Johns Hopkins University, Baltimore, MD, United States of America.
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Keith RJ, Fetterman JL, Orimoloye OA, Dardari Z, Lorkiewicz PK, Hamburg NM, DeFilippis AP, Blaha MJ, Bhatnagar A. Characterization of Volatile Organic Compound Metabolites in Cigarette Smokers, Electronic Nicotine Device Users, Dual Users, and Nonusers of Tobacco. Nicotine Tob Res 2020; 22:264-272. [PMID: 30759242 DOI: 10.1093/ntr/ntz021] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/08/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Limited research exists about the possible cardiovascular effects of electronic nicotine delivery systems (ENDS). We therefore sought to compare exposure to known or potentially cardiotoxic volatile organic compounds (VOCs) in ENDS users, smokers, and dual users. METHODS A total of 371 individuals from the Cardiovascular Injury due to Tobacco Use study, a cross-sectional study of healthy participants aged 21-45 years, were categorized as nonusers of tobacco (n = 87), sole ENDS users (n = 17), cigarette smokers (n = 237), and dual users (n = 30) based on 30-day self-reported tobacco product use patterns. Participants provided urine samples for VOC and nicotine metabolite measurement. We assessed associations between tobacco product use and VOC metabolite measures using multivariable-adjusted linear regression models. RESULTS Mean (SD) age of the population was 32 (±6.8) years, 55% men. Mean urinary cotinine level in nonusers of tobacco was 2.6 ng/mg creatinine, whereas cotinine levels were similar across all tobacco product use categories (851.6-910.9 ng/mg creatinine). In multivariable-adjusted models, sole ENDS users had higher levels of metabolites of acrolein, acrylamide, acrylonitrile, and xylene compared with nonusers of tobacco, but lower levels of most VOC metabolites compared with cigarette smokers or dual users. In direct comparison of cigarettes smokers and dual users, we found lower levels of metabolites of styrene and xylene in dual users. CONCLUSION Although sole ENDS use may be associated with lower VOC exposure compared to cigarette smoking, further study is required to determine the potential health effects of the higher levels of certain reactive aldehydes, including acrolein, in ENDS users compared with nonusers of tobacco. IMPLICATIONS ENDS use in conjunction with other tobacco products may not significantly reduce exposure to VOC, but sole use does generally reduce some VOC exposure and warrants more in-depth studies.
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Affiliation(s)
- Rachel J Keith
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Jessica L Fetterman
- American Heart Association Tobacco, Regulation and Addiction Center, Vascular Biology Section, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Olusola A Orimoloye
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Zeina Dardari
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Pawel K Lorkiewicz
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Naomi M Hamburg
- American Heart Association Tobacco, Regulation and Addiction Center, Vascular Biology Section, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Andrew P DeFilippis
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Michael J Blaha
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Aruni Bhatnagar
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
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Obisesan OH, Osei AD, Uddin SMI, Dzaye O, Cainzos-Achirica M, Mirbolouk M, Orimoloye OA, Sharma G, Al Rifai M, Stokes A, Bhatnagar A, El Shahawy O, Benjamin EJ, DeFilippis AP, Blaha MJ. E-Cigarette Use Patterns and High-Risk Behaviors in Pregnancy: Behavioral Risk Factor Surveillance System, 2016-2018. Am J Prev Med 2020; 59:187-195. [PMID: 32362509 PMCID: PMC8349302 DOI: 10.1016/j.amepre.2020.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 11/25/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The prevalence of e-cigarette use has increased dramatically in the last decade in the U.S. Understanding the prevalence, patterns of use, and risk factor associations of e-cigarette use in pregnant women is particularly important, as this could have potential health implications for the mother and the developing child. METHODS Using Behavioral Risk Factor Surveillance System Survey data from 2016 to 2018, adult women of reproductive age (18-49 years) who reported being pregnant (n=7,434) were studied. Self-reported current e-cigarette use was the main exposure. Other measures included combustible cigarette smoking status and high-risk behaviors (including other tobacco, marijuana, or heavy alcohol use; binge drinking; and others). All analyses were done in 2019. RESULTS Approximately 2.2% of pregnant women reported current e-cigarette use, of whom 0.6% reported daily use. The highest prevalence of e-cigarette use was observed in the youngest age group of pregnant women (3.2%), with 41.7% of all pregnant current e-cigarette users being aged 18-24 years. There was a marked increase in the prevalence of current use of e-cigarettes among pregnant women from 1.9% in 2016 to 3.8% in 2018. Approximately 46% of pregnant current e-cigarette users reported concomitant cigarette smoking. Compared with pregnant never e-cigarette users, pregnant current e-cigarette users had a higher prevalence of other tobacco product use, marijuana use, heavy alcohol intake, binge drinking, and other high-risk behaviors. CONCLUSIONS These findings underscore the need to strengthen prevention and policy efforts, specifically in the vulnerable subgroup of pregnant women.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | | | - Olusola A Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Andrew Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Global Health, Boston University, Boston, Massachusetts
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Omar El Shahawy
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Section on Tobacco, Alcohol and Drug Use, Department of Population Health, School of Medicine, New York University, New York, New York; Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Emelia J Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Boston University, Boston, Massachusetts
| | - Andrew P DeFilippis
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas.
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12
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Oshunbade AA, Hamid A, Lirette ST, Gbadamosi SO, Yimer WK, Orimoloye OA, Clark D, Kamimura D, Grado SD, Lutz EA, Mentz RJ, Fox ER, Butler J, Gwen Windham B, Butler KR, Mosley TH, Hall ME. Hypertensive diseases in pregnancy, cardiac structure and function later in life: Insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Pregnancy Hypertens 2020; 21:184-190. [DOI: 10.1016/j.preghy.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/08/2020] [Accepted: 05/25/2020] [Indexed: 01/14/2023]
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13
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Osei AD, Uddin SMI, Dzaye O, Achirica MC, Dardari ZA, Obisesan OH, Kianoush S, Mirbolouk M, Orimoloye OA, Shaw L, Rumberger JA, Berman D, Rozanski A, Miedema MD, Budoff MJ, Vasan RS, Nasir K, Blaha MJ. Predictors of coronary artery calcium among 20-30-year-olds: The Coronary Artery Calcium Consortium. Atherosclerosis 2020; 301:65-68. [PMID: 32330692 DOI: 10.1016/j.atherosclerosis.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS We sought to understand the risk factor correlates of very early coronary artery calcium (CAC), and the potential investigational value of CAC phenotyping in adults aged 20-30 years. METHODS We studied all participants aged 20-30 years at baseline (N = 373) in the Coronary Artery Calcium Consortium, a large multi-center cohort study of patients aged 18 years or older without known atherosclerotic cardiovascular disease (ASCVD) at baseline, referred for CAC scoring for clinical risk stratification. We described the prevalence of CAC in men and women, the frequency of risk factors by the presence of CAC (CAC = 0 vs CAC >0), and assessed the association between traditional non-demographic CVD risk factors (hypertension, hyperlipidemia, smoking, family history of CHD, and diabetes) and prevalent CAC, using age- and sex-adjusted logistic regression models. RESULTS The mean age of the study participants was 27.5 ± 2.4 years; 324 (86.9%) had CAC = 0, and 49 (13.1%) had CAC >0. Among the 49 participants with CAC, 38 (77.6%) were men, and median CAC score was low at 4.6. In age- and sex-adjusted models, there was a graded increase in the odds of CAC >0 with increasing traditional cardiovascular disease (CVD) risk factor burden (p = 0.001 for linear trend). Participants with ≥3 traditional risk factors had a statistically significant higher odds of having prevalent CAC (OR 5.57, 95% CI; 1.82-17.03) compared to participants with no risk factors. CONCLUSIONS Our study demonstrates the non-negligible prevalence of CAC among very high-risk young US adults, reinforcing the critical importance of traditional risk factors in the earliest development of detectable subclinical ASCVD.
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Affiliation(s)
| | | | - Omar Dzaye
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | - Alan Rozanski
- Division of Cardiology, Mount Sinai St, Luke's Hospital, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minnesota, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, LA, California, USA
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Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, Uddin SMI, Benjamin EJ, Hall ME, DeFilippis AP, Bhatnagar A, Biswal SS, Blaha MJ. Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017. Am J Prev Med 2020; 58:336-342. [PMID: 31902685 PMCID: PMC9843649 DOI: 10.1016/j.amepre.2019.10.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The association between e-cigarette use and chronic bronchitis, emphysema, and chronic obstructive pulmonary disease has not been studied thoroughly, particularly in populations defined by concomitant combustible smoking status. METHODS Using pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System, investigators studied 705,159 participants with complete self-reported information on e-cigarette use, combustible cigarette use, key covariates, and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. Current e-cigarette use was the main exposure, with current use further classified as daily or occasional use. The main outcome was defined as reported ever having a diagnosis of chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. For all the analyses, multivariable adjusted logistic regression was used, with the study population stratified by combustible cigarette use status (never, former, or current). All the analyses were conducted in 2019. RESULTS Of 705,159 participants, 25,175 (3.6%) were current e-cigarette users, 64,792 (9.2%) current combustible cigarette smokers, 207,905 (29.5%) former combustible cigarette smokers, 432,462 (61.3%) never combustible cigarette smokers, and 14,036 (2.0%) dual users of e-cigarettes and combustible cigarettes. A total of 53,702 (7.6%) participants self-reported chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. Among never combustible cigarette smokers, current e-cigarette use was associated with 75% higher odds of chronic bronchitis, emphysema, or chronic obstructive pulmonary disease compared with never e-cigarette users (OR=1.75, 95% CI=1.25, 2.45), with daily users of e-cigarettes having the highest odds (OR=2.64, 95% CI=1.43, 4.89). Similar associations between e-cigarette use and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease were noted among both former and current combustible cigarette smokers. CONCLUSIONS The results suggest possible e-cigarette-related pulmonary toxicity across all the categories of combustible cigarette smoking status, including those who had never smoked combustible cigarettes.
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Affiliation(s)
- Albert D Osei
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mohammadhassan Mirbolouk
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Olusola A Orimoloye
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Omar Dzaye
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - S M Iftekhar Uddin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Emelia J Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Boston University, Boston, Massachusetts
| | - Michael E Hall
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew P DeFilippis
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Shyam S Biswal
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Michael J Blaha
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
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Whelton SP, McAuley PA, Dardari Z, Orimoloye OA, Brawner CA, Ehrman JK, Keteyian SJ, Al-Mallah M, Blaha MJ. Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort. Diabetes Care 2020; 43:677-682. [PMID: 31949085 DOI: 10.2337/dc19-1673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the effect of fitness on the association between BMI and mortality among patients with diabetes. RESEARCH DESIGN AND METHODS We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford Exercise Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (<6), moderate (6-9.9), or high (≥10). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Adjusted splines centered at 22.5 kg/m2 were used to examine BMI as a continuous variable. RESULTS Patients had a mean age of 58 ± 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 ± 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P < 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI ≥30 kg/m2. Compared with the lowest fitness group, patients with higher fitness had an ∼50% (6-9.9 METs) and 70% (≥10 METs) lower mortality hazard regardless of BMI (P < 0.001). CONCLUSIONS Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality.
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Paul A McAuley
- Department of Health, Physical Education and Sport Studies, Winston-Salem State University, Winston-Salem, NC
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
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Orimoloye OA, Uddin SMI, Chen LC, Osei AD, Mirbolouk M, Malovichko MV, Sithu ID, Dzaye O, Conklin DJ, Srivastava S, Blaha MJ. Electronic cigarettes and insulin resistance in animals and humans: Results of a controlled animal study and the National Health and Nutrition Examination Survey (NHANES 2013-2016). PLoS One 2019; 14:e0226744. [PMID: 31891598 PMCID: PMC6938328 DOI: 10.1371/journal.pone.0226744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The popularity of electronic cigarettes (E-cigarettes) has risen considerably. Several studies have suggested that nicotine may affect insulin resistance, however, the impact of E-cigarette exposure on insulin resistance, an early measure of cardiometabolic risk, is not known. METHODS AND RESULTS Using experimental animals and human data obtained from 3,989 participants of the United States National Health and Nutrition Examination Survey (NHANES), respectively, we assessed the association between E-cigarette and conventional cigarette exposures and insulin resistance, as modelled using the homeostatic model assessment of insulin resistance (HOMA-IR) and glucose tolerance tests (GTT). C57BL6/J mice (on standard chow diet) exposed to E-cigarette aerosol or mainstream cigarette smoke (MCS) for 12 weeks showed HOMA-IR and GTT levels comparable with filtered air-exposed controls. In the NHANES cohort, there was no significant association between defined tobacco product use categories (non-users; sole E-cigarette users; cigarette smokers and dual users) and insulin resistance. Compared with non-users of e-cigarettes/conventional cigarettes, sole E-cigarette users showed no significant difference in HOMA-IR or GTT levels following adjustment for age, sex, race, physical activity, alcohol use and BMI. CONCLUSION E-cigarettes do not appear to be linked with insulin resistance. Our findings may inform future studies assessing potential cardiometabolic harms associated with E-cigarette use.
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Affiliation(s)
- Olusola A. Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
| | - S. M. Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
| | - Lung-Chi Chen
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo, New York, United States of America
| | - Albert D. Osei
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
| | - Marina V. Malovichko
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
- Envirome Institute, University of Louisville, Louisville, Kentucky, United States of America
| | - Israel D. Sithu
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
- Envirome Institute, University of Louisville, Louisville, Kentucky, United States of America
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Daniel J. Conklin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
- Envirome Institute, University of Louisville, Louisville, Kentucky, United States of America
| | - Sanjay Srivastava
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
- Envirome Institute, University of Louisville, Louisville, Kentucky, United States of America
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, United States of America
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Obisesan OH, Mirbolouk M, Osei AD, Orimoloye OA, Uddin SMI, Dzaye O, El Shahawy O, Al Rifai M, Bhatnagar A, Stokes A, Benjamin EJ, DeFilippis AP, Blaha MJ. Association Between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017. JAMA Netw Open 2019; 2:e1916800. [PMID: 31800073 PMCID: PMC6902792 DOI: 10.1001/jamanetworkopen.2019.16800] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE The prevalence of the use of electronic cigarettes (e-cigarettes) in the United States has grown rapidly since their introduction to the market more than a decade ago. While several studies have demonstrated an association between combustible cigarette smoking and depression, the association between e-cigarette use and depression has not been thoroughly studied. OBJECTIVE To examine the association between e-cigarette use and depression in a nationally representative sample of the adult population in the United States. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the Behavioral Risk Factor Surveillance System database, 2016 to 2017. The Behavioral Risk Factor Surveillance System is the largest national telephone-based survey of randomly sampled adults in the United States. A total of 892 394 participants with information on e-cigarette use and depression were included. Data analysis was conducted in May 2019. EXPOSURES Electronic cigarette use status defined by self-report as never, former, or current use. MAIN OUTCOMES AND MEASURES Self-reported history of a clinical diagnosis of depression. RESULTS Of the 892 394 participants (414 326 [29.0%] aged ≥60 years; 502 448 [51.3%] women), there were 28 736 (4.4%) current e-cigarette users, of whom 13 071 (62.1%) were aged between 18 and 39 years. Compared with never e-cigarette users, current e-cigarette users were more likely to be single, male, younger than 40 years, and current combustible cigarette smokers (single, 120 797 [24.3%] vs 10 517 [48.4%]; men, 318 970 [46.6%] vs 14 962 [60.1%]; aged 18-39 years, 129 085 [32.2%] vs 13 071 [62.1%]; current combustible cigarette use, 217 895 [7.9%] vs 8823 [51.8%]). In multivariable adjusted models, former e-cigarette users had 1.60-fold (95% CI, 1.54-1.67) higher odds of reporting a history of clinical diagnosis of depression than never users, whereas current e-cigarette users had 2.10 (95% CI, 1.98-2.23) times higher odds. Additionally, higher odds of reporting depression were observed with increased frequency of use among current e-cigarette users compared with never users (daily use: odds ratio, 2.39; 95% CI, 2.19-2.61; occasional use: odds ratio, 1.96; 95% CI, 1.82-2.10). Similar results were seen in subgroup analyses by sex, race/ethnicity, smoking status, and student status. CONCLUSIONS AND RELEVANCE This study found a significant cross-sectional association between e-cigarette use and depression, which highlights the need for prospective studies analyzing the longitudinal risk of depression with e-cigarette use. If confirmed by other study designs, the potential mental health consequences may have regulatory implications for novel tobacco products.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | | | - Albert D. Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Olusola A. Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. M. Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Omar Dzaye
- Johns Hopkins University, Baltimore, Maryland
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Omar El Shahawy
- Section on Tobacco, Alcohol, and Drug Use, Department of Population Health, School of Medicine, New York University, New York
- Public Health Research Center, New York University, Abu Dhabi, United Arab Emirates
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Michael J. Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
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Orimoloye OA, Osei AD, Uddin SMI, Mirbolouk M, Blaha MJ. Electronic Cigarettes and Cardiovascular Risk: Science, Policy and the Cost of Certainty. Eur Cardiol 2019; 14:159-160. [PMID: 31933683 PMCID: PMC6950348 DOI: 10.15420/ecr.2019.14.3.ge2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimore, MD, US
- American Heart Association Tobacco Regulation and Addiction Center (ATRAC)US
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimore, MD, US
- American Heart Association Tobacco Regulation and Addiction Center (ATRAC)US
| | - SM Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimore, MD, US
- American Heart Association Tobacco Regulation and Addiction Center (ATRAC)US
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimore, MD, US
- American Heart Association Tobacco Regulation and Addiction Center (ATRAC)US
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimore, MD, US
- American Heart Association Tobacco Regulation and Addiction Center (ATRAC)US
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19
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Uddin SMI, Mirbolouk M, Kianoush S, Orimoloye OA, Dardari Z, Whelton SP, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Berman DS, Budoff MJ, McEvoy JW, Matsushita K, Blaha MJ, Graham G. Role of Coronary Artery Calcium for Stratifying Cardiovascular Risk in Adults With Hypertension. Hypertension 2019; 73:983-989. [PMID: 30879359 DOI: 10.1161/hypertensionaha.118.12266] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We examined the utility of coronary artery calcium (CAC) for cardiovascular risk stratification among hypertensive adults, including those fitting eligibility for SPRINT (Systolic Blood Pressure Intervention Trial). Additionally, we used CAC to identify hypertensive adults with cardiovascular disease (CVD) mortality rates equivalent to those observed in SPRINT who may, therefore, benefit from the most intensive blood pressure therapy. Our study population included 16 167 hypertensive patients from the CAC Consortium, among whom 6375 constituted a "SPRINT-like" population. We compared multivariable-adjusted hazard ratios of coronary heart disease and CVD deaths by CAC category (0, 1-99, 100-399, ≥400). Additionally, we generated a CAC-CVD mortality curve for patients aged >50 years to determine what CAC scores were associated with CVD death rates observed in SPRINT. Mean age was 58.1±10.6 years. During a mean follow-up of 11.6±3.6 years, there were 409 CVD deaths and 207 coronary heart disease deaths. Increasing CAC scores were associated with increased coronary heart disease and CVD mortality (coronary heart disease-CAC 100-399: hazard ratio [95% CI] 1.88 [1.04-3.40], CAC ≥400: 4.16 [2.34-7.39]; CVD-CAC 100-399: 1.93 [1.31-2.83], CAC ≥400: 3.51 [2.40-5.13]). A similar increased risk was observed across 10-year atherosclerotic CVD risk categories and in the SPRINT-like population. A CAC score of 220 (confidence range, 165-270) was associated with the CVD mortality rate observed in SPRINT. CAC risk stratifies adults with hypertension, including those who are SPRINT eligible. A CAC score of 220 can identify hypertensive adults with SPRINT-level CVD mortality risk and, therefore, may be reasonable for identifying candidates for aggressive blood pressure therapy.
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Affiliation(s)
- S M Iftekhar Uddin
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Mohammadhassan Mirbolouk
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Sina Kianoush
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Olusola A Orimoloye
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Zeina Dardari
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Seamus P Whelton
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.)
| | | | | | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.)
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA (D.S.B.)
| | - Matthew J Budoff
- David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance (M.J.B.)
| | - John W McEvoy
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.)
| | - Michael J Blaha
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
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20
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Orimoloye OA, Budoff MJ, Dardari ZA, Mirbolouk M, Uddin SMI, Berman DS, Rozanski A, Shaw LJ, Rumberger JA, Nasir K, Miedema MD, Blumenthal RS, Blaha MJ. Race/Ethnicity and the Prognostic Implications of Coronary Artery Calcium for All-Cause and Cardiovascular Disease Mortality: The Coronary Artery Calcium Consortium. J Am Heart Assoc 2019; 7:e010471. [PMID: 30371271 PMCID: PMC6474975 DOI: 10.1161/jaha.118.010471] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Coronary artery calcium (CAC) predicts cardiovascular disease (CVD) events; however, less is known about how its prognostic implications vary by race/ethnicity. Methods and Results A total of 38 277 whites, 1621 Asians, 977 blacks, and 1349 Hispanics from the CAC Consortium (mean age 55 years, 35% women) were followed over a median of 11.7 years. Modeling CAC in continuous and categorical (CAC=0; CAC 1–99; CAC 100–399; CAC ≥400) forms, we assessed its predictive value for all‐cause and CVD mortality by race/ethnicity using Cox proportional hazards and Fine and Gray competing‐risk regression, respectively. We also assessed the impact of race/ethnicity on risk within individual CAC strata, using whites as the reference. Models were adjusted for traditional cardiovascular risk factors. Increased CAC was associated with higher total and CVD mortality risk in all race/ethnicity groups, including Asians. However, the risk gradient with increasing CAC was more pronounced in blacks and Hispanics. In Fine and Gray subdistribution hazards models adjusted for traditional cardiovascular risk factors and CAC (continuous), blacks (subdistribution hazard ratio 3.4, 95% confidence interval, 2.5–4.8) and Hispanics (subdistribution hazard ratio 2.3, 95% confidence interval, 1.6–3.2) showed greater risk of CVD mortality when compared with whites, while Asians had risk similar to whites. These race/ethnic differences persisted when CAC=0. Conclusions CAC predicts all‐cause and CVD mortality in all studied race/ethnicity groups, including Asians and Hispanics, who may be poorly represented by the Pooled Cohort Equations. Blacks and Hispanics may have greater mortality risk compared with whites and Asians after adjusting for atherosclerosis burden, with potential implications for US race/ethnic healthcare disparities research.
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Affiliation(s)
- Olusola A Orimoloye
- 1 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Baltimore MD
| | - Matthew J Budoff
- 2 Department of Medicine Harbor-UCLA Medical Center Los Angeles CA
| | - Zeina A Dardari
- 1 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Baltimore MD
| | - Mohammadhassan Mirbolouk
- 1 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Baltimore MD
| | - S M Iftekhar Uddin
- 1 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Baltimore MD
| | - Daniel S Berman
- 3 Department of Imaging Cedars-Sinai Medical Center Los Angeles CA
| | - Alan Rozanski
- 4 Division of Cardiology Mount Sinai St. Luke's Hospital New York NY
| | - Leslee J Shaw
- 5 Department of Radiology, Weill Cornell Medicine New York NY
| | | | - Khurram Nasir
- 1 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Baltimore MD.,7 Center for Outcomes Research and Evaluation (CORE) Section of Cardiovascular Medicine, Yale University School of Medicine New Haven CT
| | - Michael D Miedema
- 8 Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis MN
| | - Roger S Blumenthal
- 1 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Baltimore MD
| | - Michael J Blaha
- 1 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Baltimore MD
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21
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Sarkar S, Orimoloye OA, Nass CM, Blumenthal RS, Martin SS. Cardiovascular Risk Heterogeneity in Adults with Diabetes: Selective Use of Coronary Artery Calcium in Statin Use Decision-making. J Gen Intern Med 2019; 34:2643-2647. [PMID: 31414361 PMCID: PMC6848593 DOI: 10.1007/s11606-019-05266-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 01/18/2023]
Abstract
Current American College of Cardiology/American Heart Association and American Diabetes Association guidelines recommend statin therapy for all patients with diabetes between the ages of 40 and 75, including those without cardiovascular disease (CVD). While diabetes is a major CVD risk factor, not all patients with diabetes have an equal risk of CVD. Thus, a more risk-based approach warrants consideration when recommending statin therapy for the primary prevention of CVD. Coronary artery calcium (CAC) is a noninvasive imaging modality that can help risk stratify patients with diabetes for future CVD events. CAC has been extensively studied in large cohorts such as the Multi-Ethnic Study of Atherosclerosis and found to outperform other novel risk stratification tools including carotid intima-media thickness. Moreover, a CAC score of 0 has been shown to be useful in downgrading the estimated risk of a CVD event in patients with diabetes and an intermediate Pooled Cohort Equation score. As clinicians weigh the recommendation for a lifelong therapy and the problem of statin nonadherence and patients weigh concerns about adverse effects of statins, the decision to initiate statin therapy in patients with diabetes is ideally a shared one between patients and providers, and CAC could facilitate this discussion.
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Affiliation(s)
- Sudipa Sarkar
- Division of Endocrinology, Diabetes, and Metabolism, Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
| | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Caitlin M Nass
- Division of Endocrinology, Diabetes, and Metabolism, Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
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22
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Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, Uddin SMI, Dardari ZA, DeFilippis AP, Bhatnagar A, Blaha MJ. The association between e-cigarette use and asthma among never combustible cigarette smokers: behavioral risk factor surveillance system (BRFSS) 2016 & 2017. BMC Pulm Med 2019; 19:180. [PMID: 31619218 PMCID: PMC6796489 DOI: 10.1186/s12890-019-0950-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND E-cigarette use prevalence has grown rapidly in the US. Despite the popularity of these products, few acute exposure toxicity studies exist, and studies on long-term pulmonary health effects are limited. E-cigarette users who are never combustible cigarette smokers (sole users) constitute a unique group of young adults that may be at increased risk of bronchial hyperreactivity and development of asthma. Given the public health concern about the potential pulmonary health effects of sole e-cigarette use, we aimed to examine the association between e-cigarette use and asthma among never combustible cigarette smokers. METHODS We pooled 2016 and 2017 data of the Behavioral Risk Factor Surveillance System (BRFSS), a large, cross-sectional telephone survey of adults aged 18 years and older in the U.S. We included 402,822 participants without any history of combustible cigarette smoking (defined as lifetime smoking < 100 cigarettes) and with complete self-reported information on key variables. Current e-cigarette use, further classified as daily or occasional use, was the primary exposure. The main outcome, asthma, was defined as self-reported history of asthma. We assess the relationship of sole e-cigarette use with asthma using multivariable logistic regression adjusting for age, sex, race, income, level of education and body mass index. RESULTS Of 402,822 never combustible cigarette smokers, there were 3103 (0.8%) current e-cigarette users and 34,074 (8.5%) with asthma. The median age group of current e-cigarette users was 18-24 years. Current e-cigarette use was associated with 39% higher odds of self-reported asthma compared to never e-cigarette users (Odds Ratio [OR], 1.39; 95% confidence interval: 1.15, 1.68). There was a graded increased odds of having asthma with increase of e-cigarette use intensity. The odds ratio of self-reported asthma increased from 1.31 (95% confidence interval: 1.05, 1.62) in occasional users to 1.73 (95% confidence interval: 1.21, 2.48) in daily e-cigarette users, compared to never e-cigarette users. CONCLUSION Our findings from a large, nationally representative survey suggest increased odds of asthma among never combustible smoking e-cigarette users. This may have potential public health implications, providing a strong rationale to support future longitudinal studies of pulmonary health in young e-cigarette-using adults.
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Affiliation(s)
- Albert D Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA.
| | - Mohammadhassan Mirbolouk
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Olusola A Orimoloye
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Omar Dzaye
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Zeina A Dardari
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville, Louisville, KY, USA
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville, Louisville, KY, USA
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
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23
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Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, Uddin SMI, Benjamin EJ, Hall ME, DeFilippis AP, Stokes A, Bhatnagar A, Nasir K, Blaha MJ. Association Between E-Cigarette Use and Cardiovascular Disease Among Never and Current Combustible-Cigarette Smokers. Am J Med 2019; 132:949-954.e2. [PMID: 30853474 DOI: 10.1016/j.amjmed.2019.02.016] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of e-cigarette use in the United States has increased rapidly. However, the association between e-cigarette use and cardiovascular disease remains virtually unknown. Therefore, we aimed to examine the association between e-cigarette use and cardiovascular disease among never and current combustible-cigarette smokers. METHODS We pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System (BRFSS), a large, nationally representative, cross-sectional telephone survey. We included 449,092 participants with complete self-reported information on all key variables. The main exposure, e-cigarette use, was further divided into daily or occasional use, and stratified by combustible-cigarette use (never and current). Cardiovascular disease, the main outcome, was defined as a composite of self-reported coronary heart disease, myocardial infarction, or stroke. RESULTS Of 449,092 participants, there were 15,863 (3.5%) current e-cigarette users, 12,908 (2.9%) dual users of e-cigarettes + combustible cigarettes, and 44,852 (10.0%) with cardiovascular disease. We found no significant association between e-cigarette use and cardiovascular disease among never combustible-cigarette smokers. Compared with current combustible-cigarette smokers who never used e-cigarettes, dual use of e-cigarettes + combustible cigarettes was associated with 36% higher odds of cardiovascular disease (odds ratio 1.36; 95% confidence interval, 1.18-1.56); with consistent results in subgroup analyses of premature cardiovascular disease in women <65 years and men <55 years old. CONCLUSION Our results suggest significantly higher odds of cardiovascular disease among dual users of e-cigarettes + combustible cigarettes compared with smoking alone. These data, although preliminary, support the critical need to conduct longitudinal studies exploring cardiovascular disease risk associated with e-cigarette use, particularly among dual users.
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Affiliation(s)
- Albert D Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Johns Hopkins University, Baltimore, Md
| | - Mohammadhassan Mirbolouk
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Johns Hopkins University, Baltimore, Md
| | - Olusola A Orimoloye
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Johns Hopkins University, Baltimore, Md
| | - Omar Dzaye
- Johns Hopkins University, Baltimore, Md; Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Johns Hopkins University, Baltimore, Md
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Boston University, Mass
| | - Michael E Hall
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; University of Mississippi Medical Center, Jackson
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; University of Louisville, Ky
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Boston University, Mass
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; University of Louisville, Ky
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation (CORE), Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Conn
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Johns Hopkins University, Baltimore, Md.
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24
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Lahti SJ, Feldman DI, Dardari Z, Mirbolouk M, Orimoloye OA, Osei AD, Graham G, Rumberger J, Shaw L, Budoff MJ, Rozanski A, Miedema MD, Al-Mallah MH, Berman D, Nasir K, Blaha MJ. The association between left main coronary artery calcium and cardiovascular-specific and total mortality: The Coronary Artery Calcium Consortium. Atherosclerosis 2019; 286:172-178. [PMID: 30954247 PMCID: PMC6599487 DOI: 10.1016/j.atherosclerosis.2019.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/14/2019] [Revised: 02/23/2019] [Accepted: 03/21/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Left main (LM) coronary artery disease is associated with greater myocardial infarction-related mortality, however, coronary artery calcium (CAC) scoring does not account for disease location. We explored whether LM CAC predicts excess mortality in asymptomatic adults. METHODS Cause-specific cardiovascular and all-cause mortality was studied in 28,147 asymptomatic patients with non-zero CAC scores in the CAC Consortium. Multivariate regression was performed to evaluate if the presence and burden of LM CAC predict mortality after adjustment for clinical risk factors and the Agatston CAC score. We further analyzed the per-unit hazard associated with LM CAC in comparison to CAC in other arteries. RESULTS The study population had mean age of 58.3 ± 10 years and CAC score of 301 ± 631. LM CAC was present in 21.7% of the cases. During 312,398 patient-years of follow-up, 1,907 deaths were observed. LM CAC was associated with an increased burden of clinical risk factors and total CAC, and was independently predictive of increased hazard for all-cause (HR 1.2 [1.1, 1.3]) and cardiovascular disease death (HR 1.3 [1.1, 1.5]). The hazard for death increased proportionate to the percentage of CAC localized to the LM. On a per-100 Agatston unit basis, LM CAC was associated with a 6-9% incremental hazard for death beyond knowledge of CAC in other arteries. CONCLUSIONS The presence and high burden of left main CAC are independently associated with a 20-30% greater hazard for cardiovascular and total mortality in asymptomatic adults, arguing that LM CAC should be routinely noted in CAC score reports when present.
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Affiliation(s)
- Steven J Lahti
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - David I Feldman
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zeina Dardari
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | | | - Olusola A Orimoloye
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - Albert D Osei
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | | | | | - Leslee Shaw
- Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Matthew J Budoff
- Cardiology, Los Angeles Biomedical Research Center, Torrance, CA, USA
| | - Alan Rozanski
- Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, NY, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | | | - Dan Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Khurram Nasir
- Cardiology & Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
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Tibuakuu M, Okunrintemi V, Jirru E, Echouffo Tcheugui JB, Orimoloye OA, Mehta PK, DeFilippis AP, Blaha MJ, Michos ED. National Trends in Cessation Counseling, Prescription Medication Use, and Associated Costs Among US Adult Cigarette Smokers. JAMA Netw Open 2019; 2:e194585. [PMID: 31125108 PMCID: PMC6632149 DOI: 10.1001/jamanetworkopen.2019.4585] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Cigarette smoking is the leading cause of preventable disease and death in the United States. When used separately or in combination, smoking cessation counseling and cessation medications have been associated with increased cessation rates. OBJECTIVES To present trends in self-reported receipt of physician advice to quit smoking and in use of prescription smoking cessation medication along with their associated expenditures among a nationally representative sample of active adult smokers in the United States. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study of US adults aged 18 years or older was conducted from July 5, 2018, through August 15, 2018. Data were collected between January 1, 2006, and December 31, 2015, from the Medical Expenditure Panel Survey, an annual US survey of individuals and families, health care personnel, and employers. Participants (n = 29 106) were noninstitutionalized civilians who were randomly drawn from the respondents of the previous year's National Health Interview Survey. Multivariable logistic regression models were used to examine the associations between sociodemographic factors and receipt of physician cessation advice and use of cessation prescription medication. A 2-part econometric model was used to assess health care expenditures. MAIN OUTCOMES AND MEASURES Trends in self-reported receipt of physician advice to quit and uptake of prescription smoking cessation medications with associated total and out-of-pocket expenditures. RESULTS The study sample consisted of 29 106 participants, with a mean (SD) age of 57 (10) years and a composition of 13 670 women (47.0%). The results were weighted to provide estimates for 31.2 million active adult cigarette smokers. The proportion of smokers who reported receiving physician advice to quit increased from 60.2% (95% CI, 58.5%-62.0%) in 2006 to 2007 to 64.9% (95% CI, 62.8%-66.9%) in 2014 to 2015, with a P for trend = .001. The odds of receiving physician cessation advice was statistically significantly higher in women (odds ratio [OR], 1.50; 95% CI, 1.39-1.59) and lower among uninsured participants (OR, 0.58; 95% CI, 0.52-0.65). Overall, prescription smoking cessation medication use decreased with a corresponding reduction in total expenditures from $146 million (out-of-pocket cost, $46 million) in 2006 to 2007 to $73 million (out-of-pocket cost, $9 million) in 2014 to 2015. Male (odds ratio [OR], 0.78; 95% CI, 0.66-0.91), uninsured (OR, 0.58; 95% CI, 0.41-0.83), and racial/ethnic minority (African American: OR, 0.51 [95% CI, 0.38-0.69]; Asian: OR, 0.31 [95% CI, 0.10-0.93]; Hispanic: OR, 0.53 [95% CI, 0.36-0.78]) participants were less likely to use prescription smoking cessation medications. CONCLUSIONS AND RELEVANCE The lower rates of delivery of physician advice to quit smoking and the lower uptake of known prescription smoking cessation medications among men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-associated comorbidities may be associated with the higher smoking rates among these subgroups despite an all-time low prevalence of smoking in the United States; this finding calls for a more targeted implementation of smoking cessation guidelines.
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Affiliation(s)
- Martin Tibuakuu
- St Luke’s Hospital, Department of Medicine, Chesterfield, Missouri
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Victor Okunrintemi
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Ermias Jirru
- Department of Medicine, New York Presbyterian-Weill Cornell Medical College, New York
| | | | - Olusola A. Orimoloye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Puja K. Mehta
- Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Andrew P. DeFilippis
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Cardiology, University of Louisville, Louisville, Kentucky
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Dzaye O, Dudum R, Mirbolouk M, Orimoloye OA, Osei AD, Dardari ZA, Berman DS, Miedema MD, Shaw L, Rozanski A, Holdhoff M, Nasir K, Rumberger JA, Budoff MJ, Al-Mallah MH, Blankstein R, Blaha MJ. Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium. J Cardiovasc Comput Tomogr 2019; 14:12-17. [PMID: 30952612 DOI: 10.1016/j.jcct.2019.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. METHODS We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. RESULTS The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6-9.9), CVD mortality (HR4.0 (95% CI 2.8-5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1-3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001). CONCLUSION The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.
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Affiliation(s)
- Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Ramzi Dudum
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States
| | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States
| | - Daniel S Berman
- Department of Nuclear Cardiology/Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Leslee Shaw
- Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Alan Rozanski
- Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, NY, United States
| | - Matthias Holdhoff
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Khurram Nasir
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States; Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - John A Rumberger
- Department of Cardiovascular Imaging, Princeton Longevity Center, Princeton, NJ, United States
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Mouaz H Al-Mallah
- Cardiovascular Imaging and PET, Houston Methodist DeBakey Heart & Vascular Center, Houston Texas, Texas, United States
| | - Ron Blankstein
- Cardiovascular Imaging Program, Brigham and Women's Hospital and Harvard Medical School, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States.
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27
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Dudum R, Dzaye O, Mirbolouk M, Dardari ZA, Orimoloye OA, Budoff MJ, Berman DS, Rozanski A, Miedema MD, Nasir K, Rumberger JA, Shaw L, Whelton SP, Graham G, Blaha MJ. Coronary artery calcium scoring in low risk patients with family history of coronary heart disease: Validation of the SCCT guideline approach in the coronary artery calcium consortium. J Cardiovasc Comput Tomogr 2019; 13:21-25. [PMID: 30935842 DOI: 10.1016/j.jcct.2019.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/29/2019] [Accepted: 03/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population. METHODS The CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD. RESULTS This cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5-3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9-9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2-33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. CONCLUSION In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.
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Affiliation(s)
- Ramzi Dudum
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | | | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Daniel S Berman
- Department of Nuclear Cardiology/Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, NY, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Khurram Nasir
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, CT, USA
| | - John A Rumberger
- Department of Cardiovascular Imaging, Princeton Longevity Center, Princeton, NJ, USA
| | - Leslee Shaw
- Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Seamus P Whelton
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | | | - Michael J Blaha
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
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28
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Peng AW, Mirbolouk M, Orimoloye OA, Osei AD, Dardari Z, Dzaye O, Budoff MJ, Shaw L, Miedema MD, Rumberger J, Berman DS, Rozanski A, Al-Mallah MH, Nasir K, Blaha MJ. Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000: Results From the CAC Consortium. JACC Cardiovasc Imaging 2019; 13:83-93. [PMID: 31005541 DOI: 10.1016/j.jcmg.2019.02.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/18/2019] [Accepted: 02/27/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study thoroughly explored the demographic and imaging characteristics, as well as the all-cause and cause-specific mortality risks of patients with a coronary artery calcium (CAC) score ≥1,000 in the largest dataset of this population to date. BACKGROUND CAC is commonly used to quantify cardiovascular risk. Current guidelines classify a CAC score of >300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with a CAC score ≥1,000. METHODS A total of 66,636 asymptomatic adults were included from the CAC consortium, a large retrospective multicenter clinical cohort. Mean patient follow-up was 12.3 ± 3.9 years for patients with cardiovascular disease (CVD), coronary heart disease (CHD), cancer, and all-cause mortality. Multivariate Cox proportional hazards regression models adjusted for age, sex, and conventional risk factors were used to assess the relative mortality hazard of individuals with CAC ≥1,000 compared with, first, a CAC reference of 0, and second, with patients with a CAC score of 400 to 999. RESULTS There were 2,869 patients with CAC ≥1,000 (86.3% male, mean 66.3 ± 9.7 years of age). Most patients with CAC ≥1,000 had 4-vessel CAC (mean: 3.5 ± 0.6 vessels) and had greater total CAC area, higher mean CAC density, and more extracoronary calcium (79% with thoracic artery calcium, 46% with aortic valve calcium, and 21% with mitral valve calcium) than those with CAC scores of 400 to 999. After full adjustment, those with CAC ≥1,000 had a 5.04- (95% confidence interval [CI]: 3.92 to 6.48), 6.79- (95% CI: 4.74 to 9.73), 1.55- (95% CI:1.23 to 1.95), and 2.89-fold (95% CI: 2.53 to 3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC score of 0. The CAC ≥1,000 group had a 1.71- (95% CI: 1.41 to 2.08), 1.84- (95% CI: 1.43 to 2.36), 1.36- (95% CI:1.07 to 1.73), and 1.51-fold (95% CI: 1.33 to 1.70) increased risk of CVD, CHD, cancer, and all-cause mortality compared to those with CAC scores 400 to 999. Graphic analysis of CAC ≥1,000 patients revealed continued logarithmic increase in risk, with no clear evidence of a risk plateau. CONCLUSIONS Patients with extensive CAC (CAC ≥1,000) represent a unique very high-risk phenotype with mortality outcomes commensurate with high-risk secondary prevention patients. Future guidelines should consider CAC ≥1,000 patients to be a distinct risk group who may benefit from the most aggressive preventive therapy.
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Affiliation(s)
- Allison W Peng
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, California
| | - Leslee Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael D Miedema
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, New York, New York
| | - Mouaz H Al-Mallah
- Cardiovascular Imaging Department, Houston Methodist Hospital, Houston, Texas
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.
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29
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Orimoloye OA, Kambhampati S, Hicks AJ, Al Rifai M, Silverman MG, Whelton S, Qureshi W, Ehrman JK, Keteyian SJ, Brawner CA, Dardari Z, Al-Mallah MH, Blaha MJ. Higher cardiorespiratory fitness predicts long-term survival in patients with heart failure and preserved ejection fraction: the Henry Ford Exercise Testing (FIT) Project. Arch Med Sci 2019; 15:350-358. [PMID: 30899287 PMCID: PMC6425214 DOI: 10.5114/aoms.2019.83290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/11/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Higher cardiorespiratory fitness (CRF) is associated with improved exercise capacity and quality of life in heart failure with preserved ejection fraction (HFpEF), but there are no large studies evaluating the association of HFpEF, CRF, and long-term survival. We therefore aimed to determine the association between CRF and all-cause mortality, in patients with HFpEF. MATERIAL AND METHODS In the Henry Ford Exercise Testing (FIT) Project, 167 patients had baseline HFpEF, defined as a clinical diagnosis of heart failure with ejection fraction ≥ 50% on echocardiogram. The CRF was estimated from the peak workload (in METs) from a clinician-referred treadmill stress test and categorized as poor (1-4 METs), intermediate (5-6 METs), and moderate-high (≥ 7 METs). Additional analyses assessing the effect of HFpEF and CRF on mortality were also conducted, matching HFpEF patients to non-HFpEF patients using propensity scores. RESULTS Mean age was 64 ±13 years, with 55% women, and 46% Black. Over a median follow-up of 9.7 (5.2-18.9) years, there were 103 deaths. In fully adjusted models, moderate-high CRF was associated with 63% lower mortality risk (HR = 0.37, 95% CI: 0.18-0.73) compared to the poor-CRF group. In the propensity-matched cohort, HFpEF was associated with a HR of 2.3 (95% CI: 1.7-3.2) for mortality compared to non-HFpEF patients, which was attenuated to 1.8 (95% CI: 1.3-2.5) after adjusting for CRF. CONCLUSIONS Moderate-high CRF in patients with HFpEF is associated with improved survival, and differences in CRF partly explain the intrinsic risk of HFpEF. Randomized trials of interventions aimed at improving CRF in HFpEF are needed.
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Affiliation(s)
- Olusola A. Orimoloye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Swetha Kambhampati
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert J. Hicks
- Department of Medicine/Cardiology Division, Baylor Scott & White Health, Temple, USA
| | - Mahmoud Al Rifai
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Seamus Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Waqas Qureshi
- Division of Cardiovascular Medicine, Wake Forest University of Medicine, Winston Salem, NC, USA
| | - Jonathan K. Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Steven J. Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Clinton A. Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Zeina Dardari
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mouaz H. Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Saudi Arabia
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, USA
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30
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Orimoloye OA, Mirbolouk M, Uddin SMI, Dardari ZA, Miedema MD, Al-Mallah MH, Yeboah J, Blankstein R, Nasir K, Blaha MJ. Association Between Self-rated Health, Coronary Artery Calcium Scores, and Atherosclerotic Cardiovascular Disease Risk: The Multi-Ethnic Study of Atherosclerosis (MESA). JAMA Netw Open 2019; 2:e188023. [PMID: 30768193 PMCID: PMC6484585 DOI: 10.1001/jamanetworkopen.2018.8023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE The interplay of self-rated health (SRH), coronary artery calcium (CAC) scores, and cardiovascular risk is poorly described. OBJECTIVES To assess the degree of correlation between SRH and CAC, to determine whether these measures are complementary for risk prediction, and to assess the incremental value of the addition of SRH to established risk tools. DESIGN, SETTING, AND PARTICIPANTS The Multi-Ethnic Study of Atherosclerosis (MESA) is a large population-based prospective cohort study of adults aged 45 to 84 years who were recruited from 6 US communities. A total of 6764 participants without baseline cardiovascular disease (CVD) were included in the analysis. Data were collected from July 2000 through August 2002. Follow-up was completed by December 2013, and data were analyzed from October 2018 to December 2018. EXPOSURES The EVGGFP (excellent, very good, good, fair, and poor) self-assessment of overall health (assessed before the baseline study examination) and CAC score. The EVGGFP rating was categorized as poor/fair, good, very good, or excellent. MAIN OUTCOMES AND MEASURES Hard coronary heart disease (CHD) events, hard CVD events, and all-cause mortality during a median follow-up of 13.2 years (interquartile range, 12.7-13.7 years). RESULTS Among the study population of 6764 participants, the mean (SD) age was 62.1 (10.2) years, and 52.9% were women. The EVGGFP rating was strongly associated with age, sex, race/ethnicity, educational and income levels, healthy diet and physical activity, and cardiovascular risk factors. Despite encapsulating many risk variables, no correlation (r = -0.007; P = .57) or association between EVGGFP and the presence (χ2 = 0.84; P = .84) or severity (χ2 = 4.64; P = .86) of CAC was found. During follow-up, 1161 deaths, 637 hard CVD events, and 405 hard CHD events were recorded. In models adjusted for age, sex, race/ethnicity, and CAC, participants who reported excellent health had a 45% lower risk of CVD (hazard ratio [HR], 0.55; 95% CI, 0.39-0.77) and a 42% lower risk of CHD (HR, 0.58; 95% CI, 0.37-0.90) compared with those who reported poor/fair health. Participants in the excellent SRH category who had any CAC had markedly elevated risk of hard CHD (HR, 6.19; 95% CI, 2.1-18.3) and CVD (HR, 6.50; 95% CI, 2.7-15.6) events compared with those with a CAC score of 0. The addition of the EVGGFP rating to CAC improved the area under the curve (C statistic) for CHD events (0.725 vs 0.734; P = .007), CVD events (0.693 vs 0.706; P < .001), and all-cause mortality (0.685 vs 0.707; P < .001). However, the addition of the EVGGFP rating to the combination of CAC and atherosclerotic CVD risk score did not significantly improve C statistics for CHD events (0.751 vs 0.753; P = .39), CVD events (0.739 vs 0.741; P = .18), or all-cause mortality (0.779 vs 0.781; P = .13). CONCLUSIONS AND RELEVANCE Although SRH and CAC integrate many risk variables, this study suggests that they are poorly correlated and have complementary predictive utility. A perception of excellent health does not obviate the need for definitive assessment of CVD risk, whereas fair/poor perceived health may serve as a risk enhancer, arguing for advanced risk assessment in selected clinical scenarios.
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Affiliation(s)
- Olusola A. Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - S. M. Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Zeina A. Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael D. Miedema
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mouaz H. Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Joseph Yeboah
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ron Blankstein
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
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Orimoloye OA, Feldman DI, Blaha MJ. Erectile dysfunction links to cardiovascular disease-defining the clinical value. Trends Cardiovasc Med 2019; 29:458-465. [PMID: 30665816 DOI: 10.1016/j.tcm.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 12/13/2022]
Abstract
Despite many advances over the last few decades, cardiovascular disease (CVD) remains the leading cause of death globally, with men afflicted at an earlier age than women. In a bid to reduce the global burden of morbidity and mortality due to CVD, emphasis has been placed on prevention, particularly on widespread promotion of ideal cardiovascular health behaviors and advancing strategies to identify and treat high-risk individuals who may benefit from aggressive preventive therapy. Erectile dysfunction is a highly prevalent condition that has been demonstrated to share the same risk factors as clinical CVD, and to have independent predictive value for future CVD events. Importantly, subclinical atherosclerosis appears to precede vascular ED by a decade or longer, with ED preceding clinical CVD such as myocardial infarction and stroke in temporal sequence by about 2-5 years. Crucially, since ED may represent the first presentation of otherwise "healthy" men to care providers, a clinical diagnosis of vascular ED may represent a unique opportunity to identify high risk individuals, intervene, and thus prevent progression to clinical CVD. This review summarizes up-to-date evidence of the relationship between ED and subclinical and clinical CVD, and details the position of current guidelines and clinical recommendations on the role of ED assessment in CVD prevention. Finally, this review proposes a clinical framework for the incorporation of ED into standard CVD risk assessment in middle-age men.
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Affiliation(s)
- Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David I Feldman
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Mirbolouk M, Charkhchi P, Orimoloye OA, Uddin SMI, Kianoush S, Jaber R, Bhatnagar A, Benjamin EJ, Hall ME, DeFilippis AP, Maziak W, Nasir K, Blaha MJ. E-Cigarette Use Without a History of Combustible Cigarette Smoking Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med 2019; 170:76-79. [PMID: 30304466 DOI: 10.7326/m18-1826] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mohammadhassan Mirbolouk
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
| | - Paniz Charkhchi
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, and University of Michigan, Ann Arbor, Michigan (P.C.)
| | - Olusola A Orimoloye
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
| | - S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, and Yale University School of Medicine, New Haven, Connecticut (S.K.)
| | - Rana Jaber
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Robert Stempel College of Public Health, Florida International University, Miami, Florida (R.J.)
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky (A.B.)
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Boston University School of Medicine, Boston University School of Public Health, Boston, Massachusetts (E.J.B.)
| | - Michael E Hall
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Mississippi Medical Center, Jackson, Mississippi (M.E.H.)
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, Kentucky (A.P.D.)
| | - Wasim Maziak
- Robert Stempel College of Public Health, Florida International University, Miami, Florida, and Syrian Center for Tobacco Studies, Aleppo, Syria (W.M.)
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, New Haven, Connecticut, Population Health & Health Systems Research, Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut; and Robert Stempel College of Public Health, Florida International University, Miami, Florida (K.N.)
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
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33
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Mirbolouk M, Charkhchi P, Kianoush S, Uddin SMI, Orimoloye OA, Jaber R, Bhatnagar A, Benjamin EJ, Hall ME, DeFilippis AP, Maziak W, Nasir K, Blaha MJ. Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med 2018; 169:429-438. [PMID: 30167658 PMCID: PMC10534294 DOI: 10.7326/m17-3440] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Contemporary data on the prevalence of e-cigarette use in the United States are limited. Objective To report the prevalence and distribution of current e-cigarette use among U.S. adults in 2016. Design Cross-sectional. Setting Behavioral Risk Factor Surveillance System, 2016. Participants Adults aged 18 years and older. Measurements Prevalence of current e-cigarette use by sociodemographic groups, comorbid medical conditions, and states of residence. Results Of participants with information on e-cigarette use (n = 466 842), 15 240 were current e-cigarette users, representing a prevalence of 4.5%, which corresponds to 10.8 million adult e-cigarette users in the United States. Of the e-cigarette users, 15% were never-cigarette smokers. The prevalence of current e-cigarette use was highest among persons aged 18 to 24 years (9.2% [95% CI, 8.6% to 9.8%]), translating to approximately 2.8 million users in this age range. More than half the current e-cigarette users (51.2%) were younger than 35 years. In addition, the age-standardized prevalence of e-cigarette use was high among men; lesbian, gay, bisexual, and transgender (LGBT) persons; current combustible cigarette smokers; and those with chronic health conditions. The prevalence of e-cigarette use varied widely among states, with estimates ranging from 3.1% (CI, 2.3% to 4.1%) in South Dakota to 7.0% (CI, 6.0% to 8.2%) in Oklahoma. Limitation Data were self-reported, and no biochemical confirmation of tobacco use was available. Conclusion E-cigarette use is common, especially in younger adults, LGBT persons, current cigarette smokers, and persons with comorbid conditions. The prevalence of use differs across states. These contemporary estimates may inform researchers, health care policymakers, and tobacco regulators about demographic and geographic distributions of e-cigarette use. Primary Funding Source American Heart Association Tobacco Regulation and Addiction Center, which is funded by the U.S. Food and Drug Administration and National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Mohammadhassan Mirbolouk
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
| | - Paniz Charkhchi
- Johns Hopkins University, Baltimore, Maryland, and University of Michigan, Ann Arbor, Michigan (P.C.)
| | - Sina Kianoush
- Johns Hopkins University, Baltimore, Maryland, and Yale University School of Medicine, New Haven, Connecticut (S.K.)
| | - S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
| | - Olusola A Orimoloye
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
| | - Rana Jaber
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Florida International University, Miami, Florida (R.J.)
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, Kentucky (A.B., A.P.D.)
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Boston University, Boston, Massachusetts (E.J.B.)
| | - Michael E Hall
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Mississippi Medical Center, Jackson, Mississippi (M.E.H.)
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, Kentucky (A.B., A.P.D.)
| | - Wasim Maziak
- Florida International University, Miami, Florida, and Syrian Center for Tobacco Studies, Aleppo, Syria (W.M.)
| | - Khurram Nasir
- Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, New Haven, Connecticut, and Florida International University, Miami, Florida and Population Health & Health Systems Research, Center for Outcomes Research and Evaluation (CORE), Section of Cardiovascular Medicine, Yale University School of Medicine. (K.N.)
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
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