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Larsen B, Bellettiere J, Allison M, Ryu R, Tam RM, McClelland RL, Miljkovic I, Vella C, Ouyang P, Criqui M, Unkart J. Associations of Abdominal Muscle Density and Area and Incident Cardiovascular Disease, Coronary Heart Disease, and Stroke: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2024; 13:e032014. [PMID: 38348808 PMCID: PMC11010071 DOI: 10.1161/jaha.123.032014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Muscle density is inversely associated with all-cause mortality, but associations with cardiovascular disease (CVD) risk are not well understood. This study evaluated the association between muscle density and muscle area and incident total CVD, coronary heart disease (CHD), and stroke in diverse men and women. METHODS AND RESULTS Adult participants (N=1869) in the Multi-Ethnic Study of Atherosclerosis Ancillary Body Composition Study underwent computer tomography scans of the L2-L4 region of the abdomen. Muscle was quantified by density (Hounsfield units) and area in cm2. Sex-stratified Cox proportional hazard models assessed associations between incident total CVD, incident CHD, and incident stroke across sex-specific percentiles of muscle area and density, which were entered simultaneously into the model. Mean age for men and women at baseline were 64.1 and 65.1 years, respectively, and median follow-up time was 10.3 years. For men, associations between muscle density and incident CVD were inverse but not significant in fully adjusted models (P trend=0.15). However, there was an inverse association between density and CHD (P trend=0.02; HR, 0.26 for 95th versus 10th percentile), and no association with stroke (P trend=0.78). Conversely, for men, there was a strong positive association between muscle area and incident CVD (HR, 4.19 for 95th versus 10th percentile; P trend<0.001). Associations were stronger for CHD (HR, 6.18 for 95th versus 10th percentile; P trend<0.001), and null for stroke (P trend=0.67). Associations for women were mostly null. CONCLUSIONS For men, abdominal muscle density is associated with lower CHD risk, whereas greater muscle area is associated with markedly increased risk of CHD.
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - Matthew Allison
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Rita Ryu
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - Rowena M. Tam
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | | | - Iva Miljkovic
- Department of EpidemiologyUniversity of PittsburgPAUSA
| | - Chantal Vella
- Department of Movement SciencesUniversity of IdahoBoiseIDUSA
| | - Pamela Ouyang
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
| | - Michael Criqui
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Jonathan Unkart
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
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Osmancevic A, Allison M, Miljkovic I, Vella CA, Ouyang P, Trimpou P, Daka B. Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis. Res Sq 2024:rs.3.rs-3909259. [PMID: 38410430 PMCID: PMC10896404 DOI: 10.21203/rs.3.rs-3909259/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Information on the associations of testosterone levels with abdominal muscle volume and quality in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. To investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis. A community-based sample of 907 men aged 45-84 years; 878 men with complete data were included in the analysis. CT scans of the abdomen were interrogated for muscle characteristics. Multivariable linear regressions were used to test the associations. After adjustment, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.79, 0.1-3.4, & 1.79, 0.4-3.2, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0-0.6, & -0.34, -0.6 - -0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity.
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Rao SJ, Kwapong YA, Boakye E, Mallya P, Zhao J, Akel W, Hong H, Li S, Oyeka CP, Metlock FE, Ouyang P, Blumenthal RS, Nasir K, Khandelwal A, Kinzy C, Mehta LS, Roger VL, Hall JL, Sharma G. Reproductive Experiences and Cardiovascular Disease Care in Pregnancy-Capable and Postmenopausal Individuals: Insights From the American Heart Association Research Goes Red Registry. Curr Probl Cardiol 2023; 48:101853. [PMID: 37302649 PMCID: PMC10710519 DOI: 10.1016/j.cpcardiol.2023.101853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
To evaluate preconception health and adverse pregnancy outcome (APO) awareness in a large population-based registry. We examined data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry to questions regarding prenatal health care experiences, postpartum health, and awareness of the association of APOs with cardiovascular disease (CVD) risk. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk, significantly varying by race-ethnicity. Fifty-nine percent of participants were not educated regarding this association by their providers, and 37% reported providers not assessing pregnancy history during current visits, significantly varying by race-ethnicity, income, and access to care. Only 37.1% of respondents were aware that CVD was the leading cause of maternal mortality. There is an urgent, ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.
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Affiliation(s)
- Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | - Yaa A Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ellen Boakye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Juan Zhao
- American Heart Association, Dallas, TX
| | | | | | - Shen Li
- American Heart Association, Dallas, TX
| | - Chigolum P Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Abha Khandelwal
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | | | - Laxmi S Mehta
- Division of Cardiology, The Ohio State University, Columbus, OH
| | - Veronique L Roger
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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4
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Knowles KA, Stewart KJ, Ouyang P, Magliato K, Whitt MD, Silber HA. A Novel Noninvasive Device and Method for Assessing Endothelial Function Is Associated With Measures of Obesity and Fitness. J Cardiopulm Rehabil Prev 2023; 43:390-391. [PMID: 37311026 DOI: 10.1097/hcr.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Kellen A Knowles
- Division of Cardiology, Department of Medicine (Drs Knowles, Stewart, Ouyang, and Silber), Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiothoracic Surgery, Providence Saint John's Health Center, Santa Monica, California (Dr Magliato); and Department of Biomedical Engineering, California Polytechnic State University, San Luis Obispo, California (Dr Whitt)
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5
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Varadarajan V, Marques MD, Venkatesh BA, Allison M, Ostovaneh MR, Yoneyama K, Donekal S, Shah RV, Murthy VL, Wu CO, Tracy RP, Ouyang P, Rochitte CE, Bluemke DA, Lima JAC. Cardiovascular Interactions of Renin-Angiotensin-Aldosterone System Assessed by Cardiac Magnetic Resonance: The Multi-Ethnic Study of Atherosclerosis. Am J Hypertens 2023; 36:517-523. [PMID: 37208017 PMCID: PMC10403971 DOI: 10.1093/ajh/hpad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The effects of the renin-angiotensin-aldosterone system in cardiovascular system have been described based on small studies. The aim of this study was to evaluate the relationship between aldosterone and plasma renin activity (PRA) and cardiovascular structure and function. METHODS We studied a random sample of Multi-Ethnic Study of Atherosclerosis participants who had aldosterone and PRA blood assays at 2003-2005 and underwent cardiac magnetic resonance at 2010. Participants taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were excluded. RESULTS The aldosterone group was composed by 615 participants, mean age 61.6 ± 8.9 years, while the renin group was 580 participants, mean age 61.5 ± 8.8 years and both groups had roughly 50% females. In multivariable analysis, 1 SD increment of log-transformed aldosterone level was associated with 0.07 g/m2 higher left ventricle (LV) mass index (P = 0.04) and 0.11 ml/m2 higher left atrium (LA) minimal volume index (P < 0.01). Additionally, higher log-transformed aldosterone was associated with lower LA maximum strain and LA emptying fraction (P < 0.01). Aldosterone levels were not significantly associated with aortic measures. Log-transformed PRA was associated with lower LV end diastolic volume index (β standardized = 0.08, P = 0.05). PRA levels were not significantly associated with LA and aortic structural or functional differences. CONCLUSIONS Higher levels of aldosterone and PRA are associated with concentric LV remodeling changes. Moreover, aldosterone was related to deleterious LA remodeling changes.
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Affiliation(s)
| | - Mateus D Marques
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Mohammad R Ostovaneh
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sirisha Donekal
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ravi V Shah
- Cardiovascular Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Venkatesh L Murthy
- Department of Internal Medicine, University of Michigan Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Colin O Wu
- Office of Biostatistics Research, NHLBI, NIH, Bethesda, Maryland, USA
| | - Russell P Tracy
- Department of Pathology, University of Vermont, Colchester, Vermont, USA
| | - Pamela Ouyang
- Clinical Research Unit, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Carlos E Rochitte
- Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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6
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Evans CD, Nanda JP, Ouyang P, Bone L, Byiringiro S, Lacanienta C, Clark R, Weston C, Han HR, Terkowitz M, Bates-Hopkins B, Galiatsatos P, Xu AJ, Stevens S, Himmelfarb CR. Integrating community voices in the research continuum: Perspectives on a consultation service. J Clin Transl Sci 2023; 7:e177. [PMID: 37654776 PMCID: PMC10465313 DOI: 10.1017/cts.2023.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/21/2023] [Accepted: 07/13/2023] [Indexed: 09/02/2023] Open
Abstract
The Community Research Advisory Council (C-RAC) of the Johns Hopkins Institute for Clinical and Translational Research was established in 2009 to provide community-engaged research consultation services. In 2016-2017, C-RAC members and researchers were surveyed on their consultation experiences. Survey results and a 2019 stakeholder meeting proceeding helped redesign the consultation services. Transitioning to virtual consultations during COVID-19, the redesigning involved increasing visibility, providing consultation materials in advance, expanding member training, and effective communications. An increase in consultations from 28 (2009-2017) to 114 (2020-2022) was observed. Implementing stakeholder-researcher inputs is critical to holistic and sustained community-engaged research.
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Affiliation(s)
- Crystal D. Evans
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Joy P. Nanda
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Pamela Ouyang
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lee Bone
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Samuel Byiringiro
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Cyd Lacanienta
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Roger Clark
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Christine Weston
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hae-Ra Han
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mia Terkowitz
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Barbara Bates-Hopkins
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Panagis Galiatsatos
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley Jingzhi Xu
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Sarah Stevens
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Cheryl R. Himmelfarb
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
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7
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Nanda JP, Clark RS, Harrison JA, Ouyang P, Lacanienta C, Himmelfarb C. Community-academic partnerships to embrace and ensure diversity, equity, and inclusion in translational science: Evidence of successful community engagement. J Clin Transl Sci 2023; 7:e188. [PMID: 37745925 PMCID: PMC10514689 DOI: 10.1017/cts.2023.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
Community-Research Advisory Councils (C-RAC) provide a unique mechanism for building sustainable community-academic partnership, fostering bidirectional understanding of complex research issues, disseminating timely research findings, and thereby improving public trust in science. Created in 2009, the Johns Hopkins C-RAC has a mission to achieve diversity, equity, and inclusion (DEI) of stakeholders across the entire research continuum. It has nurtured over a decade of partnership among community and academic stakeholders toward addressing health disparity, health equity, structural racism, and discrimination. Evidence of successful strategies to ensure DEI in partnership and lessons learned are illustrated in this special communication.
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Affiliation(s)
- Joy P. Nanda
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
| | - Roger S. Clark
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
| | - Jennifer Ayana Harrison
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
| | - Pamela Ouyang
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins University, Baltimore, MD, USA
| | - Cyd Lacanienta
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins University, Baltimore, MD, USA
| | - Cheryl Himmelfarb
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins University, Baltimore, MD, USA
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8
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Zhang SC, Li RP, Chen JC, Yang ZG, She YL, Zhou Z, Ouyang P. [Pulmonary vein stenosis with pulmonary infarction secondary to primary mediastinal seminoma: a case report]. Zhonghua Jie He He Hu Xi Za Zhi 2023; 46:592-594. [PMID: 37278174 DOI: 10.3760/cma.j.cn112147-20221026-00847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pulmonary vein stenosis is a rare condition that is often underdiagnosed and misdiagnosed. The clinical and radiologic manifestations are unspecific such as cough, hemoptysis and pulmonary lesions and are therefore difficult to distinguished with pneumonia and tuberculosis. The present study is a successful case report of pulmonary vein stenosis and pulmonary infraction secondary to mediastinal seminoma. This case suggested that pulmonary vein stenosis should be considered when a mediastinal mass is accompanied by pulmonary opacites that cannot be explained by common causes such as infection.
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Affiliation(s)
- S C Zhang
- Department of Respiratory, Xiangya Changde Hospital, Changde 415000, China
| | - R P Li
- Department of Respiratory, Xiangya Changde Hospital, Changde 415000, China
| | - J C Chen
- Department of Radiology, Xiangya Changde Hospital, Changde 415000, China
| | - Z G Yang
- Department of Respiratory, Xiangya Changde Hospital, Changde 415000, China
| | - Y L She
- Department of Radiology, Xiangya Changde Hospital, Changde 415000, China
| | - Z Zhou
- Department of Respiratory, Xiangya Changde Hospital, Changde 415000, China
| | - P Ouyang
- Department of Respiratory, Xiangya Changde Hospital, Changde 415000, China
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9
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Varadarajan V, Marques MD, Venkatesh BA, Allison M, Ostovaneh MR, Yoneyama K, Donekal S, Shah RV, Murthy VL, Wu CO, Tracy RP, Ouyang P, Rochitte CE, Bluemke DA, Lima JAC. Cardiovascular interactions of renin angiotensin aldosterone system assessed by cardiac magnetic resonance: The Multi-Ethnic Study of Atherosclerosis. Evolution 2023:7169332. [PMID: 37195902 DOI: 10.1093/evolut/qpad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The effects of the Renin Angiotensin Aldosterone System in cardiovascular system has been described based on small studies. The aim of this study was to evaluate the relationship between aldosterone and plasma renin activity and cardiovascular structure and function. METHODS We studied a random sample of Multi-Ethnic Study of Atherosclerosis participants who had aldosterone and plasma renin activity blood assays at 2003-2005 and underwent cardiac magnetic resonance at 2010. Participants taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were excluded. RESULTS The aldosterone group was composed by 615 participants, mean age 61.6 ± 8.9 years, while the renin group was 580 participants, mean age 61.5 ± 8.8 years and both groups had roughly 50% females. In multivariable analysis, 1 SD increment of log-transformed aldosterone level was associated with 0.07 g/m 2 higher left ventricle mass index (p=0.04) and 0.11 ml/m 2 higher left atrium minimal volume index (p < 0.01). Additionally, higher log-transformed aldosterone was associated with lower left atrium maximum strain and left atrium emptying fraction (βstandardized = -0.12, p < 0.01 and - 0.15, p < 0.01, respectively). Aldosterone levels were not significantly associated with aortic measures. Log-transformed plasma renin activity was associated with lower left ventricle end diastolic volume index (βstandardized = 0.08, p=0.05). Plasma renin activity levels were not significantly associated with left atrium and aortic structural or functional differences. CONCLUSIONS Higher levels of aldosterone and plasma renin activity are associated with concentric left ventricle remodeling changes. Moreover, aldosterone was related to deleterious left atrium remodeling changes.
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Affiliation(s)
| | - Mateus D Marques
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Mohammad R Ostovaneh
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA
| | - Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sirisha Donekal
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Ravi V Shah
- Cardiovascular Division, Brigham & Women's Hospital, Boston, MA, USA
| | - Venkatesh L Murthy
- Department of Internal Medicine, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA
| | - Colin O Wu
- Office of Biostatistics Research, NHLBI, NIH, Bethesda, MD, USA
| | - Russell P Tracy
- Department of Pathology, University of Vermont, Colchester, VT
| | - Pamela Ouyang
- Clinical Research Unit, Johns Hopkins Medical Institutes, Baltimore, MD, USA
| | - Carlos E Rochitte
- Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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10
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Trainor PJ, Brambatti M, Carlisle SM, Mullick AE, Shah SJ, Kahlon T, Mostacero DO, Mousavi H, Morgan ES, Tami Y, Michos ED, Ouyang P, Tsimikas S, DeFilippis AP. Blood Levels of Angiotensinogen and Hypertension in the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Coll Cardiol 2023; 81:1248-1259. [PMID: 36990544 PMCID: PMC10352958 DOI: 10.1016/j.jacc.2023.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/28/2022] [Accepted: 01/19/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Angiotensinogen is the proximal precursor of the angiotensin peptide hormones of the renin-angiotensin-aldosterone system (RAAS). Clinical trials are ongoing targeting angiotensinogen for the treatment of hypertension and heart failure. The epidemiology of angiotensinogen is not well defined, particularly its relationship to ethnicity, sex, and blood pressure (BP)/hypertension. OBJECTIVES The authors sought to determine the relationship of circulating angiotensinogen levels to ethnicity, sex, BP, incident hypertension, and prevalent hypertension in a modern sex-balanced ethnically diverse cohort. METHODS Plasma angiotensinogen levels were measured in 5,786 participants from the MESA (Multi-Ethnic Study of Atherosclerosis). Linear, logistic, and Cox proportional hazards models were utilized to examine the associations of angiotensinogen with BP, prevalent hypertension, and incident hypertension, respectively. RESULTS Angiotensinogen levels were significantly higher in females than males and differed across self-reported ethnicities with the ordering (from highest to lowest): White, Black, Hispanic, and Chinese adults. Higher levels were associated with higher BP and odds of prevalent hypertension, after adjusting for other risk factors. Equivalent relative differences in angiotensinogen were associated with greater differences in BP in males vs females. In males not taking RAAS-blocking medications, a standard deviation increment in log-angiotensinogen was associated with 2.61 mm Hg higher systolic BP (95% CI: 1.49-3.80), while in females the same increment in angiotensinogen was associated with 0.97 mm Hg higher systolic BP (95% CI: 0.30-1.65). CONCLUSIONS Significant differences in angiotensinogen levels are present between sexes and ethnicities. A positive association is present between levels and prevalent hypertension and BP, which differs between sexes.
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Affiliation(s)
- Patrick J Trainor
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico, USA; Molecular Biology and Interdisciplinary Life Sciences Program, New Mexico State University, Las Cruces, New Mexico, USA
| | | | - Samantha M Carlisle
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico, USA; Molecular Biology and Interdisciplinary Life Sciences Program, New Mexico State University, Las Cruces, New Mexico, USA
| | | | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tanvir Kahlon
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | - Hossein Mousavi
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico, USA
| | | | - Yvonne Tami
- Ionis Pharmaceuticals, Carlsbad, California, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pamela Ouyang
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sotirios Tsimikas
- Ionis Pharmaceuticals, Carlsbad, California, USA; Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California, USA
| | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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11
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Rao SJ, Kwapong YA, Boakye E, Mallya P, Zhao J, Akel W, Hong H, Li S, Oyeka CP, Metlock FE, Ouyang P, Blumenthal RS, Nasir K, Khandelwal A, Kinzy C, Mehta LS, Roger VL, Hall JL, Sharma G. Reproductive Experiences and Cardiovascular Disease Care in Pregnancy Capable and Post-Menopausal Individuals: Insights from the American Heart Association Research Goes Red Registry. medRxiv 2023:2023.03.14.23287279. [PMID: 36993300 PMCID: PMC10055463 DOI: 10.1101/2023.03.14.23287279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Information on reproductive experiences and awareness of adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD) risk among pregnancy-capable and post-menopausal individuals has not been well described. We sought to evaluate preconception health and APO awareness in a large population-based registry. Methods Data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry (AHA-RGR) were used. Responses to questions pertaining to prenatal health care experiences, postpartum health, and awareness of the association of APOs with CVD risk were used. We summarized responses using proportions for the overall sample and by stratifications, and we tested differences using the Chi-squared test. Results Of 4,651individuals in the AHA-RGR registry, 3,176 were of reproductive age, and 1,475 were postmenopausal. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk. This varied by different racial/ethnic groups (non-Hispanic White: 38%, non-Hispanic Black: 29%, Asian: 18%, Hispanic: 41%, Other: 46%; P = 0.03). Fifty-nine percent of the participants were not educated regarding the association of APOs with long-term CVD risk by their providers. Thirty percent of the participants reported that their providers did not assess pregnancy history during current visits; this varied by race-ethnicity ( P = 0.02), income ( P = 0.01), and access to care ( P = 0.02). Only 37.1% of the respondents were aware that CVD was the leading cause of maternal mortality. Conclusions Considerable knowledge gaps exist in the association of APOs with CVD risk, with disparities by race/ethnicity, and most patients are not educated on this association by their health care professionals. There is an urgent and ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.
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12
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Polanka BM, Yanek LR, Hays AG, Sharma K, Shah SJ, St-Onge MP, Ouyang P, Mathews L. The association of multidimensional sleep health with adiposity in heart failure with preserved ejection fraction. Heart Lung 2023; 58:144-151. [PMID: 36516532 PMCID: PMC9992262 DOI: 10.1016/j.hrtlng.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/24/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are bi-directional relationships between sleep disturbances and obesity, both of which are prevalent in patients with heart failure with preserved ejection fraction (HFpEF). However, little is known about the sleep-obesity association in HFpEF. OBJECTIVES To determine associations of multidimensional sleep health, night movement, sleep fragmentation, and sleep-disordered breathing (SDB) risk with overall and regional adiposity in HFpEF patients. METHODS Men and women with HFpEF (n = 49) were assessed via 14-day actigraphy, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale to derive multidimensional sleep health. SDB risk was assessed via Berlin Questionnaire. Body composition was measured using anthropometry; MRI quantification of epicardial, abdominal, liver, and thigh adipose tissue was performed in a subsample (n = 22). Spearman correlation (rs) and linear regression analyses (β coefficient) were used to estimate bivariate and age-adjusted associations. RESULTS Multidimensional sleep health was inversely associated with BMI (rs = -0.50, p < .001; unadjusted: β = -4.00, 95%CI: -5.87, -2.13; age-adjusted: β = -2.48, 95%CI: -4.65, -0.30), thigh subcutaneous adipose tissue (rs = -0.50, p = .018; unadjusted: β = -36.95, 95%CI: -67.31, -6.59), and thigh intermuscular fat (age-adjusted: β = -0.24, 95%CI: -0.48, -0.01). Night movement and sleep fragmentation were associated with greater intermuscular thigh and lower liver fat. High SDB risk was associated with a higher visceral-to-subcutaneous ratio of abdominal adiposity and lower thigh adiposity. CONCLUSIONS Adverse multidimensional sleep health is associated with higher adiposity measures in HFpEF patients. Further studies are needed to determine whether intervening on sleep could ameliorate excess adiposity or whether weight loss could improve sleep quality in HFpEF.
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Affiliation(s)
- Brittanny M Polanka
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Lisa R Yanek
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Marie-Pierre St-Onge
- Sleep Center of Excellence and Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States; Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lena Mathews
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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13
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Heravi AS, Zhao D, Michos ED, Doria De Vasconcellos H, Ambale-Venkatesh B, Lloyd-Jones D, Schreiner PJ, Reis JP, Shikany JM, Lewis CE, Ndumele CE, Guallar E, Ouyang P, Hoogeveen RC, Lima JAC, Post WS, Vaidya D. Oxidative Stress and Cardiovascular Risk Factors: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Antioxidants (Basel) 2023; 12:antiox12030555. [PMID: 36978803 PMCID: PMC10044794 DOI: 10.3390/antiox12030555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction—Oxidative stress is linked to cardiovascular diseases (CVD) and is suggested to vary by sex. However, few population-level studies have explored these associations and the majority comprise populations with advanced CVD. We assessed urinary isoprostane concentrations, a standard measure of oxidative stress, in a relatively young and healthy cohort, hypothesizing that higher oxidative stress is associated with an adverse cardiometabolic profile and female sex. Methods—Oxidative stress was measured in 475 women and 266 men, aged 48–55 years, from the Coronary Artery Risk Development in Young Adults (CARDIA) study using urinary 8-isoprostane (IsoP) and 2,3-dinor-8-isoprostane (IsoP-M). Multivariable-adjusted regression was used to evaluate cross-sectional associations. As secondary analysis, previously measured plasma F2-isoprostanes (plasma IsoP) from another CARDIA subset was similarly analyzed. Results—Mean (SD) ages for men and women were 52.1(2.3) and 52.2(2.2) years, respectively (p = 0.46), and 39% of the participants self-identified as Black (vs. White). Before adjustments, female sex was associated with higher median urinary IsoP (880 vs. 704 ng/g creatinine in men; p < 0.01) and IsoP m (1675 vs. 1284 ng/g creatinine in men; p < 0.01). Higher body mass index (BMI), high-density cholesterol (HDL-C), and triglycerides, current smoking, and less physical activity were associated with higher oxidative stress. Diabetes was not associated with urinary IsoP but was associated with lower IsoP m and plasma IsoP. Higher serum creatinine showed diverging associations with higher plasma and lower urinary isoprostane concentrations. Conclusions—Different isoprostane entities exhibit varying association patterns with CVD risk factors, and therefore are complementary, rather than interchangeable, in assessment of oxidative stress. Still, consistently higher isoprostanes among women, smokers, less active persons, and those with higher BMI and plasma triglycerides could reflect higher oxidative stress among these groups. While urinary isoprostanes are indexed to urinary creatinine due to variations in concentration, caution should be exercised when comparing groups with differing serum creatinine.
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Affiliation(s)
- Amir S. Heravi
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Di Zhao
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Erin D. Michos
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | | | - Donald Lloyd-Jones
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
| | - Pamela J. Schreiner
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jared P. Reis
- National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA
| | - James M. Shikany
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Cora E. Lewis
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Chiadi E. Ndumele
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Eliseo Guallar
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Pamela Ouyang
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | - Joao A. C. Lima
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Wendy S. Post
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Dhananjay Vaidya
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
- Correspondence:
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14
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Kazzi B, Ogunmoroti O, Rodriguez CP, Zhao D, Minhas AS, Osibogun O, Subramanya V, Allison MA, Ouyang P, Michos ED. Parity History and Later Life Sex Hormone Levels in the Multi-Ethnic Study of Atherosclerosis (MESA). Can J Cardiol 2022; 38:1893-1900. [PMID: 36087657 DOI: 10.1016/j.cjca.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/14/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiparity is a risk factor for cardiovascular disease (CVD). A more androgenic sex hormone profile, with a higher testosterone (T)/estradiol (E2) ratio, is associated with worse CVD outcomes in women and might be one mechanism linking multiparity to increased CVD risk. We investigated the relationship between parity and sex hormones at mid-to-older age. METHODS We performed a cross-sectional analysis of 2979 women with data on parity and endogenous sex hormone levels from the Multi-Ethnic Study of Atherosclerosis (MESA), a community-based cohort. Parity and gravidity (our exposures) were categorized as 0 (reference), 1-2, 3-4, or ≥ 5. Our outcome measures were T, E2, sex hormone binding globulin, dehydroepiandrosterone, and T/E2 ratio. Progressively adjusted linear regression was used to evaluate the association of parity/gravidity with sex hormones. RESULTS In multivariable adjusted models, there were no significant associations of parity with E2, dehydroepiandrosterone, and sex hormone binding globulin. Compared with nulliparity, after adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher T, but this was not significant for grand multiparity (≥ 5 live births). However, grand multigravidity (≥ 5 pregnancies) was associated with 10% (95% confidence interval [CI], 1%-20%) higher T and 14% (95% CI, 1%-29%) higher T/E2, compared with null gravidity. Grand multiparity was associated with an 18% (95% CI, 4%-34%) higher T/E2 ratio compared with nulliparity, after adjustment for CVD risk factors. CONCLUSIONS In this multiethnic cohort, women with grand multigravidity and grand multiparity had higher T/E2 levels, reflecting a more androgenic sex hormone profile. Longitudinal studies on sex hormones' influence on the relationship between multiparity and CVD are warranted.
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Affiliation(s)
- Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carla P Rodriguez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, San Diego, California, USA
| | - Pamela Ouyang
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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15
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Wallace RL, Ogunmoroti O, Zhao D, Vaidya D, Heravi A, Guallar E, Ndumele CE, Lima JA, Ouyang P, Budoff MJ, Allison M, Thomas I, Fashanu OE, Hoogeveen R, Post WS, Michos ED. Associations of urinary isoprostanes with measures of subclinical atherosclerosis: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis Plus 2022; 51:13-21. [PMID: 36969704 PMCID: PMC10037087 DOI: 10.1016/j.athplu.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Background Urinary isoprostanes are markers of systemic oxidative stress, which is implicated in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC), thoracic aortic calcium (TAC) and carotid plaque are measure subclinical atherosclerosis and prognosticate ASCVD risk. We examined the associations between urinary isoprostane levels and measures of plaque prevalence, burden, incidence and progression across three vascular beds in a cohort from the Multi-Ethnic Study of Atherosclerosis. Methods Urinary levels of 8-isoprostane and 2,3-dinor-8-F2-isoprostane were measured in 1089 participants (mean ± SD 62 ± 8 years, 48% women) at baseline. Participants underwent computed tomography for CAC and TAC, and duplex ultrasound for carotid plaque. TAC and CAC were reassessed at 2.4 and 10 years, respectively. Regression models were adjusted for CVD risk factors. Results In adjusted models, there were no significant associations between isoprostane levels with CAC prevalence or progression. Highest versus lowest tertile of 8-isoprostane was associated with 28% lower prevalence of descending TAC at baseline [prevalence ratio (PR) 0.72 95% CI (0.56, 0.94)], while 1-SD higher 2,3-dinor-8-F2-isoprostane was associated with 96% higher incident ascending TAC at follow-up [Relative Risk 1.96 (1.24, 3.09)]. Highest versus lowest tertile of isoprostane measures were associated with 22% higher prevalence of carotid plaque [(PR 1.22 (1.04, 1.45)] and 14% difference [3,26] in greater extent of carotid plaque at baseline. Conclusions Higher urinary isoprostanes were inconsistently associated with some measures of subclinical atherosclerosis by imaging. This suggests a limited role of urinary isoprostane levels as a prognostic marker for the development of ASCVD. Trial registration The MESA cohort design is registered at clinicaltrials.gov as follows: https://clinicaltrials.gov/ct2/show/NCT00005487.
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16
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Chu JH, Michos ED, Ouyang P, Vaidya D, Blumenthal RS, Budoff MJ, Blaha MJ, Whelton SP. Coronary artery calcium and atherosclerotic cardiovascular disease risk in women with early menopause: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Prev Cardiol 2022; 11:100362. [PMID: 35769201 PMCID: PMC9234594 DOI: 10.1016/j.ajpc.2022.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/26/2022] Open
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17
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Rojhani A, Ouyang P. Food Purchasing and Preparation Practices, Food Access, and WIC Food Redemption Patterns of WIC-Enrolled Pregnant Women. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Heravi AS, Michos ED, Zhao D, Ambale-Venkatesh B, Doria De Vasconcellos H, Lloyd-Jones D, Schreiner PJ, Reis JP, Wu C, Lewis CE, Shikany JM, Sidney S, Guallar E, Ndumele CE, Ouyang P, Hoogeveen RC, Lima JAC, Vaidya D, Post WS. Oxidative Stress and Menopausal Status: The Coronary Artery Risk Development in Young Adults Cohort Study. J Womens Health (Larchmt) 2022; 31:1057-1065. [PMID: 35675673 DOI: 10.1089/jwh.2021.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Low endogenous estrogen concentrations after menopause may contribute to higher oxidative stress and greater cardiovascular disease (CVD) risk. However, differences in oxidative stress between similarly aged premenopausal and postmenopausal women are not well-characterized on a population level. We hypothesized that urinary isoprostane concentrations, a standard measure of systemic oxidative stress, are higher in women who have undergone menopause compared to premenopausal women. Methods and Results: We examined differences in urinary 8-isoprostane (iPF2α-III) and 2,3-dinor-8-isoprostane (iPF2α-III-M) indexed to urinary creatinine between 279 postmenopausal and 196 premenopausal women in the Coronary Artery Risk Development in Young Adults (CARDIA) study, using linear regression with progressive adjustment for sociodemographic factors and traditional CVD risk factors. Unadjusted iPF2α-III-M concentrations were higher among postmenopausal compared to premenopausal women (Median [25th, 75th percentile]: 1762 [1178, 2974] vs. 1535 [1067, 2462] ng/g creatinine; p = 0.01). Menopause was associated with 25.5% higher iPF2α-III-M (95% confidence interval [6.5-47.9]) adjusted for age, race, college education, and field center. Further adjustments for tobacco use (21.2% [2.9-42.6]) and then CVD risk factors (18.8% [0.1-39.6]) led to additional partial attenuation. Menopause was associated with higher iPF2α-III in Black but not White women. Conclusions: We conclude that postmenopausal women had higher oxidative stress, which may contribute to greater CVD risk. ClinicalTrials.gov Identifier: NCT00005130.
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Affiliation(s)
- Amir S Heravi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bharath Ambale-Venkatesh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Colin Wu
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Stephen Sidney
- Division of Research, Kaiser-Permanente, Oakland, California, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiadi E Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ron C Hoogeveen
- Division of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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19
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Ogunmoroti O, Osibogun O, Zhao D, Mehta RC, Ouyang P, Lutsey PL, Robinson-Cohen C, Michos ED. Associations between endogenous sex hormones and FGF-23 among women and men in the Multi-Ethnic Study of Atherosclerosis. PLoS One 2022; 17:e0268759. [PMID: 35613118 PMCID: PMC9132299 DOI: 10.1371/journal.pone.0268759] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Elevated levels of testosterone and fibroblast growth factor 23 (FGF-23) are both independently associated with a higher risk of cardiovascular disease (CVD). However, the relationship between sex hormones and FGF-23 is not well established. We explored the association between sex hormones and FGF-23 among middle-aged to older men and women in MESA. We studied 3,052 men and 2,868 postmenopausal women free of CVD at the time of enrollment with baseline serum sex hormones [total testosterone (T), free T, estradiol (E2) and sex hormone binding globulin (SHBG)] and intact FGF-23. In sex-stratified analyses, we examined the cross-sectional associations between log-transformed sex hormones (per 1 SD) and log-transformed FGF-23 using multiple linear regression adjusted for socio-demographics, CVD risk factors, estimated glomerular filtration rate and mineral metabolites (25-hydroxyvitamin D, calcium, phosphorus and parathyroid hormone). The mean (SD) age of study participants was 64 (10) years. The median (IQR) of FGF-23 was similar in women and men [38 (30–46) vs 38 (31–47) pg/mL]. In adjusted analyses, among women, 1 SD increment in free T was associated with 3% higher FGF-23 while SHBG was associated with 2% lower FGF-23. In men, 1 SD increment in E2 was associated with 6% higher FGF-23 whereas total T/E2 ratio was associated with 7% lower FGF-23. In conclusion, this exploratory analysis found that a more androgenic sex hormone profile was directly associated with FGF-23 in women and inversely associated with FGF-23 in men. Longitudinal studies are required to determine whether FGF-23 mediates the relationship between sex hormones and CVD risk.
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Affiliation(s)
- Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rupal C. Mehta
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- The Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, United States of America
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Guan C, Zahid S, Minhas AS, Ouyang P, Vaught A, Baker VL, Michos ED. Polycystic ovary syndrome: a "risk-enhancing" factor for cardiovascular disease. Fertil Steril 2022; 117:924-935. [PMID: 35512976 DOI: 10.1016/j.fertnstert.2022.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 12/12/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age and is hallmarked by hyperandrogenism, oligo-ovulation, and polycystic ovarian morphology. Polycystic ovary syndrome, particularly the hyperandrogenism phenotype, is associated with several cardiometabolic abnormalities, including obesity, dyslipidemia, elevated blood pressure, and prediabetes or type 2 diabetes. Many, but not all, studies have suggested that PCOS is associated with increased risk of cardiovascular disease (CVD), including coronary heart disease and stroke, independent of body mass index and traditional risk factors. Interpretation of the data from these observational studies is limited by the varying definitions and ascertainment of PCOS and CVD across studies. Recent Mendelian randomization studies have challenged the causality of PCOS with coronary heart disease and stroke. Future longitudinal studies with clearly defined PCOS criteria and newer genetic methodologies may help to determine association and causality. Nevertheless, CVD risk screening remains critical in this patient population, as improvements in metabolic profile and reduction in CVD risk are achievable with a combination of lifestyle management and pharmacotherapy. Statin therapy should be implemented in women with PCOS who have elevated atherosclerotic CVD risk. If CVD risk is uncertain, measurement of subclinical atherosclerosis (carotid plaque or coronary artery calcium) may be a useful tool to guide shared decision-making about initiation of statin therapy. Other medications, such as metformin and glucagon-like peptide-1 receptor agonists, also may be useful in reducing CVD risk in insulin-resistant populations. Additional research is needed to determine the best pathways to mitigate PCOS-associated CVD risk.
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Affiliation(s)
- Carolyn Guan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Anum S Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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21
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Knowles KA, Stewart KJ, Tejan J, Ouyang P, Ratchford EV, Sullam L, Magliato K, Whitt MD, Silber HA. A novel operator-independent noninvasive device for assessing arterial reactivity. IJC Heart & Vasculature 2022; 39:100960. [PMID: 35402694 PMCID: PMC8984635 DOI: 10.1016/j.ijcha.2022.100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/21/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022]
Abstract
Background Endothelial dysfunction is associated with increased risk of cardiovascular disease (CVD). Currently available noninvasive methods of measuring endothelial function have limitations. We tested a novel device that provides an automated measurement of the difference between baseline and post-ischemic, hyperemia-induced, brachial arterial compliance, a phenomenon known to be endothelium-dependent. The association between the calculated index, Flow-mediated Compliance Response (FCR), and established CVD risk indices was determined. Methods Adults with CVD risk factors or known coronary artery disease (CAD) were enrolled. Framingham Risk Score (FRS) was calculated and presence of metabolic syndrome (MetSyn) was assessed. Carotid artery plaques were identified by ultrasound. Cardiorespiratory fitness was assessed by 6-minute walk test (6MWT). FCR was measured using the device. Results Among 135 participants, mean age 49.3 +/- 17.9 years, characteristics included: 48% female, 7% smokers, 7% CAD, 10% type 2 diabetes, 34% MetSyn, and 38% with carotid plaque. Those with MetSyn had 24% lower FCR than those without (p < 0.001). Lower FCR was associated with higher FRS percentile (r = -0.29, p < 0.001), more MetSyn factors (r = -0.30, p < 0.001), more carotid plaques (r = -0.22, p = 0.01), and lower 6MWT (r = 0.34, p < 0.0001). Conclusion FCR, an index of arterial reactivity obtained automatically using a novel, operator-independent device, was inversely associated with established CVD risk indices, increased number of carotid plaques, and lower cardiorespiratory fitness. Whether measuring FCR could play a role in screening for CVD risk and assessing whether endothelial function changes in response to treatments aimed at CVD risk reduction, warrants further study.
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Affiliation(s)
- Kellen A. Knowles
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kerry J. Stewart
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joseph Tejan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elizabeth V. Ratchford
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Laura Sullam
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kathy Magliato
- Division of Cardiothoracic Surgery, Providence St. John’s Health Center, Santa Monica, CA, United States
| | - Michael D. Whitt
- Department of Biomedical Engineering, California Polytechnic State University, San Luis Obispo, CA, United States
| | - Harry A. Silber
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Corresponding author at: Cardiology, Suite 2400, 301 Building, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, United States.
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22
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Sharma A, Ogunmoroti O, Fashanu OE, Zhao D, Ouyang P, Budoff MJ, Thomas IC, Michos ED. Associations of endogenous sex hormone levels with the prevalence and progression of valvular and thoracic aortic calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2022; 341:71-79. [PMID: 34785061 PMCID: PMC8760158 DOI: 10.1016/j.atherosclerosis.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/24/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Sex hormones (SH) may contribute to sex differences in cardiovascular disease (CVD). High free testosterone (T) and low sex hormone binding globulin (SHBG) have been associated with progression of coronary artery calcification in women. We now examined the association of SH with extra-coronary calcification (ECC) prevalence and progression among MESA participants. METHODS We studied 2,737 postmenopausal women and 3,130 men free of clinical CVD with baseline SH levels. ECC measurements [ascending and descending thoracic aortic calcification (ATAC, DTAC), mitral annular calcification (MAC), aortic valve calcification (AVC)] were obtained by computed tomography at baseline and after 2.4 ± 0.9 years. We used multivariable Poisson regression to evaluate associations with ECC prevalence and incidence (Agatston scores >0) and linear mixed effects models for ECC progression, per 1-SD increment in log(SH) in women and men separately. RESULTS The mean age was 65 ± 9 and 62 ± 10 years for women and men, respectively. In women, greater free T and lower SHBG were associated with MAC incidence in a demographic-adjusted model only. In men, lower free T was associated with MAC prevalence, DTAC incidence and progression, while greater SHBG was associated with MAC prevalence and DTAC progression after further adjusting for CVD risk factors. CONCLUSIONS In this diverse cohort free of CVD, we found some associations of SH with ECC measures. In particular, free T was inversely associated with prevalent MAC and DTAC progression in men independent of CVD risk factors. SH may influence vascular calcification, but further work is needed to understand clinical implications of these findings.
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Affiliation(s)
- Apurva Sharma
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oluseye Ogunmoroti
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Isac C. Thomas
- Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Ying W, Post WS, Michos ED, Subramanya V, Ndumele CE, Ouyang P, Ambale-Venkatesh B, Doria De Vasconcellos H, Nwabuo CC, Schreiner PJ, Lewis CE, Reis J, Lloyd-Jones D, Sidney S, Lima JAC, Vaidya D. Associations between menopause, cardiac remodeling, and diastolic function: the CARDIA study. Menopause 2021; 28:1166-1175. [PMID: 34127631 DOI: 10.1097/gme.0000000000001815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Heart failure with preserved ejection fraction (HFpEF) affects more women than men. Menopause may influence HFpEF development in women. We assessed cross-sectional and longitudinal associations between menopause and echocardiographic measures of left ventricular (LV) function and cardiac remodeling. METHODS We studied 1,723 women with available echo data from at least two of: year 5 (Y5) (1990-1991), Y25 (2010-2011), or Y30 (2015-2016) in the Coronary Artery Risk Development in Young Adults study. Cardiac structure and function were measured using 2D and Doppler echocardiography. Cross-sectional associations between menopausal status and repeated echo measures at Y25 and Y30 were analyzed using linear mixed models. Two-segmented models were used to compare longitudinal changes in echocardiographic measures in the premenopausal period to changes in the postmenopausal period. RESULTS Mean ± SD age (years) at enrollment was 27 ± 3 in those with menopause by Y25, 25 ± 3 in those with menopause between Y25 and Y30, and 21 ± 3 in those premenopausal at Y30. There were no significant differences in race, body mass index, systolic blood pressure, or diabetes between the groups. Postmenopausal women had higher early diastolic mitral inflow (E) to annular (e') velocity ratio than premenopausal after adjusting for demographics and risk factors (P < 0.05). Menopause was associated with relative increases in the rates of change in LV mass and left atrial volume, even after adjustment. Change in E/e' ratio was similar before and after menopause. CONCLUSIONS Menopause is associated cross-sectionally with worse diastolic function and longitudinally with adverse LV and left atrial remodeling. This may contribute to the increased HFpEF risk in postmenopausal women.
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Affiliation(s)
- Wendy Ying
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Chiadi E Ndumele
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Chike C Nwabuo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Jared Reis
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Donald Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Joao A C Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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24
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Aladin AI, Soliman EZ, Kitzman DW, Dardari Z, Rasool SH, Yeboah J, Budoff MJ, Psaty BM, Ouyang P, Polak JF, Blumenthal RS, McEvoy JW, Gandhi SK, Herrington DM. Comparison of the Relation of Carotid Intima-Media Thickness With Incident Heart Failure With Reduced Versus Preserved Ejection Fraction (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2021; 148:102-109. [PMID: 33667446 DOI: 10.1016/j.amjcard.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
Increased carotid intima-media thickness (cIMT) is associated with heart failure (HF) in previous studies, but it is not known whether the association of cIMT differs between HF with reduced (HFrEF) versus preserved ejection fraction (HFpEF). We studied 6699 participants (mean age 62 ± 10 years, 47% male, and 38% white) from the Multi-Ethnic Study of Atherosclerosis (MESA) with baseline cIMT measurements. We classified HF events as HFrEF (EF <50%) or HFpEF (EF ≥ 50%) at the time of diagnosis. Cox proportional hazard regression was used to compute hazard ratios (HR), and 95% confidence intervals (CI) for the association between the IMT Z-score (measured maximum IMT of Internal Carotid (IC) and Common Carotid (CC) sites as the mean of the maximum IMT of the near and far walls of right and left sides), and incident HFrEF or HFpEF. Models were adjusted for covariates and interim coronary artery disease (CAD) events. A total of 191 HFrEF and 167 HFpEF events occurred during follow-up. In multivariable analysis, each 1 standard deviation increase in the measured maximum IMT (Z-score) was associated with both HFrEF and HFpEF in the unadjusted and demographically adjusted models [HR, 95% CI 1.57 (1.43 to 1.73)] and [HR, 95% CI 1.61 (1.47 to 1.77)] but not in the fully adjusted models [HR, 95% CI 1.11 (0.96 to 1.28)] and [HR, 95% CI 1.13 (0.98 to 1.30)]. In conclusion, cIMT was significantly associated with incident HF, but the association is partially attenuated with adjustment for demographic factors and becomes non-significant after adjustment for other traditional heart failure risk factors and interim CAD events. There was no difference in the association of IMT measures with HFrEF versus HFpEF.
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Affiliation(s)
- Amer I Aladin
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland.
| | - Elsayed Z Soliman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Dalane W Kitzman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Zeina Dardari
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Shereen H Rasool
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Joseph Yeboah
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Matthew J Budoff
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Bruce M Psaty
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Pamela Ouyang
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Joseph F Polak
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Roger S Blumenthal
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - John W McEvoy
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Sanjay K Gandhi
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - David M Herrington
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Saint Joseph University Medical Center, Paterson, New Jersey; Department of Medicine, Lundquist Institute, Torrance, California; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Health Research Institute, Seattle, Washington; Johns Hopkins University School of Medicine, Baltimore, Maryland; Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts; National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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25
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Ying W, Sharma K, Yanek LR, Vaidya D, Schär M, Markl M, Subramanya V, Soleimani S, Ouyang P, Michos ED, Shah SJ, Hays AG. Visceral adiposity, muscle composition, and exercise tolerance in heart failure with preserved ejection fraction. ESC Heart Fail 2021; 8:2535-2545. [PMID: 33939300 PMCID: PMC8318398 DOI: 10.1002/ehf2.13382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Aims Visceral adipose tissue (AT) promotes inflammation and may be associated with disease progression in heart failure with preserved ejection fraction (HFpEF). We characterized regional AT distribution in HFpEF patients and controls and analysed associations with co‐morbidities and exercise tolerance. Methods and results Magnetic resonance imaging was performed to quantify epicardial, liver, abdominal, and thigh skeletal muscle AT. We assessed New York Heart Association (NYHA) class, 6 min walk distance, and global well‐being score. Multivariable linear regression models adjusting for body surface area were used. We studied 55 HFpEF patients (41 women, mean age 67 ± 11 years) and 33 controls (21 women, mean age 57 ± 10 years). Epicardial AT (median [interquartile range] 4.6 [2.0] vs. 3.2 [1.4] mm, P < 0.001), thigh intermuscular fat (11.0 [11.5] vs. 5.0 [2.7] cm2, P < 0.001) and liver fat fraction (6.4% [6.1] vs. 4.1% [5.5], P = 0.001) were higher in HFpEF patients than controls. Women with HFpEF had higher abdominal and thigh subcutaneous AT than men. Greater thigh intermuscular fat was associated with higher blood pressure (β [SE] 0.73 [0.17], P < 0.001) and diabetes (odds ratio [95% confidence interval] 1.2 [1.0–1.5], P = 0.03). Greater thigh intramuscular fat was associated with both worse NYHA class (β [SE] 2.7 [1.0], P = 0.01) and shorter 6 min walk distance (β [SE] −4.1 [1.9], P = 0.03), and greater epicardial AT (β [SE] −0.2 [0.1], P < 0.001) and liver fat fraction (β [SE] −0.4 [0.2], P = 0.04) were associated with lower global well‐being score. Conclusions Heart failure with preserved ejection fraction patients have increased epicardial, liver, and skeletal muscle fat compared with controls out of proportion to their increased body size, and adiposity was associated with worse NYHA class and exercise tolerance in HFpEF. These results provide the basis for further investigation into the effect of interventions to reduce regional AT distribution in relation to HFpEF symptoms and pathophysiology.
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Affiliation(s)
- Wendy Ying
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Kavita Sharma
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Lisa R Yanek
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Dhananjay Vaidya
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Schär
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Michael Markl
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Sahar Soleimani
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Pamela Ouyang
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Erin D Michos
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allison G Hays
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
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26
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Wallace R, Michos E, Zhao D, Ogunmoroti O, Post W, Vaidya D, Ouyang P, Heravi A, Ndumele C, Budoff M, Thomas I, Fashanu O. ASSOCIATIONS OF URINARY ISOPROSTANES WITH INCIDENCE AND PROGRESSION OF THORACIC AORTIC CALCIFICATION: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02874-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Subramanya V, Zhao D, Ouyang P, Ying W, Vaidya D, Ndumele CE, Lima JA, Guallar E, Hoogeveen RC, Shah SJ, Heckbert SR, Kass DA, Post WS, Michos ED. Cyclic guanosine monophosphate and 10-year change in left ventricular mass: the Multi-Ethnic Study of Atherosclerosis (MESA). Biomarkers 2021; 26:309-317. [PMID: 33715578 DOI: 10.1080/1354750x.2021.1893811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Cyclic guanosine monophosphate (cGMP) is a second messenger for natriuretic peptide (NP) and nitric oxide pathways; its enhancement a target for heart failure and cardiovascular disease (CVD). We evaluated whether plasma cGMP was associated with change in left ventricular mass (LVM) among individuals free of CVD and if this differed by sex.Methods and Results: In 611 men and 612 women aged 45-84 years with plasma cGMP measured at baseline and cardiac MRI performed at baseline and 10 years later, we tested associations of cGMP [log-transformed, per 1 SD increment] with LVM, adjusting for CVD risk factors and N-terminal pro-B-type-NP (NT-proBNP). Participants had mean (SD) age of 63.1(8.5) years and cGMP 4.8(2.6) pmol/mL. Cross-sectionally, higher cGMP was associated with lesser LVM, non-lin- early. In contrast, longitudinally, higher cGMP was associated with increase in LVM [1.70g (0.61, 2.78)] over 10 years. Higher cGMP was associated with greater LVM change in men [2.68g (1.57, 3.79)] but not women [0.24g ((-0.92, 1.39); p-interaction < 0.001].Conclusion: In conclusion, in a community-based cohort, higher cGMP levels were associated with increase in LVM over 10 years independent of CVD risk factors and NT-proBNP in men, perhaps reflecting compensatory changes. Further studies are needed to understand mechanistic roles of cGMP in LV remodelling and associated sex differences.
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Affiliation(s)
- Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Ying
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chiadi E Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joao A Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ron C Hoogeveen
- Division of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ouyang P, Sharma G. The Potential for Pregnancy Heart Teams to Reduce Maternal Mortality in Women With Cardiovascular Disease. J Am Coll Cardiol 2021; 76:2114-2116. [PMID: 33121719 DOI: 10.1016/j.jacc.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Ciccarone Center of Prevention for Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
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St‐Onge M, Aggarwal B, Allison MA, Berger JS, Castañeda SF, Catov J, Hochman JS, Hubel CA, Jelic S, Kass DA, Makarem N, Michos ED, Mosca L, Ouyang P, Park C, Post WS, Powers RW, Reynolds HR, Sears DD, Shah SJ, Sharma K, Spruill T, Talavera GA, Vaidya D. Go Red for Women Strategically Focused Research Network: Summary of Findings and Network Outcomes. J Am Heart Assoc 2021; 10:e019519. [PMID: 33619972 PMCID: PMC8174263 DOI: 10.1161/jaha.120.019519] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
The Go Red for Women movement was initiated by the American Heart Association (AHA) in the early 2000s to raise awareness concerning cardiovascular disease (CVD) risk in women. In 2016, the AHA funded 5 research centers across the United States to advance our knowledge of the risks and presentation of CVD that are specific to women. This report highlights the findings of the centers, showing how insufficient sleep, sedentariness, and pregnancy-related complications may increase CVD risk in women, as well as presentation and factors associated with myocardial infarction with nonobstructive coronary arteries and heart failure with preserved ejection fraction in women. These projects were augmented by collaborative ancillary studies assessing the relationships between various lifestyle behaviors, including nightly fasting duration, mindfulness, and behavioral and anthropometric risk factors and CVD risk, as well as metabolomic profiling of heart failure with preserved ejection fraction in women. The Go Red for Women Strategically Focused Research Network enhanced the evidence base related to heart disease in women, promoting awareness of the female-specific factors that influence CVD.
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Affiliation(s)
- Marie‐Pierre St‐Onge
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Brooke Aggarwal
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Matthew A. Allison
- Division of Preventive MedicineDepartment of Family Medicine and Public HealthSchool of MedicineUniversity of California San DiegoLa JollaCA
| | - Jeffrey S. Berger
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | | | - Janet Catov
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPA
- Magee‐Womens Research InstituteUniversity of PittsburghPA
| | - Judith S. Hochman
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | - Carl A. Hubel
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPA
- Magee‐Womens Research InstituteUniversity of PittsburghPA
| | - Sanja Jelic
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - David A. Kass
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Nour Makarem
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Erin D. Michos
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Lori Mosca
- Division of CardiologyDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Pamela Ouyang
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Chorong Park
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | - Wendy S. Post
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Robert W. Powers
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPA
- Magee‐Womens Research InstituteUniversity of PittsburghPA
| | - Harmony R. Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | - Dorothy D. Sears
- Division of Preventive MedicineDepartment of Family Medicine and Public HealthSchool of MedicineUniversity of California San DiegoLa JollaCA
- College of Health SolutionsArizona State UniversityPhoenixAZ
- Department of Medicine and Moores Cancer CenterUniversity of California San DiegoLa JollaCA
| | | | - Kavita Sharma
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Tanya Spruill
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | | | - Dhananjay Vaidya
- General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
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30
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Zhao D, Guallar E, Ballantyne CM, Post WS, Ouyang P, Vaidya D, Jia X, Ying W, Subramanya V, Ndumele CE, Hoogeveen RC, Michos ED. Sex Hormones and Incident Heart Failure in Men and Postmenopausal Women: The Atherosclerosis Risk in Communities Study. J Clin Endocrinol Metab 2020; 105:dgaa500. [PMID: 32770207 PMCID: PMC7455306 DOI: 10.1210/clinem/dgaa500] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Sex differences exist in heart failure (HF) phenotypes, but there is limited research on the role of sex hormones in HF and its subtypes. OBJECTIVE To examine the associations of total testosterone, dehydroepiandrosterone sulfate (DHEA-S), and sex hormone-binding globulin (SHBG) with incident HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF). DESIGN Atherosclerosis Risk in Communities (ARIC) study (prospective cohort study). Median follow-up is 19.2 years. SETTING General community. PARTICIPANTS 4107 men and 4839 postmenopausal women, with mean age of 63.2 (standard deviation [SD] 5.7) and 62.8 (5.5) years, respectively. EXPOSURE Plasma sex hormone levels were measured at visit 4 (1996-1998). MAIN OUTCOME MEASURES Incident HF events were identified through hospital discharge codes and death certificates. RESULTS The Hazard Ratios for HF associated with 1 SD decrease in log-transformed total testosterone, DHEA-S, and SHBG were 1.10 (95% confidence interval 1.03, 1.17), 1.07 (1.00, 1.15), and 1.04 (0.96, 1.11) in men, and 1.05 (0.99, 1.13), 1.17 (1.09, 1.24), and 0.93 (0.85, 1.01) in women, respectively. The associations between sex hormones with subtypes of HF had similar patterns but were attenuated and became statistically insignificant. CONCLUSION In this prospective cohort, lower levels of endogenous testosterone and DHEA-S in men and DHEA-S in postmenopausal women were associated with the development of HF. Similar directions of association in both sexes and both HF subtypes suggest that sex hormones play a role in the development of HF through common pathways regardless of sex.
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Affiliation(s)
- Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine; The Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Texas
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Wendy Ying
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Chiadi E Ndumele
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ron C Hoogeveen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine; The Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Texas
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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31
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Larsen B, Bellettiere J, Allison M, McClelland RL, Miljkovic I, Vella CA, Ouyang P, De-Guzman KR, Criqui M, Unkart J. Muscle area and density and risk of all-cause mortality: The Multi-Ethnic Study of Atherosclerosis. Metabolism 2020; 111:154321. [PMID: 32712219 PMCID: PMC8062068 DOI: 10.1016/j.metabol.2020.154321] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lean muscle plays critical roles in physical functioning and metabolism. However, little is known regarding associations between muscle and mortality in adults. OBJECTIVE The purpose was to evaluate associations between abdominal muscle quantity (area) and quality (density) with risk of all-cause mortality in a diverse cohort free of cardiovascular disease. DESIGN Data were taken from the Abdominal Body Composition, Inflammation, and Cardiovascular Disease ancillary study of the Multi-Ethnic Study of Atherosclerosis prospective cohort study. Participants were adults (45-85 years) free of extant cardiovascular disease, and of Hispanic, African American, Chinese, or Caucasian descent. Of the original 6814 MESA participants, a random, representative sample (n = 1974) participated in the ancillary body composition study. Abdominal muscle area and density were measured from computed tomography scans spanning L2-L4. Muscle density was measured as attenuation in Hounsfield units, and area was quantified as cm2. Gender-stratified cox proportional hazard models assessed the risk of all-cause mortality across gender-specific quartiles of muscle area and density adjusting for confounders, with area and density entered simultaneously. RESULTS At baseline, the mean age for men (n = 946) and women (n = 955) was 61.5 and 62.5 years and median follow-up time was 10.6 and 10.9 years, respectively. Muscle density was inversely associated with mortality, with the highest quartile of density showing a 73% reduction in risk for men (HR = 0.27, 95% CI = 0.14-0.51; p-trend<0.001) and 57% reduction for women (HR = 0.43, 95% CI = 0.18-1.01; p-trend = 0.04) compared to the lowest quartile when adjusting for mortality risk factors, lifestyle, BMI and visceral fat. There was no association between muscle area and all-cause mortality for men (p-trend = 0.58) or women (p-trend = 0.47). CONCLUSIONS Greater abdominal muscle density, but not muscle area, is associated with markedly lower risk of all-cause mortality across a decade of follow up. Muscle quality may be a powerful predictor of mortality in community dwelling adults.
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America.
| | - John Bellettiere
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburg, Pittsburg, PA, United States of America
| | - Chantal A Vella
- Department of Movement Sciences, University of Idaho, Boise, ID, United States of America
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Kimberly R De-Guzman
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Michael Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Jonathan Unkart
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
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Jang S, Ogunmoroti O, Ndumele CE, Zhao D, Rao VN, Fashanu OE, Tibuakuu M, Otvos JD, Benson EM, Ouyang P, Michos ED. Association of the Novel Inflammatory Marker GlycA and Incident Heart Failure and Its Subtypes of Preserved and Reduced Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis. Circ Heart Fail 2020; 13:e007067. [PMID: 32762458 DOI: 10.1161/circheartfailure.120.007067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND GlycA, a nuclear magnetic resonance composite marker of systemic inflammation, reflects serum concentration and glycosylation state of main acute phase reactants. Prior studies have shown plasma GlycA levels were associated with cardiovascular disease even after adjusting for other inflammatory markers. However, little is known about the association of GlycA with the heart failure (HF) subtypes: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction. We examined the association of GlycA with incident HF and its subtypes in a multiethnic cohort. METHODS We studied 6507 Multi-Ethnic Study of Atherosclerosis participants aged 45 to 84 without baseline cardiovascular disease or HF who had data on GlycA and incident hospitalized HF. We used multivariable-adjusted Cox hazards models to evaluate the association of GlycA with incident total HF, HFpEF, and heart failure with reduced ejection fraction. Models were adjusted for sociodemographics, cardiovascular disease risk factors, and inflammatory biomarkers. RESULTS The mean (SD) for age was 62 (10) years and for GlycA was 375 (82) μmol/L; 53% women. Over a median follow-up of 14.0 years, participants in the highest quartile of GlycA, compared with the lowest, experienced increased risk of developing any HF (hazard ratio, 1.48 [95% CI, 1.01-2.18]) in fully adjusted models. However, this increased risk was only seen for HFpEF (2.18 [1.15-4.13]) and not heart failure with reduced ejection fraction [1.06 (0.63-1.79)]. There was no significant interaction by sex, age, or race/ethnicity. CONCLUSIONS GlycA was associated with an increased risk of any HF, and in particular, HFpEF. Future studies should examine mechanisms that might explain differential association of GlycA with HF subtypes, and whether therapeutic lowering of GlycA can prevent HFpEF development. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005487.
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Affiliation(s)
- Sunyoung Jang
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (C.E.N., D.Z., E.D.M.)
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (C.E.N., D.Z., E.D.M.)
| | - Vishal N Rao
- Division of Cardiology Duke University School of Medicine, Durham, NC (V.N.R.)
| | | | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Medicine, St Luke's Hospital, Chesterfield, MO (M.T.)
| | - James D Otvos
- Laboratory Corporation of America Holdings, Morrisville, NC (J.D.O.)
| | - Eve-Marie Benson
- Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela Ouyang
- Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (C.E.N., D.Z., E.D.M.)
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Larsen B, Belletiere J, Allison M, McClelland RL, Miljkovic I, Vella C, Ouyang P, Criqui M, Unkart J. Muscle Density, Not Size, Is Inversely Associated With All-cause Mortality: The Multi-Ethnic Study Of Atherosclerosis. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000677536.11677.aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stewart KJ, Knowles KA, Ouyang P, Ratchford EV, Sullam L, Silber HA. Associations Of Fitness, Physical Activity, And Fatness With A New Index Of Endothelial Function. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683984.71320.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sharma G, Zakaria S, Michos ED, Bhatt AB, Lundberg GP, Florio KL, Vaught AJ, Ouyang P, Mehta L. Improving Cardiovascular Workforce Competencies in Cardio-Obstetrics: Current Challenges and Future Directions. J Am Heart Assoc 2020; 9:e015569. [PMID: 32482113 PMCID: PMC7429047 DOI: 10.1161/jaha.119.015569] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Maternal mortality in the United States is the highest among all developed nations, partly because of the increased prevalence of cardiovascular disease in pregnancy and beyond. There is growing recognition that specialists involved in caring for obstetric patients with cardiovascular disease need training in the new discipline of cardio-obstetrics. Training can include integrated formal cardio-obstetrics curricula in general cardiovascular disease training programs, and developing and disseminating joint cardiac and obstetric societal guidelines. Other efforts to help strengthen the cardio-obstetric field include increased collaborations and advocacy efforts between stakeholder organizations, development of US-based registries, and widespread establishment of multidisciplinary pregnancy heart teams. In this review, we present the current challenges in creating a cardio-obstetrics community, present the growing need for education and training of cardiovascular disease practitioners skilled in the care of obstetric patients, and identify potential solutions and future efforts to improve cardiovascular care of this high-risk patient population.
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Affiliation(s)
- Garima Sharma
- Division of CardiologyJohns Hopkins Ciccarone Center for Prevention of Cardiovascular DiseasesJohns Hopkins University School of MedicineBaltimoreMD
| | - Sammy Zakaria
- Division of CardiologyJohns Hopkins Ciccarone Center for Prevention of Cardiovascular DiseasesJohns Hopkins University School of MedicineBaltimoreMD
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins Ciccarone Center for Prevention of Cardiovascular DiseasesJohns Hopkins University School of MedicineBaltimoreMD
| | - Ami B. Bhatt
- Division of CardiologyCorrigan Minehan Heart CenterMassachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Gina P. Lundberg
- Division of CardiologyDepartment of MedicineEmory School of MedicineAtlantaGA
| | - Karen L. Florio
- Department of Obstetrics and GynecologySaint Luke's HospitalKansas CityMO
| | - Arthur Jason Vaught
- Division of Maternal‐Fetal MedicineDepartment of Gynecology and ObstetricsJohns Hopkins University School of MedicineBaltimoreMD
| | - Pamela Ouyang
- Division of CardiologyJohns Hopkins Ciccarone Center for Prevention of Cardiovascular DiseasesJohns Hopkins University School of MedicineBaltimoreMD
| | - Laxmi Mehta
- Division of CardiologyDepartment of MedicineThe Ohio State University Wexner Medical CenterColumbusOH
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Knowles K, Stewart K, Ouyang P, Ratchford E, Sullam L, Silber H. A NOVEL OPERATOR-INDEPENDENT NONINVASIVE DEVICE FOR ASSESSING VASCULAR ENDOTHELIAL FUNCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Zhao D, Guallar E, Vaidya D, Ndumele CE, Ouyang P, Post WS, Lima JA, Ying W, Kass DA, Hoogeveen RC, Shah SJ, Subramanya V, Michos ED. Cyclic Guanosine Monophosphate and Risk of Incident Heart Failure and Other Cardiovascular Events: the ARIC Study. J Am Heart Assoc 2020; 9:e013966. [PMID: 31928156 PMCID: PMC7033823 DOI: 10.1161/jaha.119.013966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Cyclic guanosine monophosphate (cGMP) is a second messenger regulated through natriuretic peptide and nitric oxide pathways. Stimulation of cGMP signaling is a potential therapeutic strategy for heart failure with preserved ejection fraction (HFpEF) and atherosclerotic cardiovascular disease (ASCVD). We hypothesized that plasma cGMP levels would be associated with lower risk for incident HFpEF, any HF, ASCVD, and coronary heart disease (CHD). Methods and Results We conducted a case–cohort analysis nested in the ARIC (Atherosclerosis Risk in Communities) study. Plasma cGMP was measured in 875 participants at visit 4 (1996–1998), with oversampling of incident HFpEF cases. We used Cox proportional hazard models to assess associations of cGMP with incident HFpEF, HF, ASCVD (CHD+stroke), and CHD. The mean (SD) age was 62.4 (5.6) years and median (interquartile interval) cGMP was 3.4 pmol/mL (2.4–4.6). During a median follow‐up of 9.9 years, there were 283 incident cases of HFpEF, 329 any HF, 151 ASCVD, and 125 CHD. In models adjusted for CVD risk factors, the hazard ratios (95% CI) associated with the highest cGMP tertile compared with lowest for HFpEF, HF, ASCVD, and CHD were 1.88 (1.17–3.02), 2.18 (1.18–4.06), 2.84 (1.44–5.60), and 2.43 (1.19–5.00), respectively. In models further adjusted for N‐terminal‐proB‐type natriuretic peptide, associations were attenuated for HFpEF and HF but remained statistically significant for ASCVD (2.56 [1.26–5.20]) and CHD (2.25 [1.07–4.71]). Conclusions Contrary to our hypothesis, higher cGMP levels were associated with incident CVD in a community‐based cohort. The associations of cGMP with HF or HFpEF may be explained by N‐terminal‐proB‐type natriuretic peptide, but not for ASCVD and CHD.
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Affiliation(s)
- Di Zhao
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Eliseo Guallar
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Dhananjay Vaidya
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD.,Division of General Internal Medicine Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Chiadi E Ndumele
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD.,Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Pamela Ouyang
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Wendy S Post
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD.,Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Joao A Lima
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Wendy Ying
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - David A Kass
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Ron C Hoogeveen
- Division of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX
| | - Sanjiv J Shah
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Vinita Subramanya
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
| | - Erin D Michos
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD.,Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
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Shaddeau A, Bishop J, Wilson T, Darwin KC, Boyer T, Debrosse A, Sharma G, Vaidya D, Ouyang P, Mukherjee M, Zakaria S, Leucker T, Vaught AJ. 449: Longitudinal measurements of proprotein convertase subtilisin kexin 9 (PCSK-9) in patients with and without preeclampsia. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cao J, Nomura SO, Steffen BT, Guan W, Remaley AT, Karger AB, Ouyang P, Michos ED, Tsai MY. Apolipoprotein B discordance with low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol in relation to coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). J Clin Lipidol 2020; 14:109-121.e5. [PMID: 31882375 PMCID: PMC7085429 DOI: 10.1016/j.jacl.2019.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Discordant levels of apolipoprotein B (apo B) relative to low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) may be associated with subclinical atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE The present study investigated whether discordance between apo B and LDL-C or non-HDL-C levels was associated with subclinical ASCVD measured by coronary artery calcium (CAC). METHODS This study was conducted in a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, aged 45 to 84 years, free of ASCVD, and not taking lipid-lowering medications at the baseline (2000-2002) (prevalence analytic N = 4623; incidence analytic N = 2216; progression analytic N = 3947). Apo B discordance relative to LDL-C and non-HDL-C was defined using residuals and percentile rankings (>5/10/15 percentile). Associations with prevalent and incident CAC (CAC > 0 vs CAC = 0) were assessed using prevalence ratio/relative risk regression and CAC progression (absolute increase/year) using multinomial logistic regression. RESULTS Higher apo B levels were associated with CAC prevalence, incidence, and progression. Apo B discordance relative to LDL-C or non-HDL-C was inconsistently associated with CAC prevalence and progression. Discordantly high apo B relative to LDL-C and non-HDL-C was associated with CAC progression. Associations for apo B discordance with non-HDL-C remained after further adjustment for metabolic syndrome components. CONCLUSION Apo B was associated with CAC among adults aged ≥45 years not taking statins, but provided only modest additional predictive value of apo B for CAC prevalence, incidence, or progression beyond LDL-C or non-HDL-C. Apo B discordance may still be important for ASCVD risk assessment and further research is needed to confirm findings.
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Affiliation(s)
- Jing Cao
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA; Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Sarah O Nomura
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Brian T Steffen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alan T Remaley
- Lipoprotein Metabolism Section, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
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40
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Ying W, Zhao D, Ouyang P, Subramanya V, Vaidya D, Ndumele CE, Guallar E, Sharma K, Shah SJ, Kass DA, Hoogeveen RC, Lima JA, Heckbert SR, deFilippi CR, Post WS, Michos ED. Associations Between the Cyclic Guanosine Monophosphate Pathway and Cardiovascular Risk Factors: MESA. J Am Heart Assoc 2019; 8:e013149. [PMID: 31838972 PMCID: PMC6951064 DOI: 10.1161/jaha.119.013149] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background cGMP mediates numerous cardioprotective functions and is a potential therapeutic target for cardiovascular disease. Preclinical studies suggest that plasma cGMP is reflective of natriuretic peptide stimulation. Epidemiologic associations between cGMP and natriuretic peptide, as well as cardiovascular disease risk factors, are unknown. Methods and Results We measured plasma cGMP in 542 men and 496 women free of cardiovascular disease and heart failure in MESA (Multi‐Ethnic Study of Atherosclerosis). Cross‐sectional associations of N‐terminal pro‐B type natriuretic peptide, sex hormones, and cardiovascular disease/heart failure risk factors with log(cGMP) were analyzed using multivariable linear regression models. Mean (SD) cGMP was 4.7 (2.6) pmol/mL, with no difference between the sexes. After adjusting for cardiovascular risk factors, N‐terminal pro‐B type natriuretic peptide was significantly positively associated with cGMP (P<0.05). Higher blood pressure and lower estimated glomerular filtration rate were associated with higher cGMP (P<0.05). Triglyceride levels, total/high‐density lipoprotein cholesterol ratio, presence of diabetes mellitus, and the homeostatic model assessment of insulin resistance were inversely associated with cGMP (P<0.05). Among women, free testosterone and dehydroepiandrosterone were inversely associated with cGMP, while sex hormone binding globulin was positively associated (P<0.05). Conclusions In a community‐cohort, plasma cGMP was associated with natriuretic peptide signaling. Higher blood pressure and greater renal dysfunction were positively associated with cGMP, while adverse metabolic risk factors were inversely associated. Increased androgenicity in postmenopausal women was inversely associated with cGMP. These novel associations further our understanding of the role of cGMP in a general population.
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Affiliation(s)
- Wendy Ying
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Di Zhao
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Pamela Ouyang
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Vinita Subramanya
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
| | - Dhananjay Vaidya
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD.,Division of General Internal Medicine Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Chiadi E Ndumele
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Eliseo Guallar
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Kavita Sharma
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Sanjiv J Shah
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - David A Kass
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Ron C Hoogeveen
- Division of Atherosclerosis & Vascular Medicine Department of Medicine Baylor College of Medicine Houston TX
| | - Joao A Lima
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology University of Washington Seattle WA
| | | | - Wendy S Post
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Erin D Michos
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore MD
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Almahmoud MF, Soliman EZ, Bertoni AG, Kestenbaum B, Katz R, Lima JAC, Ouyang P, Miller PE, Michos ED, Herrington DM. Fibroblast Growth Factor-23 and Heart Failure With Reduced Versus Preserved Ejection Fraction: MESA. J Am Heart Assoc 2019; 7:e008334. [PMID: 30371180 PMCID: PMC6222949 DOI: 10.1161/jaha.117.008334] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Higher fibroblast growth factor‐23 (FGF‐23) levels are associated with incident heart failure (HF) in MESA (the Multiethnic Study of Atherosclerosis). FGF‐23 is also associated with left ventricular hypertrophy. Whether the FGF‐23 association with HF is similar for heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) is not well established. Methods and Results We studied 6542 participants (mean age 62±10 years, 53% women, mean estimated glomerular filtration rate of 81±18 mL/min per 73 m2) from MESA who were free of cardiovascular disease at baseline (2000–2002). HF events were ascertained by an adjudication committee for a median follow‐up of 12.1 years. We classified HF events as HFrEF (ejection fraction [EF] <50%) or HFpEF [EF] ≥50%) at the time of diagnosis. Cox proportional hazard regression was used to compute hazard ratios and 95% confidence intervals for the association between baseline serum FGF‐23 and incident HFrEF and HFpEF. A total of 134 events were classified as HFpEF, 151 HFrEF, and 49 unknown EF. Following imputation, 149 were classified as HFpEF, 176 HFrEF, and 291 participants had HF (34 participants had HFpEF then HFrEF). In the fully adjusted model, higher FGF‐23 levels were associated with incident HFpEF but not with HFrEF (hazard ratio 1.29, 95% confidence interval, 1.08–1.54) versus (hazard ratio 1.04, 95% confidence interval, 0.84–1.29) for each 20 pg/mL higher serum FGF‐23 concentration. Conclusions FGF‐23 association with HF is driven by the association with HFpEF but not with HFrEF in a population‐based cohort. Further studies are needed to determine the pathological mechanisms mediating this association.
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Affiliation(s)
- Mohamed Faher Almahmoud
- Department of Internal MedicineSection on CardiologyWake Forest School of MedicineWinston‐SalemNC
| | - Elsayed Z. Soliman
- Department of Internal MedicineSection on CardiologyWake Forest School of MedicineWinston‐SalemNC
| | - Alain G. Bertoni
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNC
| | - Bryan Kestenbaum
- Division of NephrologyDepartment of MedicineKidney Research InstituteUniversity of WashingtonSeattleWA
| | - Ronit Katz
- Division of NephrologyDepartment of MedicineKidney Research InstituteUniversity of WashingtonSeattleWA
| | - João A. C. Lima
- Department of RadiologyJohns Hopkins University School of MedicineBaltimoreMD
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Pamela Ouyang
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - P. Elliott Miller
- Department of Critical Care MedicineNational Institutes of HealthBethesdaMD
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - David M. Herrington
- Department of Internal MedicineSection on CardiologyWake Forest School of MedicineWinston‐SalemNC
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42
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Oluleye OW, Kronmal RA, Folsom AR, Vaidya DM, Ouyang P, Duprez DA, Dobs AS, Yarmohammadi H, Konety SH. Association Between Statin Use and Sex Hormone in the Multi-Ethnic Study of Atherosclerosis Cohort. J Clin Endocrinol Metab 2019; 104:4600-4606. [PMID: 31157875 PMCID: PMC6736052 DOI: 10.1210/jc.2019-00530] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Based on the 2018 American College of Cardiology/American Heart Association cholesterol guidelines, the number of individuals eligible for statin therapy to reduce atherosclerotic cardiovascular disease risk has greatly expanded. Statins inhibit cholesterol biosynthesis, which can impair gonadal steroidogenesis. We evaluated the effect of statins on endogenous sex hormones in a large epidemiological study. METHODS A total of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants underwent the baseline examination. Of these, 6171 had measurements of serum sex hormones available: dehydroepiandrosterone (DHEA), SHBG, estradiol, and total and bioavailable testosterone. Multivariable linear regression models were used to assess the relationship of statin use with each sex hormone. RESULTS A total of 345 women (17.4%) and 464 men (14.7%) were statin users (mean age, 67 years; 41% white, 29% black, 11% Chinese, and 19% Hispanic). Among the users vs nonusers of statins, the mean SHBG was 3.54 nmol/L (P < 0.01) lower in women and 3.37 nmol/L (P < 0.001) lower in men; the mean DHEA was 1.06 nmol/L (P < 0.05) lower in women and 0.70 nmol/L (P < 0.01) lower in men, after adjustment for potential confounders. With further propensity score adjustment, the mean DHEA and SHBG levels were 0.67 nmol/L (P < 0.05) and 3.49 nmol/L (P < 0.001) lower, respectively, for statin users vs nonusers. No statistically significant association was noted between estradiol, total testosterone, and bioavailable testosterone and statin use. CONCLUSION Statin users have lower levels of SHBG and DHEA. This is especially relevant owing to the increasing use of statin therapy.
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Affiliation(s)
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Pamela Ouyang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Adrian S Dobs
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Suma H Konety
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Correspondence and Reprint Requests: Suma H. Konety, MD, MS, Cardiovascular Division, Department of Medicine, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, Minnesota 55455. E-mail:
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Leu S, Hsu SY, Ouyang P. 4260Loss of Pnn in cardiomyocytes results in impairment of intercalated discs and arrhythmogenic cardiomyopathy in mice. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Pnn, a multiple functional protein that localizes within nucleus and in the cytoplasmic region of desmosome. Although recent studies have characterized the physiological role of nuclear Pnn in regulating pre-mRNA alternative splicing and gene transcription, the function of Pnn in desmosome, particularly in cardiomyocytes, remains unidentified.
Purpose and methods
In the present study, we applied an inducible cardiomyocyte-specific Pnn depletion mouse model (Myh6-CreERT2, Pnnflox/flox) to observe the impact of loss of Pnn on cardiac structure and function in adult mice.
Results
Six weeks after tamoxifen injection to induce cardiac Pnn depletion, the electrocardiographic abnormalities and decrease of left ventricular ejection fraction (LVEF) were observed. Histopathological examination showed that the proliferation of cardiac fibroblasts and expression of α-smooth muscle actin were increased with Pnn depletion, while the cell-cell connection among cardiomyocytes were impaired. In addition, cellular hypertrophy and decrease of capillary density were also found. Results from Immunofluorescent staining further showed that the distribution pattern of desmosomal proteins and adherent junctional proteins, including desmoglein, desmocollin, plakoglobin, plakophllin, desmoplakin and β-catenin were altered in the cardiomyocytes with Pnn depletion. Both desmosomal and adherent junctional proteins were translocated form cell-cell junction to cytoplasm, indicating the disruption of intercalated discs in Pnn-depleted cardiomyocytes. Microarray data also indicated that loss of cardiac Pnn regulated the mRNA expression of genes responsible for extracellular matrix-receptor interaction, ribosome, and integrin. In addition, expression levels of oxidative stress-associated proteins were significantly regulated by Pnn depletion.
Impairment of intercalated disc
Conclusion
Results from present study indicated that Pnn plays an essential role in the maintenance of intercalated disc integrity of cardiomyocytes, while cardiomyocyte-specific loss of Pnn leads to arrhythmogenic cardiomyopathy in mice.
Acknowledgement/Funding
Ministry of Science and Technology Taiwan, MOST-106-2320-B-182A-010-MY3
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Affiliation(s)
- S Leu
- Chang Gung Memorial Hospital Kaohsiung, Institute for Translational Research in Biomedicine, Kaohsiung, Taiwan
| | - S Y Hsu
- Chang Gung University College of Medicine, Department of Anatomy, Tao-yuan, Taiwan
| | - P Ouyang
- Chang Gung University College of Medicine, Department of Anatomy, Tao-yuan, Taiwan
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Vaught AJ, Kovell LC, Szymanski LM, Mayer SA, Seifert SM, Vaidya D, Murphy JD, Argani C, O'Kelly A, York S, Ouyang P, Mukherjee M, Zakaria S. Acute Cardiac Effects of Severe Pre-Eclampsia. J Am Coll Cardiol 2019; 72:1-11. [PMID: 29957219 DOI: 10.1016/j.jacc.2018.04.048] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [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: 02/17/2018] [Revised: 03/23/2018] [Accepted: 04/07/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pre-eclampsia with severe features (PEC) is a pregnancy-specific syndrome characterized by severe hypertension and end-organ dysfunction, and is associated with short-term adverse cardiovascular events, including heart failure, pulmonary edema, and stroke. OBJECTIVES The authors aimed to characterize the short-term echocardiographic, clinical, and laboratory changes in women with PEC, focusing on right ventricular (RV) systolic pressure (RVSP) and echocardiographic-derived diastolic, systolic, and speckle tracking parameters. METHODS In this prospective observational study, the authors recruited 63 women with PEC and 36 pregnant control patients. RESULTS The PEC cohort had higher RVSP (31.0 ± 7.9 mm Hg vs. 22.5 ± 6.1 mm Hg; p < 0.001) and decreased global RV longitudinal systolic strain (RVLSS) (-19.6 ± 3.2% vs. -23.8 ± 2.9% [p < 0.0001]) when compared with the control cohort. For left-sided cardiac parameters, there were differences (p < 0.001) in mitral septal e' velocity (9.6 ± 2.4 cm/s vs. 11.6 ± 1.9 cm/s), septal E/e' ratio (10.8 ± 2.8 vs. 7.4 ± 1.6), left atrial area size (20.1 ± 3.8 cm2 vs. 17.3 ± 2.9 cm2), and posterior and septal wall thickness (median [interquartile range]: 1.0 cm [0.9 to 1.1 cm] vs. 0.8 cm [0.7 to 0.9 cm], and 1.0 cm [0.8 to 1.2 cm] vs. 0.8 cm [0.7 to 0.9 cm]). Eight women (12.7%) with PEC had grade II diastolic dysfunction, and 6 women (9.5%) had peripartum pulmonary edema. CONCLUSIONS Women with PEC have higher RVSP, higher rates of abnormal diastolic function, decreased global RVLSS, increased left-sided chamber remodeling, and higher rates of peripartum pulmonary edema, when compared with healthy pregnant women.
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Affiliation(s)
- Arthur Jason Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Lara C Kovell
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Linda M Szymanski
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan A Mayer
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara M Seifert
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jamie D Murphy
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia Argani
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna O'Kelly
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah York
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Monica Mukherjee
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sammy Zakaria
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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45
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Zhao D, Guallar E, Ouyang P, Subramanya V, Vaidya D, Ndumele CE, Lima JA, Allison MA, Shah SJ, Bertoni AG, Budoff MJ, Post WS, Michos ED. Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women. J Am Coll Cardiol 2019; 71:2555-2566. [PMID: 29852978 DOI: 10.1016/j.jacc.2018.01.083] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Higher androgen and lower estrogen levels are associated with cardiovascular disease (CVD) risk factors in women. However, studies on sex hormones and incident CVD events in women have yielded conflicting results. OBJECTIVES The authors assessed the associations of sex hormone levels with incident CVD, coronary heart disease (CHD), and heart failure (HF) events among women without CVD at baseline. METHODS The authors studied 2,834 post-menopausal women participating in the MESA (Multi-Ethnic Study of Atherosclerosis) with testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) levels measured at baseline (2000 to 2002). They used Cox hazard models to evaluate associations of sex hormones with each outcome, adjusting for demographics, CVD risk factors, and hormone therapy use. RESULTS The mean age was 64.9 ± 8.9 years. During 12.1 years of follow-up, 283 CVD, 171 CHD, and 103 HF incident events occurred. In multivariable-adjusted models, the hazard ratio (95% confidence interval [CI]) associated with 1 SD greater log-transformed sex hormone level for the respective outcomes of CVD, CHD, and HF were as follows: total testosterone: 1.14 (95% CI: 1.01 to 1.29), 1.20 (95% CI: 1.03 to 1.40), 1.09 (95% CI: 0.90 to 1.34); estradiol: 0.94 (95% CI: 0.80 to 1.11), 0.77 (95% CI: 0.63 to 0.95), 0.78 (95% CI: 0.60 to 1.02); and testosterone/estradiol ratio: 1.19 (95% CI: 1.02 to 1.40), 1.45 (95% CI: 1.19 to 1.78), 1.31 (95% CI: 1.01 to 1.70). Dehydroepiandrosterone and SHBG levels were not associated with these outcomes. CONCLUSIONS Among post-menopausal women, a higher testosterone/estradiol ratio was associated with an elevated risk for incident CVD, CHD, and HF events, higher levels of testosterone associated with increased CVD and CHD, whereas higher estradiol levels were associated with a lower CHD risk. Sex hormone levels after menopause are associated with women's increased CVD risk later in life.
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Affiliation(s)
- Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vinita Subramanya
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chiadi E Ndumele
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joao A Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew A Allison
- Division of Preventive Medicine, University of California-San Diego, La Jolla, California
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew J Budoff
- Los Angeles Biomedical Research Center at Harbor-UCLA, Torrance, California
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kwon Y, Logan J, Redline S, Duprez D, Jacobs DR, Ouyang P, Hundley WG, Lima J, Bluemke DA, Lutsey PL. Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA). Cardiology 2019; 142:180-188. [PMID: 31189162 DOI: 10.1159/000499500] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/10/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Structural and functional properties of the proximal thoracic aorta have important implications in clinical and subclinical cardiovascular disease (CVD). We examined whether obstructive sleep apnea (OSA) is associated with proximal aortic size and aortic stiffness in a multi-ethnic community-based cohort. METHODS The sample included the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep Ancillary study participants without known CVD who underwent cardiac magnetic resonance imaging. The main exposure variable was OSA severity based on the polysomnography-derived apnea hypopnea index (AHI; normal, AHI <5/h; mild, 5≤ AHI <15/h; moderate to severe, AHI ≥15/h). The study outcomes were ascending aortic diameter (AoD, cm), aortic pulse wave velocity (AoPWV, m/s), and ascending aortic distensibility (AAD, %/mm Hg). Analyses were performed in the overall sample and in sex-specific strata, adjusted for multiple potential confounders. RESULTS The 708 participants were 55.9% female and on average 68 years old (54-93 years). There was a significant trend (p < 0.0001) of greater mean (SD) AoD across the three OSA groups: normal (n = 87), 3.13 cm (0.35); mild (n = 215), 3.25 (0.34); moderate to severe (n = 406), 3.37 (0.36). In adjusted analysis, participants with moderate to severe OSA had a greater mean AoD compared with the normal group: adjusted mean difference (95% CI), 0.12 cm (0.05, 0.20), p = 0.002. This AoD gradient was observed in women but not in men (p for interaction = 0.02). No differences were found in AoPWV or AAD among the OSA groups. CONCLUSION In a diverse community-based cohort, moderate to severe OSA (vs. no OSA) was associated with a larger ascending AoD in women.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA,
| | - Jeongok Logan
- School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| | - Susan Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Duprez
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - W Greg Hundley
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Pamela L Lutsey
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Mathews L, Subramanya V, Zhao D, Ouyang P, Vaidya D, Guallar E, Yeboah J, Herrington D, Hays AG, Budoff MJ, Michos ED. Endogenous Sex Hormones and Endothelial Function in Postmenopausal Women and Men: The Multi-Ethnic Study of Atherosclerosis. J Womens Health (Larchmt) 2019; 28:900-909. [PMID: 31170017 DOI: 10.1089/jwh.2018.7441] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 12/11/2022] Open
Abstract
Background: The relationship of endogenous sex hormones (SH) with vascular endothelial function and with cardiovascular disease (CVD) is incompletely understood. We examined the associations between SH and endothelial function measured by brachial artery flow-mediated dilation (FMD). Materials and Methods: We included 1368 postmenopausal women and 1707 men, free of clinical CVD, participating in MESA Visit 1 (2000-2002). Serum SH [total testosterone, SH binding globulin (SHBG), dehydroepiandrosterone (DHEA), estradiol] were measured; free testosterone was calculated. The percent FMD difference (%FMD) was measured by high-resolution ultrasound. Using multivariable-adjusted linear regression, we tested the cross-sectional associations of SH (log transformed, compared per one SD increment) with %FMD. Results: The mean age of women and men were 64.2 and 61.4 years, respectively. Among women, after adjusting for demographics, CVD risk factors, and hormone therapy, higher SHBG was associated with greater %FMD [β = 0.215% (95% CI 0.026-0.405)], whereas higher free testosterone was associated with a smaller %FMD [-0.209% (-0.402, -0.017)]. Estradiol and DHEA were not associated with %FMD in women after multivariable adjustment. There was an age interaction, with higher free testosterone and lower SHBG associated with worse FMD in women <65 years of age, but not in those ≥65 years (p = 0.04). We did not see similar associations in men. Conclusions: A more androgenic SH profile of higher free testosterone and lower SHBG was associated with worse %FMD in postmenopausal women. Changes in SH with aging and menopause may result in vascular changes in women. Further studies are needed to assess longitudinal changes in SH levels and their association with vascular function.
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Affiliation(s)
- Lena Mathews
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland.,2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vinita Subramanya
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Di Zhao
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela Ouyang
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dhananjay Vaidya
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,3Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eliseo Guallar
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph Yeboah
- 4Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David Herrington
- 4Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Allison G Hays
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew J Budoff
- 5David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Erin D Michos
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland.,2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Zhao Y, Evans MA, Allison MA, Bertoni AG, Budoff MJ, Criqui MH, Malik S, Ouyang P, Polak JF, Wong ND. Multisite atherosclerosis in subjects with metabolic syndrome and diabetes and relation to cardiovascular events: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2019; 282:202-209. [PMID: 30600075 PMCID: PMC6401246 DOI: 10.1016/j.atherosclerosis.2018.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The extent and relation of multisite atherosclerosis to cardiovascular disease (CVD) in metabolic syndrome (MetS) and diabetes (DM) are not well documented. We examined the extent of multisite atherosclerosis and its prognostic value for CVD events in MetS and DM. METHODS In CVD-free subjects from the Multi-Ethnic Study of Atherosclerosis, multisite atherosclerosis was measured as: (1) the number of arterial beds involved (coronary calcium>0, abdominal aortic calcium>0, carotid intima-media thickness ≥1 mm and ankle brachial index<1 or ≥1.4); (2) a composite score summing the quartile rank for each atherosclerosis measure. Hazard ratios (HRs) and c-statistics were calculated for incident CVD and coronary heart disease (CHD) over 10.6 years. RESULTS Of 1675 individuals (mean age 64 years, 51% male), 33.4% had MetS and 15.9% had DM. The number of atherosclerotic sites was higher in those with DM (mean ± SD = 1.67 ± 1.15) and MetS (1.49 ± 1.12) versus neither MetS/DM (1.09 ± 1.09) (p < 0.0001). CVD rates per 1000 person-years ranged from 3.5, 8.2, and 10.0 in those with 0 sites positive to 35.1, 79.6 and 103.4 in those with 4 sites positive among neither DM/MetS, MetS and DM groups, respectively. HRs (95% CI) for CVD comparing those with 4 vs. 0 atherosclerotic sites were 4.0 (0.8-19.1), 4.9 (2.0-12.0), and 14.4 (3.6-57.6), respectively. C-statistics adding multisite atherosclerosis measures increased over models without the measures and with CIMT or ABI but not CAC. CONCLUSIONS Multisite atherosclerosis is greater with MetS or DM, and predicts CVD and CHD events. Risk prediction is improved over CIMT and ABI but not CAC.
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Affiliation(s)
- Yanglu Zhao
- Department of Epidemiology, University of California Los Angeles, USA; Division of Cardiology, University of California Irvine, USA
| | - Marcella A Evans
- Department of Epidemiology, University of California Irvine, USA
| | - Matthew A Allison
- Department of Family Medicine & Public Health, University of California San Diego, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute, USA
| | - Michael H Criqui
- Department of Family Medicine & Public Health, University of California San Diego, USA
| | - Shaista Malik
- Division of Cardiology, University of California Irvine, USA
| | - Pamela Ouyang
- Division of Cardiology, John Hopkins University, USA
| | | | - Nathan D Wong
- Department of Epidemiology, University of California Los Angeles, USA; Division of Cardiology, University of California Irvine, USA; Department of Epidemiology, University of California Irvine, USA.
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Akhabue E, Vu THT, Vaidya A, Michos ED, de Boer IH, Kestenbaum B, Allison M, Szklo M, Ouyang P, Yancy CW, Wolf M, Isakova T, Carnethon MR. Fibroblast Growth Factor-23, Heart Failure Risk, and Renin-Angiotensin-Aldosterone-System Blockade in Hypertension: The MESA Study. Am J Hypertens 2019; 32:18-25. [PMID: 30256890 PMCID: PMC7179751 DOI: 10.1093/ajh/hpy142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/26/2018] [Accepted: 09/24/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Higher fibroblast growth factor-23 (FGF23) concentrations have been found to be associated with incident heart failure (HF). Experimental data suggest FGF23 directly stimulates myocardial hypertrophy. FGF23 may also enhance renin-angiotensin-aldosterone system activity. Whether FGF23 is associated with increased HF risk in populations with hypertension and whether this association is weaker in the presence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy is unknown. METHODS We studied 2,858 adults with hypertension free of cardiovascular disease at baseline (65.6 ± 9.5 years, 46.2% male) participating in the Multi-Ethnic Study of Atherosclerosis (MESA). We investigated the association of baseline serum intact FGF23 with incident HF over a 14-year median follow-up and whether ACEI/ARB therapy modified this risk. We also investigated the relationship of FGF23 with aldosterone and plasma renin activity in a random subgroup of the entire MESA cohort with available assays (N = 1,642). RESULTS In adjusted Cox regression models, higher FGF23 was associated with a 63% greater hazard of incident HF (hazard ratio: 1.63, 95% confidence interval: [1.13-2.36] per 1-unit increase in log-transformed FGF23), which persisted after exclusion of participants with chronic kidney disease (hazard ratio: 1.94 [1.10-3.43]). There was no heterogeneity by ACEI/ARB use (Pinteraction = 0.438). FGF23 improved model fit over covariables (likelihood ratio χ2 = 6.67, P = 0.010). In multivariable linear regression models, there was no association between FGF23 and aldosterone or plasma renin activity. CONCLUSIONS Higher FGF23 concentrations are associated with a significantly increased risk of HF in hypertension but this risk did not differ by ACEI/ARB treatment status. FGF23 may be a useful biomarker for HF risk in hypertensive populations.
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Affiliation(s)
- Ehimare Akhabue
- Division of Cardiovascular Diseases and Hypertension, Department of Medicine, Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Thanh-Huyen T Vu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anand Vaidya
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian H de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bryan Kestenbaum
- Division of Nephrology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California-San Diego School of Medicine, La Jolla, California, USA
| | - Moyses Szklo
- Division of Cardiovascular and Clinical Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Myles Wolf
- Division of Nephrology, Duke University School of Medicine, Durham, North Carolin, USA
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Vaught AJ, Kovell LC, Ouyang P, Mukherjee M, Zakaria S. Reply: Understanding the Complex Link Between Cardiac Function and Pre-Eclampsia. J Am Coll Cardiol 2018; 72:2544-2545. [PMID: 30442301 DOI: 10.1016/j.jacc.2018.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 11/25/2022]
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