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Alfaddagh A, Khraishah H, Romeo GR, Kassab MB, McMillan Z, Chandra-Strobos N, Blumenthal R, Albaghdadi M. Cardiovascular Outcomes Among Patients with Acute Coronary Syndromes and Diabetes: Results from ACS QUIK Trial in India. Glob Heart 2024; 19:37. [PMID: 38681971 PMCID: PMC11049669 DOI: 10.5334/gh.1290] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/21/2023] [Indexed: 05/01/2024] Open
Abstract
Background Despite cardiovascular disease being the leading cause of death in India, limited data exist regarding the factors associated with outcomes in patients with diabetes who suffer acute myocardial infarction (AMI). Methods We examined 21,374 patients with AMI enrolled in the ACS QUIK trial. We compared in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding in those with and without diabetes. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression. Results Mean ± SD age was 60.1 ± 12.0 years, 24.3% were females, and 44.4% had diabetes. Those with diabetes were more likely to be older, female, hypertensive, and have higher Killip class but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P < 0.001) and, in case of STEMI, longer door-to-balloon times (median, 75 vs 91 min; P < 0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR, 1.52; 95% CI, 1.15-2.02), 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day major bleeding. Conclusion Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased cardiovascular risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle-income countries who develop AMI. Clinical Trial registration ClinicalTrials.gov Unique identifier: NCT02256658.
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Affiliation(s)
- Abdulhamied Alfaddagh
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Giulio R. Romeo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, US
| | - Mohamad B. Kassab
- Cardiovascular research center, Massachusetts General Hospital, Boston, MA, US
| | - Zeb McMillan
- Department of Anesthesiology, Division of Critical Care, UC San Diego, San Diego, CA, USA
| | - Nisha Chandra-Strobos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Roger Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
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Chehab O, Akl E, Abdollahi A, Zeitoun R, Ambale-Venkatesh B, Wu C, Tracy R, Blumenthal R, Post W, Lima J, Rodriguez A. Higher HDL Cholesterol Levels Are Associated with Increased Markers of Interstitial Myocardial Fibrosis: Insights from The Multi-Ethnic Study of Atherosclerosis. Res Sq 2023:rs.3.rs-3299344. [PMID: 37790448 PMCID: PMC10543254 DOI: 10.21203/rs.3.rs-3299344/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] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease(CVD)outcomes. Yet, there's no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association between HDL-C levels with interstitial myocardial fibrosis (IMF) and myocardial scar measured by CMR T1-mapping and late-gadolinium enhancement(LGE), respectively. Methods There were 1,863 participants (mean age of 69-years) who had both serum HDL-C measurements and underwent CMR. Analysis was done among those with available indices of interstitial fibrosis (extracellular volume fraction[ECV];N=1,172 and native-T1;N=1,863) and replacement fibrosis by LGE(N=1,172). HDL-C was analyzed as both logarithmically-transformed and categorized into <40 (low), 40-59 (normal), and ≥60mg/dL (high). Multivariable linear and logistic regression models were constructed to assess the associations of HDL-C with CMR-obtained measures of IMF, ECV% and native-T1 time, and myocardial scar, respectively. Results In the fully adjusted model, each 1-SD increment of log HDL-C was associated with a 1% increment in ECV%(p=0.01) and an 18-ms increment in native-T1(p<0.001). When stratified by HDL-C categories, those with high HDL-C(≥60mg/dL) had significantly higher ECV(β=0.5%,p=0.01) and native-T1(β =7ms,p=0.01) compared with those with normal HDL-C levels. Those with low HDL-C were not associated with IMF. Results remained unchanged after excluding individuals with a history of myocardial infarction. Neither increasing levels of HDL-C nor any HDL-C category was associated with the prevalence of myocardial scar. Conclusions Increasing levels of HDL-C were associated with increased markers of IMF, with those with high levels of HDL-C being linked to subclinical fibrosis in a community-based setting.
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Affiliation(s)
| | | | | | | | | | - Colin Wu
- National Heart Lung and Blood Institute
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Boakye E, Uddin SI, Obisesan OH, Osei AD, Dzaye O, Sharma G, McEvoy JW, Blumenthal R, Blaha MJ. Aspirin for cardiovascular disease prevention among adults in the United States: Trends, prevalence, and participant characteristics associated with use. Am J Prev Cardiol 2021; 8:100256. [PMID: 34632437 PMCID: PMC8488247 DOI: 10.1016/j.ajpc.2021.100256] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE : Aspirin has been widely utilized over several decades for atherosclerotic cardiovascular disease (ASCVD) prevention among adults in the United States. We examined trends in aspirin use among adults aged ≥40 years from 1998 to 2019 and assessed factors associated with its use for primary and secondary ASCVD prevention. METHODS : Using 1998-2019 Behavioral Risk Factor Surveillance System data, we obtained weighted prevalence of aspirin use among adults aged ≥40 years for each year and examined trends in use over this period. Using multivariable logistic regression and utilizing data from 54,388 respondents aged ≥40 years in the 2019 data, we assessed factors associated with aspirin use for secondary prevention and for primary prevention stratified by the number of traditional ASCVD risk factors reported (hypertension, diabetes mellitus, high cholesterol, overweight/obesity, and cigarette smoking). RESULTS : Aspirin use prevalence increased from 29.0%(95%CI, 27.9%-30.2%) in 1998 to 37.5%(36.9%-38.0%) in 2009. However, use has slightly declined over the last decade: 35.6%(34.6%-36.6%) in 2011 to 33.5%(32.5%-34.6%) in 2019. In 2019, among respondents without cardiovascular disease (CVD), 27.5%(26.4%-28.6%) reported primary prevention aspirin use while 69.7%(67.0%-72.2%) of respondents with CVD reported secondary prevention aspirin use. Of concern, 45.6%(43.5%-47.7%) of adults aged ≥70 years without CVD reported primary prevention aspirin use. Additionally, among individuals without any self-reported traditional ASCVD risk factor, males (adjusted odds ratio(aOR):1.60, 95%CI:1.12-2.27), persons aged ≥70 years (aOR:3.22, 95%CI:2.27-4.55), and individuals with healthcare coverage (aOR:2.28, 95%CI:1.17-4.44) had higher odds of primary prevention aspirin use compared to females, persons aged 40-69 years, and individuals without healthcare coverage, respectively. Females were less likely than males to report secondary prevention aspirin use (aOR:0.64, 95%CI:0.50-0.82). CONCLUSION : Aspirin use has slightly declined over the last decade. A significant proportion of adults aged ≥70 years reported primary prevention aspirin use in 2019. Since current guidelines do not recommend primary prevention aspirin use among adults aged ≥70 years, such use should be discouraged.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX
| | - S.M. Iftekhar Uddin
- Department of Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY
| | | | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - John William McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - Roger Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX
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Han D, Kuronuma K, Rozanski A, Budoff M, Miedema M, Nasir K, Shaw L, Rumberger J, Gransar H, Blumenthal R, Blaha M, Berman D. Implication Of Thoracic Aortic Calcification Over Coronary Calcium Score Regarding The 2018 Acc/aha Cholesterol Guideline: Results From The Cac Consortium. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.229] [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: 10/20/2022]
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Ogunmoroti O, Osibogun O, Ferraro R, Esuruoso O, Ndunda P, Larson N, Decker P, Bielinski S, Blumenthal R, Budoff M, Michos E. HEPATOCYTE GROWTH FACTOR AND PROGRESSION OF EXTRA-CORONARY CALCIFICATION IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sharma G, Boakye E, Dzaye O, Kwapong YA, Zakaria S, Vaught A, Creanga A, Mehta L, Cainzos-Achirica M, Nasir K, Blaha M, Blumenthal R, Wang X. THE ASSOCIATION OF PRETERM BIRTH AND CARDIOVASCULAR RISK FACTORS WITH MATERNAL NATIVITY AND DURATION OF RESIDENCE IN THE UNITED STATES AMONG NON-HISPANIC BLACK WOMEN. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04751-3] [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: 11/26/2022]
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Sharma G, Boakye E, Dzaye O, Kwapong YA, Zakaria S, Vaught A, Creanga A, Cainzos-Achirica M, Mehta L, Nasir K, Blaha M, Blumenthal R, Wang X. THE ASSOCIATION OF PREECLAMPSIA AND CARDIOVASCULAR RISK FACTORS WITH MATERNAL NATIVITY AND DURATION OF US RESIDENCE AMONG TWO DIVERSE RACIAL GROUPS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04748-3] [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: 11/29/2022]
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Refaat M, Leblebjian M, Blumenthal R, Mora S, Jaffa M. CARDIOVASCULAR DISEASE MORTALITY AND ITS ASSOCIATION WITH PATERNAL, MATERNAL AND SIBLING HISTORY OF DISEASES AN 18-YEAR FOLLOW-UP STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01550-3] [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: 11/16/2022]
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9
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Gharios C, Refaat MM, Abdulhai F, Blumenthal R, Jaffa MA, Mora S. EXERCISE-INDUCED VENTRICULAR ECTOPY AND FUTURE CARDIOVASCULAR DEATH IN ASYMPTOMATIC INDIVIDUALS: A 20-YEAR FOLLOW-UP OF THE LIPID RESEARCH CLINICS PREVALENCE STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Akanyirige P, Ezema A, Boakye E, Bryant A, Jackson K, Mandieka E, Ohiomoba R, Princewill O, Youmans Q, Blaha M, Blumenthal R, Lewis A, Okwuosa I. CARDIOVASCULAR RISK PROFILES IN MARIJUANA SMOKERS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03011-4] [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: 11/15/2022]
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11
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Alter R, Sperling M, Blumenthal R, Rodriguez G, Vogel T, Hurteau J, Kirschner C, Moore E. Enhanced recovery after surgery (ERAS) protocol on the gynecologic oncology surgery service dramatically decreases narcotic use and decreases inpatient costs. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.341] [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: 11/30/2022]
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12
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Shaw LJ, Goyal A, Mehta C, Xie J, Phillips L, Kelkar A, Knapper J, Berman DS, Nasir K, Veledar E, Blaha MJ, Blumenthal R, Min JK, Fazel R, Wilson PWF, Budoff MJ. 10-Year Resource Utilization and Costs for Cardiovascular Care. J Am Coll Cardiol 2019. [PMID: 29519347 DOI: 10.1016/j.jacc.2017.12.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited. OBJECTIVES This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health. METHODS Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data. Costs were derived by using Medicare nationwide and zip code-specific costs, inflation corrected, discounted at 3% per year, and presented in 2014 U.S. dollars. RESULTS Risk factor prevalence increased dramatically and, by 10 years, diabetes, hypertension, and dyslipidemia was reported in 19%, 57%, and 53%, respectively. Self-reported symptoms (i.e., chest pain or shortness of breath) were common (approximately 40% of enrollees). At 10 years, approximately one-third of enrollees reported having an echocardiogram or exercise test, whereas 7% underwent invasive coronary angiography. These utilization patterns resulted in 10-year health care costs of $23,142. The largest proportion of costs was associated with CVD medication use (78%). Approximately $2 of every $10 were spent for outpatient visits and diagnostic testing among the elderly, obese, those with a high-sensitivity C-reactive protein level >3 mg/l, or coronary artery calcium score (CACS) ≥400. Costs varied widely from <$7,700 for low-risk (Framingham risk score <6%, 0 CACS, and normal glucose measurements at baseline) to >$35,800 for high-risk (persons with diabetes, Framingham risk score ≥20%, or CACS ≥400) subgroups. Among high-risk enrollees, CVD costs accounted for $74 million of the $155 million consumed by MESA participants. CONCLUSIONS Longitudinal patterns of health care resource use after screening revealed new evidence on the economic burden of treatment and testing patterns not previously reported. Maintenance of a healthy population has the potential to markedly reduce the economic burden of CVD among asymptomatic individuals.
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Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia.
| | - Abhinav Goyal
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Joe Xie
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Anita Kelkar
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Emir Veledar
- Baptist Health South Florida, South Miami, Florida
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Roger Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - James K Min
- Weill Cornell Medical College, New York, New York
| | - Reza Fazel
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Matthew J Budoff
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
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Morobadi K, Blumenthal R, Saayman G. Thermal fatalities in Pretoria: A 5-year retrospective review. Burns 2019; 45:1707-1714. [PMID: 31174970 DOI: 10.1016/j.burns.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022]
Abstract
In South Africa, research on burn mortality has emanated primarily from specialised burn centres and has focused on specific age groups and hospital-based fatalities. This study describes the demographic profile and the pathology of trauma related to burn fatalities as seen at the Pretoria Medico-Legal Laboratory (PTA MLL), a large urban medico-legal mortuary over a 5-year period from January 2011 to December 2015. Mortuary admission records and autopsy reports were used to gather information on demographics, circumstances of injury, apparent manner and cause of death, pathology of burns, toxicology and histology reports and identification of the decedents. RESULTS: Of the 9558 unnatural deaths admitted to the PTA MLL during this time period, 291 (3.0%) of the fatalities met the inclusion criteria. The male:female ratio was 2.9:1. Most fatalities occurred between the ages of 0-4 years. One hundred and forty-two (142) decedents were charred beyond recognition. Identification was confirmed in 134 (94.4%) of the charred remains. In 208 (69.8%) of the cases the manner of death was deemed to be accidental, 23 (7.9%) were homicidal and 11 (3.8%) were suicides. Two hundred and fifty-five (87.4%) of the fatalities were as a result of open flames/fires. Shack fires were responsible for 105 (36%) of all fatalities. In 32 (11.0%) cases of open flame/fire fatalities where death occurred at the scene of injury, more than one fatality was reported per incident. In 122 (79.2%) of scene fatalities, soot deposition was noted in the upper and lower airways. Forty-five (32.8%) of hospital fatalities occurred within 24 h of admission. The most common complications in hospital fatalities were from the respiratory system. The mean blood alcohol concentrations (BAC) was 0.09 g/100 ml. The mean carboxyhaemoglobin concentrations (COHb) was 19.9%. All available cyanide results were negative. CONCLUSION: The study is the first of its kind in South Africa to generate bimodal descriptive statistics for burn fatalities. Approximately 3% of unnatural deaths at the PTA-MLL were due to burns, occurring at a rate of ±1 death per week. The data provides a platform for funding, collaborative research, planning and development of public health programs.
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Affiliation(s)
- K Morobadi
- Department of Forensic Medicine, University of Pretoria, Pathology Building, Prinshof Campus, Corner Dr Savage Rd. and Bophelo Rd., South Africa.
| | - R Blumenthal
- Department of Forensic Medicine, University of Pretoria, Pathology Building, Prinshof Campus, Corner Dr Savage Rd. and Bophelo Rd., South Africa.
| | - G Saayman
- Department of Forensic Medicine, University of Pretoria, Pathology Building, Prinshof Campus, Corner Dr Savage Rd. and Bophelo Rd., South Africa.
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McEvoy JW, Daya N, Rahman F, Hoogeveen R, Blumenthal R, Shah A, Ballantyne C, Coresh J, Selvin E. ISOLATED DIASTOLIC HYPERTENSION IN THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY: CHANGING DEFINITIONS AND IMPLICATIONS FOR CARDIOVASCULAR HEALTH. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32301-0] [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: 11/25/2022]
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15
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Knijnik L, Cardoso R, Rivera M, Filho GCF, Fernandes A, McEvoy J, Whelton S, Gluckman T, Blumenthal R. A SYSTEMATIC REVIEW AND META-ANALYSIS OF DUAL ANTIPLATELET THERAPY VERSUS ANTIPLATELET MONOTHERAPY AFTER CORONARY ARTERY BYPASS GRAFT SURGERY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Sathiyakumar V, Park J, Toth P, Lazo M, Quispe R, Guallar E, Blumenthal R, Jones S, Martin S. MODERN-DAY PREVALENCE OF THE FREDRICKSON-LEVY-LEES DYSLIPIDEMIAS: MORE COMMON THAN YOU THINK. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32313-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Grandhi G, Saxena A, Rajan T, Veledar E, Khera A, Blankstein R, Blumenthal R, Shaw L, Blaha M, Nasir K. RISK RECLASSIFICATION WITH ABSENCE OF CORONARY ARTERY CALCIUM AMONG STATIN CANDIDATES ACCORDING TO AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION (ACC/AHA) GUIDELINES: SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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McEvoy JW, Rahman F, Al Rifai M, Blaha M, Nasir K, Budoff M, Psaty B, Post W, Blumenthal R. Abstract 031: Diastolic Blood Pressure, Coronary Artery Calcium, and Cardiac Outcomes in the Multi-ethnic Study of Atherosclerosis. Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diastolic blood pressure (BP) has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic BP, our objective was to test whether the J-curve is most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic BP category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic BP of 80 to 89 mmHg (reference), persons with diastolic BP <60 mmHg had increased risk of coronary heart disease events (HR 1.69 [95% confidence interval 1.02-2.79]) and all-cause mortality (HR 1.48 [95% confidence interval 1.10-2.00]), but not stroke. After stratification, associations of diastolic BP <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic BP <60 mmHg was not associated with events when coronary artery calcium was zero. We also found no interaction in the association between low diastolic BP and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with elevated CAC; suggesting that added caution may be needed when pursuing intensive BP treatment targets among persons with subclinical atherosclerosis.
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Affiliation(s)
| | | | | | | | | | | | - Bruce Psaty
- Depts of Medicine, Epidemiology and Health Services, Univ of Washington, Seattle, WA
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19
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Hong J, Blankstein R, Blaha M, Blumenthal R, Arrieta A, Padula W, Krumholz H, Nasir K. COST-EFFECTIVENESS OF CORONARY ARTERY CALCIUM TESTING AMONG STATIN CANDIDATES ACCORDING TO THE AMERICAN COLLEGE OF CARDIOLOGY AND AMERICAN HEART ASSOCIATION CHOLESTEROL GUIDELINES. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35217-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, Blumenthal R, Danesh J, Smith GD, DeMets D, Evans S, Law M, MacMahon S, Martin S, Neal B, Poulter N, Preiss D, Ridker P, Roberts I, Rodgers A, Sandercock P, Schulz K, Sever P, Simes J, Smeeth L, Wald N, Yusuf S, Peto R. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016; 388:2532-2561. [PMID: 27616593 DOI: 10.1016/s0140-6736(16)31357-5] [Citation(s) in RCA: 1141] [Impact Index Per Article: 142.6] [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: 05/13/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023]
Abstract
This Review is intended to help clinicians, patients, and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomised controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment. Large-scale evidence from randomised trials shows that statin therapy reduces the risk of major vascular events (ie, coronary deaths or myocardial infarctions, strokes, and coronary revascularisation procedures) by about one-quarter for each mmol/L reduction in LDL cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (eg, atorvastatin 40 mg daily, costing about £2 per month) for 5 years in 10 000 patients would typically prevent major vascular events from occurring in about 1000 patients (ie, 10% absolute benefit) with pre-existing occlusive vascular disease (secondary prevention) and in 500 patients (ie, 5% absolute benefit) who are at increased risk but have not yet had a vascular event (primary prevention). Statin therapy has been shown to reduce vascular disease risk during each year it continues to be taken, so larger absolute benefits would accrue with more prolonged therapy, and these benefits persist long term. The only serious adverse events that have been shown to be caused by long-term statin therapy-ie, adverse effects of the statin-are myopathy (defined as muscle pain or weakness combined with large increases in blood concentrations of creatine kinase), new-onset diabetes mellitus, and, probably, haemorrhagic stroke. Typically, treatment of 10 000 patients for 5 years with an effective regimen (eg, atorvastatin 40 mg daily) would cause about 5 cases of myopathy (one of which might progress, if the statin therapy is not stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases of diabetes, and 5-10 haemorrhagic strokes. However, any adverse impact of these side-effects on major vascular events has already been taken into account in the estimates of the absolute benefits. Statin therapy may cause symptomatic adverse events (eg, muscle pain or weakness) in up to about 50-100 patients (ie, 0·5-1·0% absolute harm) per 10 000 treated for 5 years. However, placebo-controlled randomised trials have shown definitively that almost all of the symptomatic adverse events that are attributed to statin therapy in routine practice are not actually caused by it (ie, they represent misattribution). The large-scale evidence available from randomised trials also indicates that it is unlikely that large absolute excesses in other serious adverse events still await discovery. Consequently, any further findings that emerge about the effects of statin therapy would not be expected to alter materially the balance of benefits and harms. It is, therefore, of concern that exaggerated claims about side-effect rates with statin therapy may be responsible for its under-use among individuals at increased risk of cardiovascular events. For, whereas the rare cases of myopathy and any muscle-related symptoms that are attributed to statin therapy generally resolve rapidly when treatment is stopped, the heart attacks or strokes that may occur if statin therapy is stopped unnecessarily can be devastating.
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Affiliation(s)
- Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christina Reith
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Armitage
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Colin Baigent
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lisa Blackwell
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roger Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - David DeMets
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Stephen Evans
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Malcolm Law
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen MacMahon
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Seth Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Neil Poulter
- International Centre for Circulatory Health & Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - David Preiss
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Anthony Rodgers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Schulz
- FHI 360, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Peter Sever
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - John Simes
- National Health and Medical Research Council Clinical Trial Centre, University of Sydney, Sydney, Australia
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Nicholas Wald
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Shah N, Quispe R, Kulkarni K, Martin S, Blaha M, Blumenthal R, Jones S, Swiger K. LIPID AND LIPOPROTEIN SUBFRACTIONS IN A LARGE CENTENARIAN POPULATION: THE VERY LARGE DATABASE OF LIPIDS STUDY 10C (VLDL-10C). J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gupta A, Varshney R, Lau E, Hulten E, Bittencourt M, Blaha M, Blumenthal R, Budoff M, Umscheid C, Nasir K, Blankstein R. THE IDENTIFICATION OF CORONARY ATHEROSCLEROSIS IS ASSOCIATED WITH INITIATION OF PHARMACOLOGIC AND LIFESTYLE PREVENTIVE THERAPIES: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31973-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Commodore-Mensah Y, Hill M, Allen J, Cooper LA, Blumenthal R, Agyemang C, Himmelfarb CD. Sex Differences in Cardiovascular Disease Risk of Ghanaian- and Nigerian-Born West African Immigrants in the United States: The Afro-Cardiac Study. J Am Heart Assoc 2016; 5:e002385. [PMID: 26896477 PMCID: PMC4802474 DOI: 10.1161/jaha.115.002385] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of African immigrants in the United States grew 40-fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease (CVD) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States. METHODS AND RESULTS This cross-sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35-74 years in the Baltimore-Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m(2)) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/dL. In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033-0.29) and 0.25 (95% CI 0.09-0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83-0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%. CONCLUSIONS The prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men.
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Affiliation(s)
| | - Martha Hill
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Jerilyn Allen
- Johns Hopkins University School of Nursing, Baltimore, MD
| | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre/University of Amsterdam, The Netherlands
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Juraschek SP, Blaha MJ, Whelton SP, Blumenthal R, Jones SR, Keteyian SJ, Schairer J, Brawner CA, Al-Mallah MH. Physical fitness and hypertension in a population at risk for cardiovascular disease: the Henry Ford ExercIse Testing (FIT) Project. J Am Heart Assoc 2015; 3:e001268. [PMID: 25520327 PMCID: PMC4338714 DOI: 10.1161/jaha.114.001268] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increased physical fitness is protective against cardiovascular disease. We hypothesized that increased fitness would be inversely associated with hypertension. METHODS AND RESULTS We examined the association of fitness with prevalent and incident hypertension in 57 284 participants from The Henry Ford ExercIse Testing (FIT) Project (1991–2009). Fitness was measured during a clinician‐referred treadmill stress test. Incident hypertension was defined as a new diagnosis of hypertension on 3 separate consecutive encounters derived from electronic medical records or administrative claims files. Analyses were performed with logistic regression or Cox proportional hazards models and were adjusted for hypertension risk factors. The mean age overall was 53 years, with 49% women and 29% black. Mean peak metabolic equivalents (METs) achieved was 9.2 (SD, 3.0). Fitness was inversely associated with prevalent hypertension even after adjustment (≥12 METs versus <6 METs; OR: 0.73; 95% CI: 0.67, 0.80). During a median follow‐up period of 4.4 years (interquartile range: 2.2 to 7.7 years), there were 8053 new cases of hypertension (36.4% of 22 109 participants without baseline hypertension). The unadjusted 5‐year cumulative incidences across categories of METs (<6, 6 to 9, 10 to 11, and ≥12) were 49%, 41%, 30%, and 21%. After adjustment, participants achieving ≥12 METs had a 20% lower risk of incident hypertension compared to participants achieving <6 METs (HR: 0.80; 95% CI: 0.72, 0.89). This relationship was preserved across strata of age, sex, race, obesity, resting blood pressure, and diabetes. CONCLUSIONS Higher fitness is associated with a lower probability of prevalent and incident hypertension independent of baseline risk factors.
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Affiliation(s)
- Stephen P Juraschek
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore
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Bild DE, McClelland R, Kaufman JD, Blumenthal R, Burke GL, Carr JJ, Post WS, Register TC, Shea S, Szklo M. Ten-year trends in coronary calcification in individuals without clinical cardiovascular disease in the multi-ethnic study of atherosclerosis. PLoS One 2014; 9:e94916. [PMID: 24743658 PMCID: PMC3990562 DOI: 10.1371/journal.pone.0094916] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 03/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background Coronary heart disease (CHD) incidence has declined significantly in the US, as have levels of major coronary risk factors, including LDL-cholesterol, hypertension and smoking, but whether trends in subclinical atherosclerosis mirror these trends is not known. Methods and Findings To describe recent secular trends in subclinical atherosclerosis as measured by serial evaluations of coronary artery calcification (CAC) prevalence in a population over 10 years, we measured CAC using computed tomography (CT) and CHD risk factors in five serial cross-sectional samples of men and women from four race/ethnic groups, aged 55–84 and without clinical cardiovascular disease, who were members of Multi-Ethnic Study of Atherosclerosis (MESA) cohort from 2000 to 2012. Sample sizes ranged from 1062 to 4837. After adjusting for age, gender, and CT scanner, the prevalence of CAC increased across exams among African Americans, whose prevalence of CAC was 52.4% in 2000–02, 50.4% in 2003–04, 60.0% is 2005–06, 57.4% in 2007–08, and 61.3% in 2010–12 (p for trend <0.001). The trend was strongest among African Americans aged 55–64 [prevalence ratio for 2010–12 vs. 2000–02, 1.59 (95% confidence interval 1.06, 2.39); p = 0.005 for trend across exams]. There were no consistent trends in any other ethnic group. Risk factors generally improved in the cohort, and adjustment for risk factors did not change trends in CAC prevalence. Conclusions There was a significant secular trend towards increased prevalence of CAC over 10 years among African Americans and no change in three other ethnic groups. Trends did not reflect concurrent general improvement in risk factors. The trend towards a higher prevalence of CAC in African Americans suggests that CHD risk in this population is not improving relative to other groups.
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Affiliation(s)
- Diane E. Bild
- Division of Cardiovascular Sciences, NHLBI, Bethesda, Maryland, United States of America
- * E-mail:
| | - Robyn McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Roger Blumenthal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Gregory L. Burke
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - J. Jeffrey Carr
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Wendy S. Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Thomas C. Register
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Steven Shea
- Columbia University, New York, New York, United States of America
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Hung R, Qadi M, Shaya G, Blumenthal R, Nasir K, Schairer J, Keteyian S, Al-Mallah M, Blaha M. EXERCISE CAPACITY ATTENUATES RISK FOR MORTALITY AND ADVERSE CLINICAL OUTCOMES IN MEN AND WOMEN WITH DYSLIPIDEMIA INDEPENDENT OF STATIN THERAPY: THE FIT PROJECT. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Swiger K, Martin S, Blaha M, Toth P, Nasir K, Gerstenblith G, Blumenthal R, Jones S. ATHEROGENIC LIPID LEVELS IN 662,711 ELDERLY PERSONS: THE VERY LARGE DATABASE OF LIPIDS 10A (VLDL 10A). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61459-5] [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: 11/25/2022]
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Bittencourt MS, Blankstein R, Patel J, Blaha M, Hulten E, Blumenthal R, Shaw L, Liu S, Eng J, Agatston A, Budoff M, Nasir K. IMPLICATIONS OF CORONARY ARTERY CALCIUM SCORE ON SAMPLE SIZE CALCULATIONS IN CARDIOVASCULAR PRIMARY PREVENTION TRIALS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61159-1] [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: 11/27/2022]
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Joshi P, Martin S, Blaha M, McEvoy J, Santos R, Cannon C, Blumenthal R, Jones S. SEASONAL VARIATIONS IN LIPID PROFILES FROM 2.8 MILLION US ADULTS: THE VERY LARGE DATABASE OF LIPIDS (VLDL 14). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61458-3] [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: 10/25/2022]
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Lewis EF, Wang R, Quan S, Gottlieb D, Bhatt D, Blumenthal R, Mehra R, Punjabi N, Patel S, Weng J, Redline S. IMPACT OF TREATMENT MODALITIES ON HEALTH STATUS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61539-4] [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: 11/29/2022]
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Quaglia LA, Freitas W, Soares AA, Santos RA, Nadruz W, Blaha M, Coelho OR, Blumenthal R, Agatston A, Nasir K, Sposito AC. C-reactive protein is independently associated with coronary atherosclerosis burden among octogenarians. Aging Clin Exp Res 2014; 26:19-23. [PMID: 23959959 DOI: 10.1007/s40520-013-0114-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/24/2013] [Indexed: 11/26/2022]
Abstract
AIM OF THE STUDY In contrast to the general population, individuals with primarily persistent elevation of inflammatory activity display a significant association between inflammatory biomarkers and atherosclerotic burden. In older individuals, immunosenescence upregulates the innate response and, by this way, may hypothetically favor the presence of this association. The aim of this study was to evaluate this hypothesis in healthy octogenarians. METHODS Participants (n = 208) aged 80 years or older, asymptomatic and without medical and laboratory evidence of chronic diseases or use of anti-inflammatory treatments were included in the study. Lipid profile and plasma C-reactive protein (CRP) were measured at baseline and cardiac computed tomography was performed within 1-week interval for measuring coronary calcium score (CCS). RESULTS The median plasma CRP was 1.9 mg/L (1.0–3.4) and 33 % of the participants had elevated CRP defined as C3 mg/L. Among those with high CRP, there was an increased frequency of high CCS (C100) as compared with their counterparts (71 vs 50 %, p = 0.001). The association between CRP and CCS persisted even after adjustment for age, sex, cardiovascular risk factors and statin therapy. The area under the receiver-operating curve for CRP was 0.606 using CCS C100 as a binary outcome. The sensitivities for CCS C100 were 40 and 74 % for the cutoff points of CRP C3 or 1 mg/L, respectively. CONCLUSION The present study was able to confirm that in very elderly individuals, systemic inflammatory activity is independently associated with coronary atherosclerosis burden.
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Roberson L, Shaharyar S, Aneni E, Freitas W, Blaha M, Agatston A, Blumenthal R, Santos RD, Feiz H, Nasir K, Sposito A. The prevalence of the metabolically healthy obese phenotype in an aging population and its association with subclinical cardiovascular disease: The Brazilian study on healthy aging. Diabetol Metab Syndr 2014; 6:121. [PMID: 25411583 PMCID: PMC4236419 DOI: 10.1186/1758-5996-6-121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/29/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Current literature has elucidated a new phenotype, metabolically healthy obese (MHO), with risks of cardiovascular disease similar to that of normal weight individuals. Few studies have examined the MHO phenotype in an aging population, especially in association with subclinical CVD. RESEARCH DESIGN AND METHODS This cross sectional study population consisted of 208 octogenarians and older. Anthropometrics, biochemical, and radiological parameters were measured to assess obesity, metabolic health (assessed by the National Cholesterol Education Program -Adult Treatment Panel (NCEP-ATP III) criteria), and subclinical measures of CVD. RESULTS The prevalence of MHO was 13.5% (N = 28). No significant association with MHO was noted for age, coronary artery calcium score, cIMT, or hs-CRP > 3 mg/dl (p = NS). CONCLUSIONS Our results suggest that the MHO phenotype exists in the elderly; however, subclinical CVD measures were not different in sub-group analysis suggesting traditional metabolic risk factor algorithms may not be accurate in the very elderly.
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Affiliation(s)
- Lara Roberson
- />Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL USA
| | | | - Ehimen Aneni
- />Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL USA
| | - Wladimir Freitas
- />Cardiology Department, State University of Campinas School of Medicine Campinas, Sao Paulo, Brazil
| | - Michael Blaha
- />Johns Hopkins Hospital Ciccarone Preventive Cardiology Center, Baltimore, MD USA
| | - Arthur Agatston
- />Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL USA
| | - Roger Blumenthal
- />Johns Hopkins Hospital Ciccarone Preventive Cardiology Center, Baltimore, MD USA
| | - Raul D Santos
- />Lipid Clinic- Heart Institute (InCor), University of São Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Hamid Feiz
- />Aventura Hospital & Medical Center, Aventura, FL USA
| | - Khurram Nasir
- />Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL USA
- />Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL USA
- />The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD USA
- />Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA
| | - Andrei Sposito
- />Cardiology Division, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Cidade Universitária, Campinas, SP 13084-971 Brazil
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Makadia SS, Blaha M, Keenan T, Ndumele C, Jones S, DeFilippis A, Martin S, Kohli P, Conceicao R, Carvalho J, Nasir K, Blumenthal R, Santos RD. Relation of hepatic steatosis to atherogenic dyslipidemia. Am J Cardiol 2013; 112:1599-604. [PMID: 24012029 DOI: 10.1016/j.amjcard.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/01/2013] [Accepted: 08/01/2013] [Indexed: 12/31/2022]
Abstract
Hepatic steatosis is closely associated with the metabolic syndrome. We assessed for an independent association between hepatic steatosis and atherogenic dyslipidemia after adjustment for obesity, physical activity, hyperglycemia, and systemic inflammation. We studied 6,333 asymptomatic subjects without clinical cardiovascular disease undergoing a health screen in Brazil from November 2008 to July 2010. Hepatic steatosis was diagnosed by ultrasound. Atherogenic dyslipidemia was defined using 2 definitions: criteria for (1) metabolic syndrome or (2) insulin resistance (triglyceride/high-density-lipoprotein cholesterol ratio of ≥2.5 in women and ≥3.5 in men). In hierarchical multivariate regression models, we evaluated for an independent association of hepatic steatosis with atherogenic dyslipidemia. Hepatic steatosis was detected in 36% of participants (average age 43.5 years, 79% men, average body mass index 26.3 kg/m(2)). Subjects with hepatic steatosis had similar levels of low-density-lipoprotein cholesterol, with significantly lower level of high-density-lipoprotein cholesterol and higher level of triglyceride compared with those without steatosis. Hepatic steatosis remained significantly independently associated with atherogenic dyslipidemia of both definitions (metabolic syndrome [odds ratio 2.47, 95% confidence interval 2.03 to 3.02] and insulin resistance [odds ratio 2.50, 95% confidence interval 2.13 to 2.91]) after multivariate adjustment. Stratified analyses showed a persistent independent association in nonobese subjects, those without metabolic syndrome, those with normal high-sensitivity C-reactive protein, nonalcohol abusers, and those with normal liver enzymes. Hepatic steatosis was significantly associated with atherogenic dyslipidemia independent of obesity, physical activity, hyperglycemia, and systemic inflammation after multivariate adjustment. In conclusion, this adds to the growing body of evidence that hepatic steatosis may play a direct metabolic role in conferring increased cardiovascular risk.
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Abstract
Electrical excitation is interpreted in terms of a cooperative structural transition of membrane protomers coupled with the translocation of a permeant molecule in a non-equilibrium environment. Equations for flow of permeant and for membrane conformation are derived for the simple case of a single non-charged permeant. On the basis of a few simple physical assumptions, the theory predicts several important properties of electrically excitable membranes: the steepness of the relation between membrane conductance and potential, the presence of a negative conductance, and the occurrence of instabilities following rapid perturbations of membrane environment, giving rise to some simple cases of action potentials. Several experimental tests of the membrane with its changes of electrical properties are proposed. From a thermodynamic point of view, an electrically excitable membrane, in its resting state, lies beyond a dissipative instability and consequently is in a non-equilibrium state but with stable organization, a "dissipative structure" of Prigogine. Membrane excitation following a small perturbation of the environment would correspond to a jump from such an organization to another stable organization but close to thermodynamic equilibrium. It is shown how the cooperative molecular properties of the membrane are amplified by energy dissipation at the macroscopic level.
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Affiliation(s)
- R Blumenthal
- Département de Biologie Moléculaire, Institut Pasteur, Paris, France
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Blumenthal R, Hardt W. 60 Jahre Berufsverband der Deutschen Dermatologen: Vom lokalen Hilfsverein an die Schaltstellen der Gesundheitspolitik. Akt Dermatol 2013. [DOI: 10.1055/s-0032-1326395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - W. Hardt
- Berufsverband der Deutschen Dermatologen
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Joshi P, Patel B, Blaha M, Berry J, Blankstein R, Budoff M, Wong N, Agatston A, Blumenthal R, Nasir K. CORONARY ARTERY CALCIUM PREDICTS INTERMEDIATE-TERM EVENTS IN SUBJECTS WITH A LOW LIFETIME RISK OF CARDIOVASCULAR DISEASE: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60979-1] [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: 10/27/2022]
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37
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Makadia S, Blaha M, Keenan T, Ndumele C, Jones S, DeFilippis A, Martin S, Kohli P, Nasir K, Blumenthal R, Filho RS. HEPATIC STEATOSIS IS ASSOCIATED WITH ATHEROGENIC DYSLIPIDEMIA INDEPENDENT OF OBESITY, COMPONENTS OF THE METABOLIC SYNDROME, MEDICATION USE, AND SYSTEMIC INFLAMMATION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61430-8] [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: 11/25/2022]
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38
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Aneni E, Roberson L, Blaha M, Sameer S, Agatston A, Blumenthal R, Conceicao R, Carvalho J, Nasir K, Santos R. PRE-HYPERTENSION IS STRONGLY ASSOCIATED WITH DELAYED HEART-RATE RECOVERY DURING EXERCISE STRESS TEST. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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39
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Martin SS, Blaha M, Muse E, Qasim A, Reilly M, Blumenthal R, Nasir K, Criqui M, McClelland R, Harris TB, Hughes-Austin J, Allison M. LEPTIN AND INCIDENT HEART FAILURE IN WOMEN VERSUS MEN: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60791-3] [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: 10/27/2022]
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40
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Rana JS, Pencina M, Blaha M, Blumenthal R, Agatston A, Min JK, Blankstein R, Wong ND, Lima J, Shaw LJ, Budoff MJ, Cushman M, Berman D, Nasir K. CORONARY ARTERY CALCIUM SCORE VERSUS A MULTIPLE BIOMARKER APPROACH FOR CORONARY HEART DISEASE RISK ASSESSMENT: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60812-8] [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: 10/27/2022]
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41
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Bittencourt MS, Blaha M, Blankstein R, Vargas J, Budoff M, Agatston A, Blumenthal R, Nasir K. ELIGIBILITY FOR POLYPILL THERAPY, SUBCLINICAL ATHEROSCLEROSIS, AND CARDIOVASCULAR EVENTS – NATIONAL IMPLICATIONS FOR THE APPROPRIATE USE OF PREVENTIVE PHARMACOTHERAPY: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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42
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Oni E, Sinha P, Karim A, Blumenthal R, Blaha M, Agatston A, Conceicao R, Carvalho JA, Nasir K, Santos R. STATIN USE IS NOT ASSOCIATED WITH PRESENCE OF AND SEVERITY OF NON-ALCOHOLIC FATTY LIVER DISEASE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61427-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Minder CM, Blaha M, McEvoy J, Michos E, Carvalho JAM, Conceição RD, Blumenthal R, Nasir K, Santos R. THE ASSOCIATION BETWEEN SELF-REPORTED ACTIVITY LEVEL AND CARDIORESPIRATORY FITNESS ON CARDIOVASCULAR RISK FACTORS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vranian M, Blaha M, Silverman M, Michos E, Minder C, Blumenthal R, Nasir K, de Carvalho JM, Santos R. THE INTERACTION OF FITNESS, FATNESS, AND CARDIOMETABOLIC RISK. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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45
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Hamirani YS, Nasir K, Blaha M, Katz R, Blumenthal R, Kronmal R, Budoff M. ASSOCIATION BETWEEN INFLAMMATORY MARKERS AND LIVER FAT: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61345-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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46
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Tison GH, Blaha M, Nasir K, Blumenthal R, Szklo M, Ding J, Budoff M. THE ASSOCIATION OF ANTHROPOMETRIC OBESITY MEASURES WITH CT-MEASURED NON-ALCOHOLIC FATTY LIVER DISEASE IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Martin SS, Blaha M, Brinton E, Toth P, McEvoy J, Joshi P, Kulkarni K, Mize P, Kwiterovich P, DeFilippis A, Blumenthal R, Jones S. CLINICALLY MEANINGFUL UNDERESTIMATION OF LDL-C BY FRIEDEWALD AT LEVELS BELOW 70 MG/ DL: A STUDY OF 1.3 MILLION ADULTS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61694-5] [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: 10/28/2022]
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Harkness J, Blaha M, Blankstein R, Lima J, Budoff M, Rivera J, Agatston A, Blumenthal R, Nasir K. DISTRIBUTION AND BURDEN OF CORONARY ARTERY CALCIUM AS PREDICTORS OF SURGICAL AND PERCUTANEOUS REVASCULARIZATION: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tota-Maharaj R, Budoff MJ, Blaha MJ, Zeb I, Katz R, Blankstein R, Blumenthal R, Nasir K. ETHNIC DIFFERENCES IN LIVER FAT ON CARDIAC COMPUTED TOMOGRAPHY SCANS: THE MULTIETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61347-3] [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: 10/28/2022]
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Feringa H, Blaha M, Blankstein R, Rivera J, Budoff M, Shaw L, Raggi P, Berman D, Callister T, Agatston A, Blumenthal R, Krumholz H, Nasir K. DERIVATION AND VALIDATION OF A RISK MODEL TO PREDICT THE PRESENCE AND EXTENT OF CORONARY ARTERY CALCIFICATION IN ASYMPTOMATIC INDIVIDUALS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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