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Golub I, Benzing T, Kianoush S, Krishnan S, Ichikawa K, Budoff MJ. Hemodynamic significance of coronary anomalies: Computed tomography-based fractional flow reserve (CT-FFR) as an Adjudicator. Coron Artery Dis 2024:00019501-990000000-00216. [PMID: 38652086 DOI: 10.1097/mca.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Ilana Golub
- Department of Cardiology, Harbor-UCLA Medical Center Lundquist Institute, Torrance, California, USA
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Aldana-Bitar J, Golub IS, Moore J, Krishnan S, Verghese D, Manubolu VS, Benzing T, Ichikawa K, Hamal S, Kianoush S, Anderson LR, Ramirez NR, Leipsic JA, Karlsberg RP, Budoff MJ. Colchicine and plaque: A focus on atherosclerosis imaging. Prog Cardiovasc Dis 2024:S0033-0620(24)00031-8. [PMID: 38423236 DOI: 10.1016/j.pcad.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
Colchicine is an anti-inflammatory medication, classically used to treat a wide spectrum of autoimmune diseases. More recently, colchicine has proven itself a key pharmacotherapy in cardiovascular disease (CVD) management, atherosclerotic plaque modification, and coronary artery disease (CAD) treatment. Colchicine acts on many anti-inflammatory pathways, which translates to cardiovascular event reduction, plaque transformation, and plaque reduction. With the FDA's 2023 approval of colchicine for reducing cardiovascular events, a novel clinical pathway opens. This advancement paves the route for CVD management that synergistically merges lipid lowering approaches with inflammation inhibition modalities. This pioneering moment spurs the need for this manuscript's comprehensive review. Hence, this paper synthesizes and surveys colchicine's new role as an atherosclerotic plaque modifier, to provide a framework for physicians in the clinical setting. We aim to improve understanding (and thereby application) of colchicine alongside existing mechanisms for CVD event reduction. This paper examines colchicine's anti-inflammatory mechanism, and reviews large cohort studies that evidence colchicine's blossoming role within CAD management. This paper also outlines imaging modalities for atherosclerotic analysis, reviews colchicine's mechanistic effect upon plaque transformation itself, and synthesizes trials which assess colchicine's nuanced effect upon atherosclerotic transformation.
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Affiliation(s)
- Jairo Aldana-Bitar
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA; Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA.
| | - Ilana S Golub
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Jeff Moore
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Srikanth Krishnan
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA; Department of Medicine, Division of Cardiology, University of California Los Angeles, Westwood, CA, USA
| | - Dhiran Verghese
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Venkat S Manubolu
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Travis Benzing
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Keshi Ichikawa
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Sajad Hamal
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Sina Kianoush
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Lauren R Anderson
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Noah R Ramirez
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Canada
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
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Krishnan S, Aldana-Bitar J, Golub I, Ichikawa K, Shabir A, Bagheri M, Hamidi H, Benzing T, Kianoush S, Budoff MJ. Testosterone therapy and the risk of cardiovascular disease in older, hypogonadal men. Prog Cardiovasc Dis 2024:S0033-0620(24)00036-7. [PMID: 38423237 DOI: 10.1016/j.pcad.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
The debate over the cardiovascular (CV) implications of testosterone therapy (TT) have resulted in diverging safety recommendations and clinical guidelines worldwide. This narrative review synthesizes and critically evaluates long-term studies examining the effects of TT within the context of aging, obesity, and endogenous sex hormones on CV disease (CVD) risk to support informed clinical decision-making. Observational studies have variably linked low endogenous testosterone with increased CVD risk, while randomized controlled trials (RCTs) demonstrate that TT yields cardiometabolic benefits without increasing short-term CV risk. The TRAVERSE trial, as the first RCT powered to assess CVD events, did not show increased major adverse cardiac events (MACE) incidence; however, its limitations - specifically the maintenance of testosterone at low-normal levels, a high participant discontinuation rate, and short follow-up - warrant a careful interpretation of its results. Furthermore, findings from the TTrials cardiovascular sub-study, which showed an increase in non-calcified plaque, indicate the need for ongoing research into the long-term CV impact of TT. The decision to initiate TT should consider the current evidence gaps, particularly for older men with known CVD. The CV effects of maintaining physiological testosterone levels through exogenous means remain to be fully explored. Until more definitive evidence is available, clinical practice should prioritize individualized care and informed discussions on the potential CV implications of TT.
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Affiliation(s)
- Srikanth Krishnan
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502.
| | - Jairo Aldana-Bitar
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Ilana Golub
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502; David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Keishi Ichikawa
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Ayesha Shabir
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Marziyeh Bagheri
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Hossein Hamidi
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Travis Benzing
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Sina Kianoush
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Matthew J Budoff
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502.
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Inam M, Kianoush S, Sheikh S, Krittanawong C, Zhu D, Rifai MA, Minhas AMK, Samad Z, Khan U, Merchant A, Virani SS. The Association Between Race, Ethnicity and Sleep Quality and Duration: A National Health Interview Survey Study. Curr Probl Cardiol 2023; 48:102004. [PMID: 37506957 DOI: 10.1016/j.cpcardiol.2023.102004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Inadequate sleep duration and poor sleep quality are associated with adverse cardiovascular outcomes. METHODS Using data from the National Health Interview Survey, we compared self-reported sleep duration and quality among different groups: Whites, Chinese, Asian Indian, Filipino, and Other Asians. Outcome included Sleep duration (≥7 and <7 hours) and sleep quality (coded as a binary variable). RESULTS We included 155,203 participants. The overall prevalence of ≥7 hours of sleep was 69.5% and poor sleep quality was reported by 73.9%. Compared to Whites and Chinese, Filipinos, and Other Asians were less likely to get adequate sleep (≥7 hours). All 4 Asian groups were less likely to report poor sleep quality compared with White individuals, while Asian Indians reported poor sleep quality less frequently compared with Chinese individuals. CONCLUSION There are significant differences in sleep duration and quality between White and Asian groups, as well as within Asian subgroups. Further studies with disaggregated Asian subgroup data are needed to formally study these disparities.
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Affiliation(s)
- Maha Inam
- Research and Graduate Studies, Office of the Vice Provost, Aga Khan University, Karachi, Pakistan
| | - Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sana Sheikh
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Chayakrit Krittanawong
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mahmoud Al Rifai
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | | | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan; Division of Cardiology, Aga Khan University, Karachi, Sindh, Pakistan
| | - Unab Khan
- Department of Family Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Salim S Virani
- Research and Graduate Studies, Office of the Vice Provost, Aga Khan University, Karachi, Pakistan; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; The Texas Heart Institute, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX.
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Al Rifai M, Kianoush S, Jain V, Joshi PH, Cainzos-Achirica M, Nasir K, Merchant AT, Dodani S, Wong SS, Samad Z, Mehta A, Chunara R, Kalra A, Virani SS. Association of U.S. birth, duration of residence in the U.S., and atherosclerotic cardiovascular disease risk factors among Asian adults. Prev Med Rep 2022; 29:101916. [PMID: 35898194 PMCID: PMC9309422 DOI: 10.1016/j.pmedr.2022.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans. Methods We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S. Results The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean (standard error) age was 43.8 (0.21) years and 53 % were women. In multivariable-adjusted logistic regression models, U.S. birth was associated with a higher prevalence odds ratio (95 % confidence interval) of current smoking 1.31 (1.07,1.60), physical inactivity 0.62 (0.54,0.72), obesity 2.26 (1.91,2.69), hypertension 1.33 (1.12,1.58), and CAD 1.96 (1.24,3.11), but lower prevalence of stroke 0.28 (0.11,0.71). Spending greater than 15 years in the U.S. was associated with a higher prevalence of current smoking 1.65 (1.24,2.21), obesity 2.33 (1.57,3.47), diabetes 2.68 (1.17,6.15), and hyperlipidemia 1.72 (1.09,2.71). Conclusion Heterogeneity exists in cardiovascular risk factor burden among Asian Americans according to Asian ethnicity, U.S. birth, and duration of time living in the U.S.
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Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Parag H Joshi
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sunita Dodani
- Section of Cardiology, Department of Internal Medicine, Eastern Virginia Medical School (EVMS), Norfolk, VA, United States.,EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Norfolk, VA, United States
| | - Sally S Wong
- Office of Science, Medicine and Health, The American Heart Association, Dallas, TX, United States
| | | | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University & Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, NY, United States
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, & Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Al Rifai M, Kianoush S, Jain V, Minhas AMK, Hussain A, Krittanawong C, Patel J, Agarwala A, Hanif B, Samad Z, Yang E, Virani SS. Healthcare Access Among Individuals of Asian Descent in the U.S. Kans J Med 2022; 15:352-357. [PMID: 36196100 PMCID: PMC9518708 DOI: 10.17161/kjm.vol15.17942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Some groups of Asian Americans, especially Asian Indians, experience higher rates of atherosclerotic cardiovascular disease (ASCVD) compared with other groups in the U.S. Barriers in accessing medical care partly may explain this higher risk as a result of delayed screening for cardiovascular risk factors and timely initiation of preventive treatment.
Methods. Cross-sectional data were utilized from the 2006 to 2015 National Health Interview Survey (NHIS). Barriers to accessing medical care included no place to seek medical care when needed, no healthcare coverage, no care due to cost, delayed care due to cost, inability to afford medication, or not seeing a doctor in the past 12 months.
Results. The study sample consisted of 18,150 Asian individuals, of whom 20.5% were Asian Indian, 20.5% were Chinese, 23.4% were Filipino, and 35.6% were classified as “Other Asians”. The mean (standard error) age was 43.8 (0.21) years and 53% were women. Among participants with history of hypertension, diabetes mellitus, or ASCVD (prevalence = 25%), Asian Indians were more likely to report delayed care due to cost (2.58 (1.14,5.85)), while Other Asians were more likely to report no care due to cost (2.43 (1.09,5.44)) or delayed care due to cost (2.35 (1.14,4.86)), compared with Chinese. Results among Filipinos were not statistically significant.
Conclusions. Among Asians living in the U.S. with cardiovascular risk factors or ASCVD, Asian Indians and Other Asians are more likely to report delayed care or no care due to cost compared with Chinese.
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Affiliation(s)
- Mahmoud Al Rifai
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Sina Kianoush
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Aliza Hussain
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX
| | | | - Jaideep Patel
- Greater Baltimore Medical Center (Johns Hopkins Heart Center at GBMC) and Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Anandita Agarwala
- Division of Cardiology, Baylor Scott & White Medical Center, Plano, TX
| | - Bashir Hanif
- Tabba Heart Institute, Karachi, Karachi City, Sindh, Pakistan
| | - Zainab Samad
- Division of Cardiology, Aga Khan University, Karachi, Pakistan
| | - Eugene Yang
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Salim S Virani
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety Health Policy, Quality & Informatics Program
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
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Kianoush S, Rifai MA, Patel J, Michos ED, Alam M, Samad Z, Sohail R, Cader FA, Sayed A, Zhu D, Virani SS. Racial disparity in flu vaccine uptake among Asian American Individuals: A National Health Interview Survey Study. Curr Probl Cardiol 2022; 47:101391. [PMID: 36100094 DOI: 10.1016/j.cpcardiol.2022.101391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Vaccination coverage rates across Asian American subpopulations with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus is not well-studied. We used data from the National Health Interview Survey (NHIS) from 2006-2018 and included participants with a history of ASCVD or diabetes. Vaccination coverage in White were compared with Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) adults using univariable and multivariable logistic regression models. We included 50,839 participants, mean age 62.7±0.1 years, 46.3% women, 89.1% US-born. Filipino (59%) and Asian Indian (56%) adults were less likely to receive influenza vaccine than 'other Asians' (66%), Chinese (65%), and White (60%) participants (P<0.001). In multivariable adjusted models, Chinese (OR=1.66, 1.02-2.69), Asian Indian (OR=1.50, 1.07-2.10), and 'other Asian' ethnicity (OR=1.81, 1.38-2.36) were associated with higher odds of receiving influenza vaccination compared with White. Influenza vaccine coverage remains suboptimal across all studied races/ethnicities.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jaideep Patel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan Aga Khan University, Karachi, Pakistan
| | - Rizwan Sohail
- Section of Infectious Disease, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - F Aaysha Cader
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | | | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX; DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX.
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Kianoush S, Al Rifai M, Merchant AT, Jia X, Samad Z, Bhalla A, Khan A, Zhu D, Virani S. Heterogeneity in the prevalence of premature hypertension among Asian American populations compared with white individuals: A National Health Interview Survey study. International Journal of Cardiology Cardiovascular Risk and Prevention 2022; 14:200147. [PMID: 36039164 PMCID: PMC9418798 DOI: 10.1016/j.ijcrp.2022.200147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
Abstract
Background Differences in prevalence of risk factors such as hypertension may explain heterogeneity in cardiovascular risk across Asian American populations. Methods We used National Health Interview Survey (NHIS) data from 2006 to 2018 among White, Chinese, Asian Indian, Filipino, and ‘other Asians’ (Japanese, Korean, and Vietnamese). Unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals were reported using logistic regression models for the association between race and self-reported premature hypertension (age <50 years old). Models were adjusted for sex, education, body mass index, smoking status, diabetes, and coronary heart disease. Results We studied 99,864 participants with history of hypertension (mean age, 59.3 ± 0.1; 50% women, 90% US born). Asian Indians had higher prevalence of premature hypertension (37%) compared with Filipinos (27%), ‘other Asians’ (26%), Whites (25%), and Chinese (21%). Compared with Whites, Chinese individuals had lower odds of premature hypertension (aOR = 0.79, 0.63–0.98), but Asian Indians had higher odds (aOR = 1.85, 1.48–2.31). Compared with Chinese, odds of premature hypertension was higher for Asian Indians (aOR = 2.39, 1.74–3.27), Filipinos (aOR = 1.53, 1.16–2.04), and ‘other Asians’ (OR = 1.32, 1.03–1.70; aOR = 1.59, 1.20–2.10). Overall prevalence of hypertension was lower among Asian Indians (aOR = 0.52, 0.46–0.58) and ‘other Asians’ (aOR = 0.74, 0.68–0.79) compared with Whites. Conclusions There is heterogeneity in the risk of hypertension across Asian Americans by age. Asian Indians and ‘other Asians’ had higher prevalence of premature hypertension and lower prevalence of overall hypertension, which may call for earlier screening for risk factors among these populations. There is heterogeneity in the risk of hypertension across Asian Americans by age. Asian Indians and ‘other Asians’, defined as Japanese, Korean, and Vietnams, have higher prevalence of premature hypertension. Asian Americans with higher prevalence of premature hypertension may benefit from early screening to prevent cardiovascular disease.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Xiaoming Jia
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan Aga Khan University, Karachi, Pakistan
| | - Aneil Bhalla
- Section of Cardiovascular Medicine, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ayesha Khan
- Department of Medicine, Aga Khan University, Karachi, Pakistan Aga Khan University, Karachi, Pakistan
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Salim Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX, USA
- Corresponding author. Baylor College of Medicine 2002 Holcombe Blvd., Houston, TX, 77030, USA.
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Patel NA, Kianoush S, Jia X, Nambi V, Koh S, Patel J, Saeed A, Ahmed AI, Al-Mallah M, Agarwala A, Virani SS, Al Rifai M. Racial/Ethnic Disparities and Determinants of Sufficient Physical Activity Levels. Kans J Med 2022; 15:267-272. [PMID: 36042841 PMCID: PMC9409869 DOI: 10.17161/kjm.vol15.17592] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Adequate physical activity is an integral requirement for achieving cardiovascular health. Physical inactivity is the fourth leading cause of death worldwide. Hence, it is important to identify racial/ethnic groups that are less likely to achieve sufficient physical activity levels, and to address barriers to meeting physical activity requirements. Methods Cross-sectional data from the 2006–2015 National Health Interview Survey (NHIS) were used to compare self-reported sufficient physical activity among different racial/ethnic groups: non-Hispanic (NH) Whites, NH Blacks, NH Asians, and Hispanics in the United States. Sufficient physical activity was defined as ≥ 150 minutes per week of moderate-intensity physical activity, ≥ 75 minutes per week of vigorous-intensity physical activity, or ≥ 150 minutes per week of moderate and vigorous physical activity. Results The study sample consisted of 296,802 individuals, mean age ± standard error age 46.4 ± 0.10 years, 52% women, 70% NH White, 12% NH Black, 5% NH Asian, and 14% Hispanic. The prevalence of sufficient physical activity in the overall population was 46%, while it was 48% among NH Whites, 39% among NH Blacks, 45% among NH Asians, and 40% among Hispanics. In multivariable-adjusted models (odds ratio; 95% confidence interval), NH Blacks (0.79; 0.64,0.97), NH Asians (0.72; 0.62,0.85) and Hispanics (0.71; 0.61,0.82) were significantly less likely to engage in sufficient physical activity compared with NH Whites. Older age, women, and low income were inversely associated with sufficient physical activity, while a college education or higher was associated directly with it. Conclusions NH Black and Asian Americans and Hispanic adults were less likely to engage in sufficient physical activity levels compared with Whites. It is important to address barriers to meeting physical activity thresholds to help achieve optimal cardiovascular health.
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Affiliation(s)
| | - Sina Kianoush
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Xiaoming Jia
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Vijay Nambi
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Stephanie Koh
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Jaideep Patel
- Johns Hopkins Heart Center at Greater Baltimore Medical Center, Baltimore, MD
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Anum Saeed
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Mouaz Al-Mallah
- Houston Methodist Debakey Heart& Vascular Center, Houston, TX
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Division of Cardiology, Baylor Scott & White Medical Center, Plano, TX
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Mahmoud Al Rifai
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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Thompson ZM, Jain V, Chen YH, Kayani W, Patel A, Kianoush S, Medhekar A, Khan SU, George J, Petersen LA, Virani SS, Al Rifai M. State-Level Social Vulnerability Index and Healthcare Access in Patients With Atherosclerotic Cardiovascular Disease (from the BRFSS Survey). Am J Cardiol 2022; 178:149-153. [PMID: 35787337 DOI: 10.1016/j.amjcard.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Abstract
We analyzed the association between social vulnerability index (SVI) and healthcare access among patients with atherosclerotic cardiovascular disease (ASCVD). Using cross-sectional data from the Behavioral Risk Factor Surveillance System 2016 to 2019, we identified measures related to healthcare access in individuals with ASCVD, which included healthcare coverage, presence of primary care clinician, duration since last routine checkup, delay in access to healthcare, inability to see doctor because of cost, and cost-related medication nonadherence. We analyzed the association of state-level SVI (higher SVI denotes higher social vulnerability) and healthcare access using multivariable-adjusted logistic regression models. The study population comprised 203,347 individuals aged 18 years or older who reported a history of ASCVD. In a multivariable-adjusted analysis, prevalence odds ratios (95% confidence interval) for participants residing in states in the third tertile of SVI compared with those in the first tertile (used as reference) were as follows: absence of healthcare coverage = 1.03 (0.85 to 1.24), absence of primary care clinician = 1.33 (1.12 to 1.58), >1 year since last routine checkup = 1.09 (0.96 to 1.23), delay in access to healthcare = 1.39 (1.18, 1.63), inability to see a doctor because of cost = 1.21 (1.06 to 1.40), and cost-related medication nonadherence = 1.10 (0.83 to 1.47). In conclusion, SVI is associated with healthcare access in those with pre-existing ASCVD. Due to the ability of SVI to simultaneously and holistically capture many of the factors of social determinants of health, SVI can be a useful measure for identifying high-risk populations.
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Affiliation(s)
| | - Vardhmaan Jain
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Yu Han Chen
- Weill Cornell Medical College, New York, New York
| | - Waleed Kayani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashley Patel
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ankit Medhekar
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Jerin George
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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Kianoush S, Al-Rifai M, Kalra A, Bk A, Mehta A, Sadaf MI, Misra A, Khalid U, Lavie CJ, Kayani WT, Virani SS. Use of preventive cardiovascular health care among Asian American individuals: A National Health Interview Survey Study. Curr Probl Cardiol 2022:101241. [PMID: 35513186 DOI: 10.1016/j.cpcardiol.2022.101241] [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] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
The risk of atherosclerotic cardiovascular disease (ASCVD) varies across Asian Americans. Heterogeneity in preventive health care use may have a role in health disparity across Asian American populations. We included 318,069 White, Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) participants with and without self-reported history of ASCVD or ASCVD risk factors (including hypertension, hypercholesterolemia, and diabetes) from 2006-2018 National Health Interview Survey (NHIS). We used multivariable logistic regression models adjusted for age, sex, US birth, education, insurance coverage, and a comorbidity score to assess the association between Asian American race/ethnicity and annual health care use. Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Of the total, 187,093 participants did not report ASCVD or ASCVD risk factors (mean age, 40.2 ± 0.1 y; 52% women), and 130,976 participants reported ASCVD or ASCVD risk factors (mean age, 58.3 ± 0.9 y; 49.5% women). Compared with White individuals, among the group without ASCVD or ASCVD risk factors (N=187,093), 'other Asian' adults were less likely to visit general practitioner (aOR=0.80, 0.72-0.89), or check blood pressure (aOR=0.77, 0.66-0.89), blood cholesterol (aOR=0.80, 0.70-0.92), and fasting blood sugar (aOR=0.73, 0.63-0.84). Among participants with ASCVD or ASCVD risk factors (N=130,976), Asian Indian adults were more likely to visit general practitioner (aOR=1.29, 1.01-1.66), or check blood pressure (aOR=1.27, 0.83-1.96), blood cholesterol (aOR=1.46, 1.00-2.15), and fasting blood sugar (aOR=1.49, 1.11-1.99). Annual preventive health care use is heterogenous across the Asian American populations.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Mahmoud Al-Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Anupama Bk
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Murrium I Sadaf
- Division of Cardiology, University of Arkansas Medical Center, Little Rock, AR
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Umair Khalid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Waleed T Kayani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX.
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Kianoush S, Al Rifai M, Patel J, George J, Gulati M, Taub P, Moran T, Shapiro MD, Agarwala A, Ullah W, Lavie CJ, Bittner V, Ballantyne CM, Virani SS. Association of participation in Cardiac Rehabilitation with Social Vulnerability Index: The behavioral risk factor surveillance system. Prog Cardiovasc Dis 2022; 71:86-91. [PMID: 35182577 DOI: 10.1016/j.pcad.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify whether social vulnerability is associated with low cardiac rehabilitations (CR) use, a Class I recommendation by current treatment guidelines following acute myocardial infarction (AMI). METHODS We performed this cross-sectional study using the 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey. The Centers for Disease Control and Prevention Social Vulnerability Index (CDC SVI) was calculated using 15 social risk factors from 4 main themes including socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. A higher SVI indicates higher social vulnerability. We used multivariable logistic regression models to evaluate the association of CR use with state-level SVI adjusted for demographic, behavioral, socioeconomic, and comorbidity variables. RESULTS A total 2093 participants with history of AMI were included. Out of total, 61.7% were older than 65 years, 42.5% female, 72.5% White, and 42.4% used CR. Participation in CR was lower among females (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.44-0.91), those without a primary care physician (OR, 0.45; 95% CI, 0.23-0.87), and higher with college degree education (OR, 1.95; 95% CI, 1.06-3.59). CR use decreased with increasing SVI tertiles (1st =61%, 2nd =52%, and 3rd =35%). Compared with those residing in states in the 1st tertile, CR use was lower in the 2nd (OR, 0.68; 95% CI, 0.47-0.98) and 3rd (OR, 0.33; 95% CI 0.23-0.48) SVI tertiles. CONCLUSION CR use following AMI is low and is associated with social vulnerability. Identifying social risk factors may help improve access to care among vulnerable populations.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jaideep Patel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Jerin George
- Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Tyler Moran
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anandita Agarwala
- Department of Medicine, Division of Cardiology, Baylor Scott and White, The Health Heart Hospital Baylor Plano, 1100 Allied Dr., Plano, TX 75093, USA
| | - Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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13
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Kianoush S, Rifai MA, Jain V, Samad Z, Rana J, Dodani S, Jia X, Lee M, Khan SU, Gupta K, Lavie CJ, Wong SS, Palla AH, Virani S. Prevalence and predictors of premature coronary heart disease among Asians in the United States: A National Health Interview Survey Study. Curr Probl Cardiol 2022; 48:101152. [DOI: 10.1016/j.cpcardiol.2022.101152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
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14
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Kherallah RY, Al Rifai M, Liu J, Kianoush S, Misra A, Virani SS. Mental Health and Access to Medical Care in Patients with Chronic Cardiovascular Conditions: An Analysis of the Behavior Risk Factor Surveillance System. Kans J Med 2022; 15:17-21. [PMID: 35106118 PMCID: PMC8765506 DOI: 10.17161/kjm.vol15.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Poor mental health is associated with worse outcomes for chronic diseases. It is unclear whether mental illness predisposes to difficulties with healthcare access. Methods Using a combined dataset of the 2016–2019 Behavioral Risk Factor Surveillance System, this study focused on individuals who reported a chronic cardiovascular condition. Weighted multivariable logistic regression analyses were used to explore the association between domains of mental health and measures of healthcare access including delaying medical care, more than one year since last routine checkup, lack of a primary care physician, and cost-related medication nonadherence. Results Among 1,747,397 participants, 27% had a chronic cardiovascular condition, 12% had clinical depression, and 12% had poor mental health. Those with poor mental health (OR 3.20 [3.08 – 3.33]) and clinical depression (OR 2.43 [2.35 – 2.52]) were more likely to report delays in medical care. Those with greater stress frequency (OR 8.47 [6.84 – 10.49] stressed all of the time), lower levels of emotional support received (OR 3.07 [2.21 – 4.26] rarely get needed emotional support), and greater life dissatisfaction (6.66 [4.14 – 10.70] very dissatisfied) reported greater delays in medical care. Conclusions Individuals with poor mental health have greater difficulty accessing medical care independent of socioeconomic variables.
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Affiliation(s)
| | - Mahmoud Al Rifai
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Jing Liu
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Sina Kianoush
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Arunima Misra
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
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Rifai MA, Mahtta D, Kherallah R, Kianoush S, Liu J, Rodriguez F, Nasir K, Elizondo JV, Khan S, Ballantyne C, Petersen L, Virani S. PREVALENCE AND DETERMINANTS OF DIFFICULTY ACCESSING MEDICAL CARE IN ADULTS WITH CHRONIC DISEASE RESULTS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) SURVEY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02850-3] [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: 10/21/2022]
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Al Rifai M, Kianoush S, Saeed A, Krittanawong C, Merchant AT, Virani SS. Temporal Trends in the Prevalence of Current E-Cigarette and Cigarette Use by Annual Household Income from 2016 to 2018 (from the Behavioral Risk Factor Surveillance System [BRFSS] Survey). Am J Cardiol 2020; 137:139-140. [PMID: 33080211 DOI: 10.1016/j.amjcard.2020.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
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Osei AD, Uddin SMI, Dzaye O, Achirica MC, Dardari ZA, Obisesan OH, Kianoush S, Mirbolouk M, Orimoloye OA, Shaw L, Rumberger JA, Berman D, Rozanski A, Miedema MD, Budoff MJ, Vasan RS, Nasir K, Blaha MJ. Predictors of coronary artery calcium among 20-30-year-olds: The Coronary Artery Calcium Consortium. Atherosclerosis 2020; 301:65-68. [PMID: 32330692 DOI: 10.1016/j.atherosclerosis.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS We sought to understand the risk factor correlates of very early coronary artery calcium (CAC), and the potential investigational value of CAC phenotyping in adults aged 20-30 years. METHODS We studied all participants aged 20-30 years at baseline (N = 373) in the Coronary Artery Calcium Consortium, a large multi-center cohort study of patients aged 18 years or older without known atherosclerotic cardiovascular disease (ASCVD) at baseline, referred for CAC scoring for clinical risk stratification. We described the prevalence of CAC in men and women, the frequency of risk factors by the presence of CAC (CAC = 0 vs CAC >0), and assessed the association between traditional non-demographic CVD risk factors (hypertension, hyperlipidemia, smoking, family history of CHD, and diabetes) and prevalent CAC, using age- and sex-adjusted logistic regression models. RESULTS The mean age of the study participants was 27.5 ± 2.4 years; 324 (86.9%) had CAC = 0, and 49 (13.1%) had CAC >0. Among the 49 participants with CAC, 38 (77.6%) were men, and median CAC score was low at 4.6. In age- and sex-adjusted models, there was a graded increase in the odds of CAC >0 with increasing traditional cardiovascular disease (CVD) risk factor burden (p = 0.001 for linear trend). Participants with ≥3 traditional risk factors had a statistically significant higher odds of having prevalent CAC (OR 5.57, 95% CI; 1.82-17.03) compared to participants with no risk factors. CONCLUSIONS Our study demonstrates the non-negligible prevalence of CAC among very high-risk young US adults, reinforcing the critical importance of traditional risk factors in the earliest development of detectable subclinical ASCVD.
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Affiliation(s)
| | | | - Omar Dzaye
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | - Alan Rozanski
- Division of Cardiology, Mount Sinai St, Luke's Hospital, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minnesota, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, LA, California, USA
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Shan R, Yanek LR, Silverman-Lloyd LG, Kianoush S, Blaha MJ, German CA, Graham GN, Martin SS. Using Mobile Health Tools to Assess Physical Activity Guideline Adherence and Smoking Urges: Secondary Analysis of mActive-Smoke. JMIR Cardio 2020; 4:e14963. [PMID: 31904575 PMCID: PMC6971509 DOI: 10.2196/14963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/30/2019] [Accepted: 11/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background Rates of cigarette smoking are decreasing because of public health initiatives, pharmacological aids, and clinician focus on smoking cessation. However, a sedentary lifestyle increases cardiovascular risk, and therefore, inactive smokers have a particularly enhanced risk of cardiovascular disease. Objective In this secondary analysis of mActive-Smoke, a 12-week observational study, we investigated adherence to guideline-recommended moderate-to-vigorous physical activity (MVPA) in smokers and its association with the urge to smoke. Methods We enrolled 60 active smokers (≥3 cigarettes per day) and recorded continuous step counts with the Fitbit Charge HR. MVPA was defined as a cadence of greater than or equal to 100 steps per minute. Participants were prompted to report instantaneous smoking urges via text message 3 times a day on a Likert scale from 1 to 9. We used a mixed effects linear model for repeated measures, controlling for demographics and baseline activity level, to investigate the association between MVPA and urge. Results A total of 53 participants (mean age 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite, and 38% [20/53] obese) recorded 6 to 12 weeks of data. Data from 3633 person-days were analyzed, with a mean of 69 days per participant. Among all participants, median daily MVPA was 6 min (IQR 2-13), which differed by sex (12 min [IQR 3-20] for men vs 3.5 min [IQR 1-9] for women; P=.004) and BMI (2.5 min [IQR 1-8.3] for obese vs 10 min [IQR 3-15] for nonobese; P=.04). The median total MVPA minutes per week was 80 (IQR 31-162). Only 10% (5/51; 95% CI 4% to 22%) of participants met national guidelines of 150 min per week of MVPA on at least 50% of weeks. Adjusted models showed no association between the number of MVPA minutes per day and mean daily smoking urge (P=.72). Conclusions The prevalence of MVPA was low in adult smokers who rarely met national guidelines for MVPA. Given the poor physical activity attainment in smokers, more work is required to enhance physical activity in this population.
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Affiliation(s)
- Rongzi Shan
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States
| | - Lisa R Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Luke G Silverman-Lloyd
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,University of California, Berkeley-University of California, San Francisco Joint Medical Program, Berkeley, CA, United States
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Yale New Haven Medical Center - Waterbury Hospital, Waterbury, CT, United States
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Charles A German
- Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC, United States
| | | | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Mirbolouk M, Kianoush S, Dardari Z, Miedema MD, Shaw LJ, Rumberger JA, Berman DS, Budoff MJ, Rozanski A, Al-Mallah MH, McEvoy JW, Nasir K, Blaha MJ. The association of coronary artery calcium score and mortality risk among smokers: The coronary artery calcium consortium. Atherosclerosis 2019; 294:33-40. [PMID: 31951880 DOI: 10.1016/j.atherosclerosis.2019.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/29/2019] [Accepted: 12/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) and cancer are the two leading causes of death in smokers. Lung cancer screening is recommended in a large proportion of smokers. We examined the implication of coronary artery calcium (CAC) score (quantitative and qualitative) for cardiovascular disease (CVD), coronary heart disease (CHD), and cancer mortality risk prediction among current smokers. METHODS We included current smokers without known heart disease from the CAC Consortium. Cox regression (for all-cause mortality) and Fine-and-Gray competing-risk regression (for CVD, CHD, and cancer mortality) models, adjusted for traditional CVD risk factors, were used to assess the association between CAC and each mortality outcome, with CAC as a continuous (log2-transformed) or categorical variable (CAC = 0, CAC = 1-99, CAC = 100-399, and CAC ≥400). We used number of vessels with CAC as a surrogate for the qualitative measure of CAC and mortality outcomes. Analyses were repeated for lung cancer screening-eligible population (defined as ever smokers with >30 pack years smoking history) (n = 1,149). Hazard ratios (HR) for all-cause mortality and Subdistribution HRs (sHR) with 95% confidence intervals (CI) were reported. RESULTS Over a median of 11.9 years (25th-75th percentile: 10.2-13.3) of follow-up, of 5,147 current smokers (mean age 52.5 ± 9.4, 32.4% women) 337 died (102 of CVD, 54 of CHD, and 123 of cancer). A doubling of CAC score was associated with increased HRs of all-cause mortality (1.10 (1.06-1.14)), and sHRs for CVD (1.15 (1.07-1.24)), CHD (1.26 (1.11-1.42)) and cancer mortality (1.06 (1.00-1.13)). Those with CAC ≥400 had increased sHR of CVD (3.55 (1.70-7.41)), CHD (8.80 (2.41-32.10)), and cancer mortality (1.85 (1.07-3.22)), compared with those with CAC = 0. A diffuse CAC pattern significantly increased the risk of all-cause, CVD, and CHD mortality among smokers. Results were consistent for the lung cancer screening-eligible population. CONCLUSIONS Qualitative and quantitative CAC scores can prognosticate risk of all-cause, CVD, CHD, and cancer mortality beyond traditional risk factors among all smokers as well as those eligible for lung cancer screening.
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Affiliation(s)
- Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Yale University School of Medicine, New Haven, CT, United States
| | - Sina Kianoush
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Yale University School of Medicine, New Haven, CT, United States
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Leslee J Shaw
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, United States
| | - Alan Rozanski
- Department of Medicine, St. Luke's Roosevelt Hospital, New York, NY, United States
| | | | - John W McEvoy
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Center for Outcomes Research and Evaluation (CORE), Section of Cardiovascular Medicine, Yale University School of Medicine, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States.
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Quispe R, Al-Rifai M, Di Carlo PA, Michos ED, Amin NP, Kianoush S, Handy CE, McEvoy JW, Blaha MJ, Nasir K, Blumenthal RS, Tota-Maharaj R, Lima JA, Comin-Colet J, Cainzos-Achirica M. Breast Arterial Calcium. JACC Cardiovasc Imaging 2019; 12:2538-2548. [DOI: 10.1016/j.jcmg.2018.07.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 12/22/2022]
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Uddin SMI, Mirbolouk M, Kianoush S, Orimoloye OA, Dardari Z, Whelton SP, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Berman DS, Budoff MJ, McEvoy JW, Matsushita K, Blaha MJ, Graham G. Role of Coronary Artery Calcium for Stratifying Cardiovascular Risk in Adults With Hypertension. Hypertension 2019; 73:983-989. [PMID: 30879359 DOI: 10.1161/hypertensionaha.118.12266] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We examined the utility of coronary artery calcium (CAC) for cardiovascular risk stratification among hypertensive adults, including those fitting eligibility for SPRINT (Systolic Blood Pressure Intervention Trial). Additionally, we used CAC to identify hypertensive adults with cardiovascular disease (CVD) mortality rates equivalent to those observed in SPRINT who may, therefore, benefit from the most intensive blood pressure therapy. Our study population included 16 167 hypertensive patients from the CAC Consortium, among whom 6375 constituted a "SPRINT-like" population. We compared multivariable-adjusted hazard ratios of coronary heart disease and CVD deaths by CAC category (0, 1-99, 100-399, ≥400). Additionally, we generated a CAC-CVD mortality curve for patients aged >50 years to determine what CAC scores were associated with CVD death rates observed in SPRINT. Mean age was 58.1±10.6 years. During a mean follow-up of 11.6±3.6 years, there were 409 CVD deaths and 207 coronary heart disease deaths. Increasing CAC scores were associated with increased coronary heart disease and CVD mortality (coronary heart disease-CAC 100-399: hazard ratio [95% CI] 1.88 [1.04-3.40], CAC ≥400: 4.16 [2.34-7.39]; CVD-CAC 100-399: 1.93 [1.31-2.83], CAC ≥400: 3.51 [2.40-5.13]). A similar increased risk was observed across 10-year atherosclerotic CVD risk categories and in the SPRINT-like population. A CAC score of 220 (confidence range, 165-270) was associated with the CVD mortality rate observed in SPRINT. CAC risk stratifies adults with hypertension, including those who are SPRINT eligible. A CAC score of 220 can identify hypertensive adults with SPRINT-level CVD mortality risk and, therefore, may be reasonable for identifying candidates for aggressive blood pressure therapy.
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Affiliation(s)
- S M Iftekhar Uddin
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Mohammadhassan Mirbolouk
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Sina Kianoush
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Olusola A Orimoloye
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Zeina Dardari
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Seamus P Whelton
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.)
| | | | | | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.)
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA (D.S.B.)
| | - Matthew J Budoff
- David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance (M.J.B.)
| | - John W McEvoy
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.)
| | - Michael J Blaha
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., S.K., O.A.O., Z.D., S.P.W., J.W.M., M.J.B.)
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22
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Watson M, Dardari Z, Kianoush S, Hall ME, DeFilippis AP, Keith RJ, Benjamin EJ, Rodriguez CJ, Bhatnagar A, Lima JA, Butler J, Blaha MJ, Rifai MA. Relation Between Cigarette Smoking and Heart Failure (from the Multiethnic Study of Atherosclerosis). Am J Cardiol 2019; 123:1972-1977. [PMID: 30967285 PMCID: PMC6529241 DOI: 10.1016/j.amjcard.2019.03.015] [Citation(s) in RCA: 15] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 12/18/2022]
Abstract
We studied the association between cigarette smoking and incident heart failure (HF) in a racially diverse US cohort. We included 6,792 participants from the Multi-Ethnic Study of Atherosclerosis with information on cigarette smoking at baseline, characterized by status, intensity, burden, and time since quitting. Adjudicated outcomes included total incident HF cases and HF stratified by ejection fraction (EF) into HF with reduced EF (HFrEF; EF ≤ 40%) and preserved EF (HFpEF; EF ≥ 50%). We used Cox proportional hazards models adjusted for traditional cardiovascular risk factors and accounted for competing risk of each HF type. Mean age was 62 ± 10 years; 53% were women, 61% were nonwhite, and 13% were current smokers. A total of 279 incident HF cases occurred over a median follow-up of 12.2 years. The incidence rates of HFrEF and HFpEF were 2.2 and 1.9 cases per 1000 person-years, respectively. Current smoking was associated with higher risk of HF compared with never smoking (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.36 to 3.09); this was similar for HFrEF (HR, 2.58; 95% CI, 1.27 to 5.25) and HFpEF (HR, 2.51; 95% CI, 1.15 to 5.49). Former smoking was not significantly associated with HF (HR, 1.17; 95% CI, 0.88 to 1.56). Smoking intensity, burden, and time since quitting did not provide additional information for HF risk after accounting for smoking status.
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Affiliation(s)
- Megan Watson
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Zeina Dardari
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Sina Kianoush
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Medicine, Yale-Waterbury, Waterbury, Connecticut
| | - Michael E Hall
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew P DeFilippis
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rachel J Keith
- Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Emelia J Benjamin
- Department of Medicine, Division of Cardiology, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Carlos J Rodriguez
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina
| | - Aruni Bhatnagar
- Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Joao A Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Mahmoud Al Rifai
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Medicine, University of Kansas School of Medicine, Wichita, Kansas.
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23
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Shan R, Yanek LR, Silverman-Lloyd LG, Kianoush S, Blaha MJ, Martin SS. Abstract 278: Using mHealth to Assess Physical Activity Guideline Adherence in Smokers: A Secondary Analysis of mActive-Smoke. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.278] [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: 11/16/2022]
Abstract
Background:
Rates of cigarette smoking are decreasing due to public health initiatives, pharmacological aids, and clinician focus on smoking cessation. However, a sedentary lifestyle increases cardiovascular risk and therefore inactive smokers have a particularly enhanced risk of cardiovascular disease. We previously linked acute bouts of physical activity, but not total daily steps, to a decreased urge to smoke. In this secondary analysis, we investigate adherence to guideline-recommended moderate-vigorous physical activity (MVPA) in smokers and its association with urge to smoke.
Methods:
We enrolled 60 active smokers (≥3 cigarettes/day) and recorded free-living continuous step counts with the Fitbit Charge HR. MVPA was defined as cadence ≥100 steps/min. Participants were prompted to report instantaneous smoking urges via text message 3 times a day, on a Likert scale from 1 to 9. The Wilcoxon rank-sum test was used to test between-group differences in MVPA. A mixed-effects linear model for repeated measures, controlling for demographics and baseline activity level, was used to investigate the association between MVPA and urge.
Results:
Fifty-three participants (aged 40 ± 12 years, 57% [30/53] women, 49% [26/53] nonwhite, 38% [20/53] obese) recorded at least 6 weeks of data and were thus included; 3,633 days were analyzed, with a mean of 69 days per participant. Among all participants, median daily MPVA was 6 minutes (IQR 2-13), and this differed by sex (12 min [IQR 3-20] for men versus 3.5 min [IQR 1-9] for women, p=0.004) and BMI (2.5 min [IQR 1-8.25] for obese versus 10 min [IQR 3-15] for non-obese, p=0.035). The median daily MVPA minutes was poorly correlated with self-report via the International Physical Activity Questionnaire (Spearman’s coefficient -0.162, p=0.25). Thirty-one out of 53 (58%) participants ever obtained 30 min/day of MVPA over the study duration, and these 31 participants obtained 30 min/day MVPA on a mean of 19% of days. Only 15/53 (28%) participants met the national guidelines of 150 min/week of MVPA at least once throughout the study, and the median total MVPA per week was 80 minutes (IQR 31-162). Adjusted models showed no association between the number of MVPA minutes per day and mean daily smoking urge (p=0.72).
Conclusion:
In this 12-week study of adult smokers, the prevalence of MVPA was low and participants rarely met national guidelines for physical activity. Given poor attainment of guideline-recommended physical activity goals and the dual cardiovascular risk of inactivity and smoking, more work is required to address risk factors in smokers through promotion of physical activity.
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Affiliation(s)
- Rongzi Shan
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Lisa R Yanek
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
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24
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Mirbolouk M, Charkhchi P, Orimoloye OA, Uddin SMI, Kianoush S, Jaber R, Bhatnagar A, Benjamin EJ, Hall ME, DeFilippis AP, Maziak W, Nasir K, Blaha MJ. E-Cigarette Use Without a History of Combustible Cigarette Smoking Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med 2019; 170:76-79. [PMID: 30304466 DOI: 10.7326/m18-1826] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mohammadhassan Mirbolouk
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
| | - Paniz Charkhchi
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, and University of Michigan, Ann Arbor, Michigan (P.C.)
| | - Olusola A Orimoloye
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
| | - S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, and Yale University School of Medicine, New Haven, Connecticut (S.K.)
| | - Rana Jaber
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Robert Stempel College of Public Health, Florida International University, Miami, Florida (R.J.)
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky (A.B.)
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Boston University School of Medicine, Boston University School of Public Health, Boston, Massachusetts (E.J.B.)
| | - Michael E Hall
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Mississippi Medical Center, Jackson, Mississippi (M.E.H.)
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, Kentucky (A.P.D.)
| | - Wasim Maziak
- Robert Stempel College of Public Health, Florida International University, Miami, Florida, and Syrian Center for Tobacco Studies, Aleppo, Syria (W.M.)
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, New Haven, Connecticut, Population Health & Health Systems Research, Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut; and Robert Stempel College of Public Health, Florida International University, Miami, Florida (K.N.)
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland (M.M., O.A.O., S.I.U., M.J.B.)
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25
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Kianoush S, DeFilippis AP, Rodriguez CJ, Rifai MA, Benjamin EJ, Hall ME, Ouyang P, Allison MA, Blaha MJ. Race/Ethnicity-Specific Associations between Smoking, Serum Leptin, and Abdominal Fat: The Multi-Ethnic Study of Atherosclerosis. Ethn Dis 2018; 28:531-538. [PMID: 30405297 DOI: 10.18865/ed.28.4.531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Smoking is a well-known cardiovascular risk factor associated with weight loss. We aimed to evaluate the association between smoking, serum leptin levels, and abdominal fat. Design Cross-sectional. Setting Data from examinations 2 or 3 (2002-2005) of the Multi-Ethnic Study of Atherosclerosis (MESA). Participants 1,875 asymptomatic, community-dwelling adults. Main Outcome Measures We used multivariable linear regression models to assess the race/ethnicity-specific associations between smoking, serum logeleptin levels, and computed tomography ascertained abdominal fat. Results were adjusted for demographic and relevantclinical covariates. Results Participants (mean age 64.5±9.6 years; 50.6% women; 42.2% former, 11.4% current smokers) were White (40.1%), Hispanic (25.8%), African American (21.1%), and Chinese (13.0%). Overall, median (25th - 75th percentile) leptin levels were significantly lower among current (11.14 ng/mL; 4.13 - 26.18) and former smokers (11.68 ng/mL; 4.72 - 27.57), as compared with never smokers (15.61 ng/mL; 3.05 - 30.12) (P<.001). The difference in median leptin levels between current and never smokers were significantly higher for Hispanics (Δ9.64 ng/mL) and African Americans (Δ8.81 ng/mL) than Whites (Δ2.10 ng/mL) and Chinese (Δ4.70 ng/mL) (P<.001). After adjustment for total abdominal fat, loge-leptin levels remained lower for former (-.14 [-.22 - -.07]) and current (-.17 [-.28 - -.05]) smokers, compared with never smokers. Results differed by race/ethnicity, with significantly lower loge-leptin levels observed only among current and former African Americans and Hispanic smokers, compared with their never smoker counterparts. (Ps for interaction <.05). Conclusions Among smokers, leptin levels significantly vary by race/ethnicity. Former and current smoking are associated with lower leptin levels, although this may be restricted to Hispanics and African Americans.
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Affiliation(s)
- Sina Kianoush
- Yale University, Department of Internal Medicine, New Haven, CT
| | | | - Carlos J Rodriguez
- Wake Forest School of Medicine, Department of Public Health Sciences, Winston Salem, NC
| | - Mahmoud Al Rifai
- University of Kansas School of Medicine, Department of Internal Medicine, Wichita, KS
| | | | - Michael E Hall
- University of Mississippi Medical Center, Department of Cardiology, Jackson, MS
| | - Pamela Ouyang
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD
| | - Matthew A Allison
- University of California-San Diego, Department of Family Medicine / Public Health, La Jolla, CA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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26
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Mirbolouk M, Charkhchi P, Kianoush S, Uddin SMI, Orimoloye OA, Jaber R, Bhatnagar A, Benjamin EJ, Hall ME, DeFilippis AP, Maziak W, Nasir K, Blaha MJ. Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med 2018; 169:429-438. [PMID: 30167658 PMCID: PMC10534294 DOI: 10.7326/m17-3440] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Contemporary data on the prevalence of e-cigarette use in the United States are limited. Objective To report the prevalence and distribution of current e-cigarette use among U.S. adults in 2016. Design Cross-sectional. Setting Behavioral Risk Factor Surveillance System, 2016. Participants Adults aged 18 years and older. Measurements Prevalence of current e-cigarette use by sociodemographic groups, comorbid medical conditions, and states of residence. Results Of participants with information on e-cigarette use (n = 466 842), 15 240 were current e-cigarette users, representing a prevalence of 4.5%, which corresponds to 10.8 million adult e-cigarette users in the United States. Of the e-cigarette users, 15% were never-cigarette smokers. The prevalence of current e-cigarette use was highest among persons aged 18 to 24 years (9.2% [95% CI, 8.6% to 9.8%]), translating to approximately 2.8 million users in this age range. More than half the current e-cigarette users (51.2%) were younger than 35 years. In addition, the age-standardized prevalence of e-cigarette use was high among men; lesbian, gay, bisexual, and transgender (LGBT) persons; current combustible cigarette smokers; and those with chronic health conditions. The prevalence of e-cigarette use varied widely among states, with estimates ranging from 3.1% (CI, 2.3% to 4.1%) in South Dakota to 7.0% (CI, 6.0% to 8.2%) in Oklahoma. Limitation Data were self-reported, and no biochemical confirmation of tobacco use was available. Conclusion E-cigarette use is common, especially in younger adults, LGBT persons, current cigarette smokers, and persons with comorbid conditions. The prevalence of use differs across states. These contemporary estimates may inform researchers, health care policymakers, and tobacco regulators about demographic and geographic distributions of e-cigarette use. Primary Funding Source American Heart Association Tobacco Regulation and Addiction Center, which is funded by the U.S. Food and Drug Administration and National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Mohammadhassan Mirbolouk
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
| | - Paniz Charkhchi
- Johns Hopkins University, Baltimore, Maryland, and University of Michigan, Ann Arbor, Michigan (P.C.)
| | - Sina Kianoush
- Johns Hopkins University, Baltimore, Maryland, and Yale University School of Medicine, New Haven, Connecticut (S.K.)
| | - S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
| | - Olusola A Orimoloye
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
| | - Rana Jaber
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Florida International University, Miami, Florida (R.J.)
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, Kentucky (A.B., A.P.D.)
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Boston University, Boston, Massachusetts (E.J.B.)
| | - Michael E Hall
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Mississippi Medical Center, Jackson, Mississippi (M.E.H.)
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, Kentucky (A.B., A.P.D.)
| | - Wasim Maziak
- Florida International University, Miami, Florida, and Syrian Center for Tobacco Studies, Aleppo, Syria (W.M.)
| | - Khurram Nasir
- Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, New Haven, Connecticut, and Florida International University, Miami, Florida and Population Health & Health Systems Research, Center for Outcomes Research and Evaluation (CORE), Section of Cardiovascular Medicine, Yale University School of Medicine. (K.N.)
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
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Miedema MD, Dardari ZA, Kianoush S, Virani SS, Yeboah J, Knickelbine T, Sandfort V, Rodriguez CJ, Nasir K, Blaha MJ. Statin Eligibility, Coronary Artery Calcium, and Subsequent Cardiovascular Events According to the 2016 United States Preventive Services Task Force (USPSTF) Statin Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Heart Assoc 2018; 7:JAHA.118.008920. [PMID: 29899017 PMCID: PMC6220526 DOI: 10.1161/jaha.118.008920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background The potential impact of the 2016 United States Preventive Services Task Force (USPSTF) guidelines on statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) warrants further analysis. Methods and Results We studied participants from MESA (Multi‐Ethnic Study of Atherosclerosis) aged 40 to 75 years and not on statins. We compared statin eligibility at baseline (2000–2002) and over follow‐up between USPSTF and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Coronary artery calcium (CAC) was measured at baseline. Absolute ASCVD event rates were calculated according to eligibility categories for each guideline. Among 4962 MESA participants (aged 59.3±8.8 years, 47.2% female), compared with ACC/AHA guidelines, baseline statin eligibility by USPSTF was significantly lower (34.4% versus 49.1%) and increased less over time (39.1% versus 59.1%) at examination 5 [years 2010–2012]). Compared with ACC/AHA, participants eligible by USPSTF were less likely to have zero CAC at baseline (36.6% versus 41.2%) and had higher rates of hard ASCVD events per 1000 person‐years (11.6 [95% confidence interval, 10.2–13.3] versus 10.0 [8.9–11.3]). The hard ASCVD event rate in those eligible by ACC/AHA but not USPSTF was 6.5 (4.9–8.5) events per 1000 person‐years, with the rate varying significantly according to baseline CAC (4.2 [2.7–6.7] events in those with CAC=0, 12.8 [8.3–19.9] events in those with CAC >100). Conclusions In MESA, compared with ACC/AHA, the USPSTF statin guidelines resulted in a 15% absolute decrease in eligibility. Participants with discordant eligibility had ASCVD rates that varied significantly according to baseline CAC, suggesting CAC could aid clinical decision making for statins in these individuals.
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Affiliation(s)
- Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Zeina A Dardari
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Joseph Yeboah
- Department of Cardiology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Thomas Knickelbine
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Veit Sandfort
- Department of Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD
| | | | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.,Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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Silverman-Lloyd LG, Kianoush S, Blaha MJ, Sabina AB, Graham GN, Martin SS. mActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges. JMIR Mhealth Uhealth 2018; 6:e121. [PMID: 29752250 PMCID: PMC5970286 DOI: 10.2196/mhealth.9292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/27/2017] [Revised: 02/23/2018] [Accepted: 03/20/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Evidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment. OBJECTIVE This study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study. METHODS We enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey. RESULTS A total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=-6.95×10-3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=-.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=-.153 per 1000 steps) and 30-min level (mean individualized beta=-1.66 per 1000 steps). CONCLUSIONS Although there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study.
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Affiliation(s)
- Luke G Silverman-Lloyd
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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29
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Blaha MJ, Mortensen MB, Kianoush S, Tota-Maharaj R, Cainzos-Achirica M. Coronary Artery Calcium Scoring: Is It Time for a Change in Methodology? JACC Cardiovasc Imaging 2018; 10:923-937. [PMID: 28797416 DOI: 10.1016/j.jcmg.2017.05.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [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: 04/11/2017] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023]
Abstract
Quantification of coronary artery calcium (CAC) has been shown to be reliable, reproducible, and predictive of cardiovascular risk. Formal CAC scoring was introduced in 1990, with early scoring algorithms notable for their simplicity and elegance. Yet, with little evidence available on how to best build a score, and without a conceptual model guiding score development, these scores were, to a large degree, arbitrary. In this review, we describe the traditional approaches for clinical CAC scoring, noting their strengths, weaknesses, and limitations. We then discuss a conceptual model for developing an improved CAC score, reviewing the evidence supporting approaches most likely to lead to meaningful score improvement (for example, accounting for CAC density and regional distribution). After discussing the potential implementation of an improved score in clinical practice, we follow with a discussion of the future of CAC scoring, asking the central question: do we really need a new CAC score?
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Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
| | - Martin Bødtker Mortensen
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Rajesh Tota-Maharaj
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Florida Heart and Vascular Multi-Specialty Group, Leesburg, Florida
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; IDIBELL-Bellvitge Biomedical Research Institute, Barcelona, Spain; RTI Health Solutions, Barcelona, Spain
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30
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Tibuakuu M, Kianoush S, DeFilippis AP, McEvoy JW, Zhao D, Guallar E, Ballantyne CM, Hoogeveen RC, Blaha MJ, Michos ED. Usefulness of Lipoprotein-Associated Phospholipase A 2 Activity and C-Reactive Protein in Identifying High-Risk Smokers for Atherosclerotic Cardiovascular Disease (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2018; 121:1056-1064. [PMID: 29525060 PMCID: PMC5927844 DOI: 10.1016/j.amjcard.2018.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 11/16/2022]
Abstract
Despite the causal role of cigarette smoking in atherosclerotic cardiovascular disease (ASCVD), the underlying mechanisms are not fully understood. We evaluated the joint relation between smoking and inflammatory markers with ASCVD risk. We tested cross-sectional associations of self-reported smoking status (never, former, current) and intensity (packs/day) with lipoprotein-associated phospholipase A2 (Lp-PLA2) activity and high-sensitivity C-reactive protein (hsCRP) in 10,506 Atherosclerosis Risk in Communities participants at Visit 4 (1996 to 1998). Using Cox hazard models adjusted for demographic and traditional ASCVD risk factors, we examined the associations of smoking status and intensity with incident adjudicated ASCVD events (n = 1,745 cases) over an average of 17 years, stratified by Lp-PLA2 and hsCRP categories. Greater packs/day smoked was linearly associated with higher levels of both Lp-PLA2 and hsCRP among current smokers. Compared with never smokers, the hazard ratio for incident ASCVD in current smokers was 2.04 (95% CI 1.76 to 2.35). Among current smokers, the risk for ASCVD per 1 pack/day greater was 1.39 (1.10 to 1.76). Both Lp-PLA2 activity ≥253 nmol/min/ml and hsCRP >3 mg/L identified current smokers at the highest risk for incident ASCVD, with similar hazard ratios. hsCRP risk-stratified current smokers better based on intensity. Among current smokers, hsCRP improved ASCVD prediction beyond traditional risk factors better than Lp-PLA2 (C-statistic 0.675 for hsCRP vs 0.668 for Lp-PLA2, p = 0.001). In this large cohort with long follow-up, we found a dose-response relation between smoking intensity with Lp-PLA2 activity, hsCRP, and ASCVD events. Although both Lp-PLA2 activity and hsCRP categories identified high risk among current smokers, hsCRP may better stratify risk of future ASCVD.
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Affiliation(s)
- Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew P DeFilippis
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland
| | - Christie M Ballantyne
- Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Texas
| | - Ron C Hoogeveen
- Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Texas
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland.
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31
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Gandapur Y, Kianoush S, Kelli HM, Misra S, Urrea B, Blaha MJ, Graham G, Marvel FA, Martin SS. The role of mHealth for improving medication adherence in patients with cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes 2018; 2:237-244. [PMID: 29474713 DOI: 10.1093/ehjqcco/qcw018] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality worldwide, and a key barrier to improved outcomes is medication non-adherence. The aim of this study is to review the role of mobile health (mHealth) tools for improving medication adherence in patients with cardiovascular disease. We performed a systematic search for randomized controlled trials that primarily investigated mHealth tools for improving adherence to cardiovascular disease medications in patients with hypertension, coronary artery disease, heart failure, peripheral arterial disease, and stroke. We extracted and reviewed data on the types of mHealth tools used, preferences of patients and healthcare providers, the effect of the mHealth interventions on medication adherence, and the limitations of trials. We identified 10 completed trials matching our selection criteria, mostly with <100 participants, and ranging in duration from 1 to 18 months. mHealth tools included text messages, Bluetooth-enabled electronic pill boxes, online messaging platforms, and interactive voice calls. Patients and healthcare providers generally preferred mHealth to other interventions. All 10 studies reported that mHealth interventions improved medication adherence, though the magnitude of benefit was not consistently large and in one study was not greater than a telehealth comparator. Limitations of trials included small sample sizes, short duration of follow-up, self-reported outcomes, and insufficient assessment of unintended harms and financial implications. Current evidence suggests that mHealth tools can improve medication adherence in patients with cardiovascular diseases. However, high-quality clinical trials of sufficient size and duration are needed to move the field forward and justify use in routine care.
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Affiliation(s)
- Yousuf Gandapur
- Department of Internal Medicine, Good Samaritan/Union Memorial Hospital, 201 East University Parkway, Baltimore, MD 21218, USA
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Satish Misra
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruno Urrea
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garth Graham
- Aetna Foundation, Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Francoise A Marvel
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Silverman-Lloyd L, Kianoush S, Blaha M, Sabina AB, Graham G, Martin S. MACTIVE-SMOKE: USING MOBILE HEALTH TOOLS TO ASSESS THE ASSOCIATION OF PHYSICAL ACTIVITY WITH SMOKING URGES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32333-7] [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: 10/17/2022]
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White WB, Cain LR, Benjamin EJ, DeFilippis AP, Blaha MJ, Wang W, Okhomina V, Keith RJ, Al Rifai M, Kianoush S, Winniford MD, Robertson RM, Bhatnagar A, Correa A, Hall ME. High-Intensity Cigarette Smoking Is Associated With Incident Diabetes Mellitus In Black Adults: The Jackson Heart Study. J Am Heart Assoc 2018; 7:JAHA.117.007413. [PMID: 29330255 PMCID: PMC5850161 DOI: 10.1161/jaha.117.007413] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Previous reports on whether smoking is associated with insulin resistance and diabetes mellitus have yielded inconsistent findings. We aimed to evaluate the relationship between cigarette smoking and incident diabetes mellitus in the Jackson Heart Study. Methods and Results Jackson Heart Study participants enrolled at baseline without prevalent diabetes mellitus (n=2991) were classified by self‐report as current smokers, past smokers (smoked ≥400 cigarettes/life and no longer smoking), or never smokers. We quantified smoking intensity by number of cigarettes smoked daily; we considered ≥20 cigarettes per day (1 pack) “high‐intensity.” We defined diabetes mellitus as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5% or International Federation of Clinical Chemistry units HbA1c 48 mmol/mol, or use of diabetes mellitus medication. We estimated the adjusted associations of smoking status, intensity, and dose (pack‐years) with incident diabetes mellitus using Poisson regression models. At baseline there were 361 baseline current (1–10 cigarettes per day [n=242]; ≥20 [n=119]), 502 past, and 2128 never smokers. From Visit 1 to Visit 3 (mean 8.0±0.9 years), 479 participants developed incident diabetes mellitus. After adjustment for covariates, baseline current smokers who smoked less than a pack/d and past smokers had similar rates of incident diabetes mellitus compared with never smokers (incidence rate ratios 1.04, 95% confidence interval, 0.69–1.58 and 1.08, 95% confidence interval, 0.82–1.42, respectively). Baseline current high‐intensity smokers had a 79% (95% confidence interval, 1.14–2.81) higher incidence of diabetes mellitus compared with never smokers. Smoking dose (per 10 pack‐years) was also associated with a higher incidence of diabetes mellitus (incidence rate ratios 1.10, 95% confidence interval, 1.03–1.19) in adjusted models. Conclusions High‐intensity cigarette smoking and smoking pack‐years are associated with an increased risk of developing diabetes mellitus in blacks.
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Affiliation(s)
| | - Loretta R Cain
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | | | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Wei Wang
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Victoria Okhomina
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Rachel J Keith
- Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Mahmoud Al Rifai
- Department of Medicine, University of Kansas School of Medicine, Wichita, KS
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Michael D Winniford
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Rose M Robertson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Aruni Bhatnagar
- Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Kianoush S, Al Rifai M, Cainzos-Achirica M, Al-Mallah MH, Tison GH, Yeboah J, Miedema MD, Allison MA, Wong ND, DeFilippis AP, Longstreth W, Nasir K, Budoff MJ, Matsushita K, Blaha MJ. Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2017; 267:61-67. [PMID: 29100062 DOI: 10.1016/j.atherosclerosis.2017.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/01/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). METHODS We followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0-4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. RESULTS With an increasing number of thoracic ECC sites, there was a significant (p < 0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n = 184), total stroke (n = 235), and TIA (n = 85), but not hemorrhagic stroke (n = 32) and stroke mortality (n = 42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p > 0.10). CONCLUSIONS Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.
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Affiliation(s)
- Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mahmoud Al Rifai
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; RTI Health Solutions, Barcelona, Spain
| | - Mouaz H Al-Mallah
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research, Saudi Arabia
| | - Geoffrey H Tison
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Cardiology, University of California, San Francisco, CA, USA
| | - Joseph Yeboah
- Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California - San Diego, San Diego, CA, USA
| | - Nathan D Wong
- Los Angeles Biomedical Research Institute, Torrance, CA, USA; University of Washington, Seattle, WA, USA
| | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, University of Louisville, Jewish Hospital/Kentucky One Health, Louisville, KY, USA
| | | | - Khurram Nasir
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Torrance, CA, USA; University of Washington, Seattle, WA, USA
| | - Kunihiro Matsushita
- Departments of Epidemiology and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Abstract
OPINION STATEMENT Detecting subclinical atherosclerosis with coronary artery calcium (CAC) is promising for identifying individuals at risk for cardiovascular events and appears to be a robust tool for guiding initiation of appropriate and timely primary prevention strategies. However, how do we best determine its clinical value? It is clear that traditional risk prediction models based primarily on age, gender, and risk factors are insufficient for ideal personalization of risk estimation. It is now well established from epidemiologic studies that CAC adds to traditional risk scores for a more accurate risk prediction. However, such traditional epidemiology studies have limitations in establishing "clinical value," and they must be supplemented by additional data before being translated into strong recommendations in clinical practice guidelines. Fortunately, over the last few years, the research around CAC has matured to include data supporting enhanced clinician-patient risk discussions, shared decision-making, flexible risk factor treatment goals, specific clinical decision algorithms, as well as favorable cost-effectiveness analyses. We had moved from a time when we asked "if CAC adds to the risk score" to a time when we are asking "does CAC facilitate a shared decision-making model matching risk, treatment, and patient preferences?" A new risk calculator incorporating CAC into global risk scoring, and 2017 guidelines on the use of CAC published by the Society of Cardiovascular Computed Tomography (SCCT), reflect this new approach. In this article, we review the recent transition to this more clinically relevant CAC research that may support a stronger recommendation for its use in future prevention guidelines.
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Affiliation(s)
- Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Blalock building Suit 501, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Blalock building Suit 501, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Raghavendra Charan Makam
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Blalock building Suit 501, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Blalock building Suit 501, 600 N Wolfe Street, Baltimore, MD, 21287, USA.,Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, 1500 San Remo Ave, Suite 340, Coral Gables, FL, 33139, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Blalock building Suit 501, 600 N Wolfe Street, Baltimore, MD, 21287, USA. .,Division of Cardiology, Johns Hopkins Ciccarone Center Preventive Cardiology Center, Blalock 524C, 600 North Wolfe St, Baltimore, MD, 21287, USA.
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Kianoush S, Bittencourt MS, Lotufo PA, Bensenor IM, Jones SR, DeFilippis AP, Toth PP, Otvos JD, Tibuakuu M, Hall ME, Harada PHN, Blaha MJ. Association Between Smoking and Serum GlycA and High-Sensitivity C-Reactive Protein Levels: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Am Heart Assoc 2017; 6:JAHA.117.006545. [PMID: 28838917 PMCID: PMC5586473 DOI: 10.1161/jaha.117.006545] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Inflammation is suggested to be a central feature of atherosclerosis, particularly among smokers. We studied whether inflammatory biomarkers GlycA and high‐sensitivity C‐reactive protein are associated with cigarette smoking. Methods and Results A total of 11 509 participants, 6774 from the MESA (Multi‐Ethnic Study of Atherosclerosis) and 4735 from ELSA‐Brasil (The Brazilian Longitudinal Study of Adult Health) were included. We evaluated the cross‐sectional association between multiple measures of smoking behavior and the inflammatory biomarkers, GlycA and high‐sensitivity C‐reactive protein, using regression models adjusted for demographic, anthropometric, and clinical characteristics. Participants were 57.7±11.1 years old and 46.4% were men. Never, former, and current smokers comprised 51.7%, 34.0%, and 14.3% of the population, respectively. Multivariable‐adjusted mean absolute difference in GlycA levels (μmol/L) with 95% confidence interval (CI) were higher for former (4.1, 95% CI, 1.7–6.6 μmol/L) and current smokers (19.9, 95% CI, 16.6–23.2 μmol/L), compared with never smokers. Each 5‐unit increase in pack‐years of smoking was associated with higher GlycA levels among former (0.7, 95% CI, 0.3–1.1 μmol/L) and current smokers (1.6, 95% CI, 0.8–2.4 μmol/L). Among former smokers, each 5‐year increase in time since quitting smoking was associated with lower GlycA levels (−1.6, 95% CI, −2.4 to −0.8 μmol/L) and each 10‐unit increase in number of cigarettes/day was associated with higher GlycA among current smokers (2.8, 95% CI, 0.5–5.2 μmol/L). There were similar significant associations between all measures of smoking behavior, and both log‐transformed GlycA and high‐sensitivity C‐reactive protein. Conclusions Acute and chronic exposure to tobacco smoking is associated with inflammation, as quantified by both GlycA and high‐sensitivity C‐reactive protein. These biomarkers may have utility for the study and regulation of novel and traditional tobacco products.
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Affiliation(s)
- Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of Sao Paulo, Brazil .,School of Medicine, University of Sao Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, University of Sao Paulo, Brazil.,School of Medicine, University of Sao Paulo, Brazil
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.,School of Medicine, University of Louisville, Louisville, KY
| | - Peter P Toth
- Sterling Rock Falls Clinic, Ltd., CGH Medical Center, University of Illinois School of Medicine, Sterling, IL
| | | | - Martin Tibuakuu
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Michael E Hall
- University of Mississippi Medical Center, Division of Cardiology, Jackson, MS
| | - Paulo H N Harada
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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Kianoush S, Yakoob MY, Al-Rifai M, DeFilippis AP, Bittencourt MS, Duncan BB, Bensenor IM, Bhatnagar A, Lotufo PA, Blaha MJ. Associations of Cigarette Smoking With Subclinical Inflammation and Atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health). J Am Heart Assoc 2017. [PMID: 28647689 PMCID: PMC5669156 DOI: 10.1161/jaha.116.005088] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background There is a need to identify sensitive biomarkers of early tobacco‐related cardiovascular disease. We examined the association of smoking status, burden, time since quitting, and intensity, with markers of inflammation and subclinical atherosclerosis. Methods and Results We studied 14 103 participants without clinical cardiovascular disease in ELSA‐Brasil (Brazilian Longitudinal Study of Adult Health). We evaluated baseline cross‐sectional associations between smoking parameters and inflammation (high‐sensitivity C‐reactive protein [hsCRP]) and measures of subclinical atherosclerosis (carotid intima–media thickness, ankle‐brachial index, and coronary artery calcium [CAC]). The cohort included 1844 current smokers, 4121 former smokers, and 8138 never smokers. Mean age was 51.7±8.9 years; 44.8% were male. After multivariable adjustment, compared with never smokers, current smokers had significantly higher levels of hsCRP (β=0.24, 0.19–0.29 mg/L; P<0.001) and carotid intima–media thickness (β=0.03, 0.02–0.04 mm; P<0.001) and odds of ankle‐brachial index ≤1.0 (odds ratio: 2.52; 95% confidence interval, 2.06–3.08; P<0.001) and CAC >0 (odds ratio: 1.83; 95% confidence interval, 1.46–2.30; P<0.001). Among former and current smokers, pack‐years of smoking (burden) were significantly associated with hsCRP (P<0.001 and P=0.006, respectively) and CAC (P<0.001 and P=0.002, respectively). Among former smokers, hsCRP and carotid intima–media thickness levels and odds of ankle‐brachial index ≤1.0 and CAC >0 were lower with increasing time since quitting (P<0.01). Among current smokers, number of cigarettes per day (intensity) was positively associated with hsCRP (P<0.001) and CAC >0 (P=0.03) after adjusting for duration of smoking. Conclusions Strong associations were observed between smoking status, burden, and intensity with inflammation (hsCRP) and subclinical atherosclerosis (carotid intima–media thickness, ankle‐brachial index, CAC). These markers of early cardiovascular disease injury may be used for the further study and regulation of traditional and novel tobacco products.
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Affiliation(s)
- Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | - Mahmoud Al-Rifai
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.,Department of Medicine, University of Kansas School of Medicine, Wichita, KS
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.,School of Medicine, University of Louisville, KY
| | | | - Bruce B Duncan
- Postgraduate Studies Program and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, University of São Paulo, Brazil.,School of Medicine, University of São Paulo, Brazil
| | | | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo, Brazil .,School of Medicine, University of São Paulo, Brazil
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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Kianoush S, Blaha MJ. Early interventions for optimal control of prediabetes and diabetes: Critical to prevent cardiovascular disease? Atherosclerosis 2016; 253:265-267. [PMID: 27594538 DOI: 10.1016/j.atherosclerosis.2016.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Sina Kianoush
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
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Kianoush S, Al Rifai M, Whelton SP, Shaya GE, Bush AL, Graham G, Wong ND, Blaha MJ. Stratifying cardiovascular risk in diabetes: The role of diabetes-related clinical characteristics and imaging. J Diabetes Complications 2016; 30:1408-15. [PMID: 27179751 DOI: 10.1016/j.jdiacomp.2016.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 02/07/2023]
Abstract
Diabetes is a major coronary heart disease (CHD) and cardiovascular disease (CVD) risk factor and has traditionally been classified as a CHD risk equivalent. CVD risk, however, is heterogeneous among diabetic patients and thus further evaluation is warranted before initiating or titrating preventive pharmacotherapy. Prognostic clinical characteristics of diabetes such as age of onset, duration, and severity of diabetes, as well as concomitant cardiometabolic factors account for much of the variability in CHD and CVD risk. This heterogeneity can also be evaluated directly using non-invasive imaging, which allows for a more individualized risk assessment in order to minimize both under and overtreatment. In this paper, we review guideline recommendations for atherosclerotic CVD risk assessment driving the use of statins or aspirin for certain subgroups of patients with diabetes. We further discuss imaging techniques, such as stress myocardial perfusion imaging, coronary computed tomography angiography, and coronary artery calcium (CAC) scoring that can guide the decision to treat high-risk patients. Among imaging tests, current guidelines consider CAC scoring the most appropriate risk stratification tool for asymptomatic individuals with diabetes that can guide initiating/intensifying or withholding the most aggressive pharmacological therapies among high-risk (CAC>100) or low-risk (CAC=0) individuals, respectively.
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Affiliation(s)
- Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Mahmoud Al Rifai
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | | | - Aaron L Bush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Garth Graham
- Aetna Foundation, Hartford, CT, USA; University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, Irvine, CA, USA.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins, Baltimore, MD, USA.
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Rokni Yazdi H, Borhani A, Rasuli B, Kianoush S, Rafieian S, Jafarian A. Percutaneous Transhepatic N-Butyl Cyanoacrylate Injection Therapy of an Isolated Bile Duct Associated with a Bronchobiliary Fistula. J Vasc Interv Radiol 2016; 27:930-2. [PMID: 27287976 DOI: 10.1016/j.jvir.2016.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hadi Rokni Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran
| | - Ali Borhani
- Departments of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Rasuli
- Departments of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Kianoush
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shahab Rafieian
- General Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- General Surgery, Tehran University of Medical Sciences, Tehran, Iran
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Dadpour B, Afshari R, Mousavi SR, Kianoush S, Keramati MR, Moradi VA, Sadeghi M, Madani Sani F, Balali Mood M. Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory. IJT 2016. [DOI: 10.32598/ijt.10.2.327.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-manufacturing workers. Methods: This cross sectional study was carried out in Mashhad, Iran, during April-June 2011. One hundred and twelve workers underwent blood and urine sampling for determination of lead concentrations and liver function tests. Clinical signs and symptoms of possible lead hepatotoxicity were investigated. Results: Mean (±SD) age of the workers was 28.78 (±5.17) yr with a daytime work of 8.67 (±1.41) h and mean work duration of 3.89 (±2.40) yr. Mean blood lead concentration (BLC) and urine lead concentration (ULC) were 398.95 (±177.41) µg/l and 83.67(±50) μg/l, respectively. We found no correlation between the clinical findings and BLC or ULC. A weak correlation (R: 0.27, P=0.087) between serum alkaline phosphatase concentration and BLC was obtained. No significant relationship was found between other liver function tests and BLC or ULC. Conclusion: We found no specific clinical and laboratory abnormalities of liver in the workers of car battery manufacturer who had chronic lead toxicity. Further investigations with more specific laboratory tests such as LDH5 and gamma glutamyl transferase (GGT) as well as novel biomarkers of metal induced hepatotoxicity might be helpful in evaluating lead hepatotoxicity.
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Kianoush S, Bikdeli B, Desai MM, Eikelboom JW. Risk of Stent Thrombosis and Major Bleeding with Bivalirudin Compared with Active Control: A Systematic Review and Meta-analysis of Randomized Trials. Thromb Res 2015; 136:1087-98. [DOI: 10.1016/j.thromres.2015.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/23/2015] [Accepted: 06/01/2015] [Indexed: 11/26/2022]
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Kianoush S, Sadeghi M, Balali-Mood M. Recent Advances in the Clinical Management of Lead Poisoning. Acta Med Iran 2015; 53:327-336. [PMID: 26069169] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/18/2014] [Indexed: 06/04/2023] Open
Abstract
Lead poisoning is a historic universal disease. Acute or chronic lead exposure may cause reversible or even permanent damages in human beings. Environmental lead exposure is a global health concern in children. Occupational lead poisoning is still a health issue, particularly in developing countries. During the last decades, new methods and medications have been advocated for the prevention and treatment of lead poisoning. This review deals mainly with recent developments in the management of lead poisoning. Sources of lead exposure are introduced, and methods for the primary prevention of lead poisoning are discussed. Details for the screening of adults and children are also explained to serve as a practical guideline for the secondary prevention. Standard chelation therapy in different groups and up-to-date less toxic new medications for the treatment of lead poisoning are finally discussed. Our published clinical research on the therapeutic effects of garlic tablets in mild to moderate occupational lead poisoning will also be discussed.
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Affiliation(s)
- Sina Kianoush
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahmood Sadeghi
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahdi Balali-Mood
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Gharaee H, Shayegan MR, Khakzad MR, Kianoush S, Varasteh AR, Sankian M, Meshkat M. The expression of vascular endothelial growth factor in pterygium tissue of atopic patients. Int Ophthalmol 2014; 34:1175-81. [PMID: 25344752 DOI: 10.1007/s10792-013-9876-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/23/2013] [Indexed: 01/28/2023]
Abstract
The exact pathogenesis of pterygium has not been completely elucidated. Growth factors have been considered to play a role in pterygium formation. Vascular endothelial growth factor (VEGF) is one of the principal mediators of angiogenesis, fibroblast stimulation and tissue remodeling in allergic conditions. The aim of this study was to compare the association between pterygium and VEGF gene expression between atopic and non-atopic individuals. At first visit, all patients with pterygium underwent blood tests, serum immunoglobulin E (IgE), serum cytokines including interleukin-4 (IL-4) and interferon-γ (IFN-γ) and peripheral blood eosinophil count. After obtaining informed consents, questionnaires were used to obtain demographic and clinical data from patients who underwent pterygium excision surgery. Skin prick test was performed to confirm or rule out atopy in 30 patients with (case group) and 30 patients without (control group) atopy. Pterygium tissues were then removed by surgery. A semi-quantitative reverse transcriptase polymerase chain reaction was performed to determine VEGF gene expression in all patients. Our results illustrated that VEGF mRNA expression in atopic patients was significantly higher than in the non-atopic group (P = 0.01). Eosinophil count, serum IgE and IL-4 were also significantly higher in atopic patients than in the non-atopic group (P = 0.03, 0.001 and 0.001, respectively). However, no significant difference was noted in serum IFN-γ between the two groups (P = 0.06). The excessive expression of VEGF gene in pterygium tissue of patients with atopy suggests that growth factors may play a role in the pathogenesis of pterygium or accelerate its formation.
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Affiliation(s)
- Hamid Gharaee
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Eghbali K, Shayegan MR, Kianoush S. Investigating the effect of tamsulosin on the measurement of bladder wall thickness and International Prostate Symptom Score in benign prostatic hyperplasia. Can Urol Assoc J 2013; 7:E317-21. [PMID: 23766833 DOI: 10.5489/cuaj.11262] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION According to previous studies, aging, gender, bladder volume and pathological states, such as bladder outflow obstruction, affect bladder wall thickness (BWT). The aim of this study was to evaluate the correlation between BWT and the International Prostatic Symptom Score (IPSS) in patients with benign prostatic hyperplasia (BPH) before and after tamsulosin treatment. METHODS In this study, 60 BPH patients were included. After obtaining informed consent, data were gathered using questionnaires to determine IPSS. After that, prostate-specific antigen was measured and a clinical examination, including a digital rectal examination, was performed for all patients. BWT was determined by transabdominal ultrasound. Finally, all patients were treated with tamsulosin (0.4 mg/day) for 2 months. After completing treatment, the IPSS and BWT were measured again and compared with the initial findings. RESULTS In total, 44 patients completed treatment. Patients aged 61.7 ± 9.2 years old. The mean ± standard deviation of IPSS and BWT were 14.6 ± 5.0 and 5.36 ± 1.28 mm before treatment, while they significantly (p < 0.0001) decreased to 8.2 ± 4.7 and 4.69 ± 1.23 mm, respectively, after treatment. Chi-square test showed that the decrease in BWT was significantly correlated with the improvement in IPSS (p = 0.002; r = 0.449). CONCLUSION After treatment with tamsulosin, patients experienced a reduction in their BWT which was significantly correlated with improvement in their IPSS. We conclude that transabdominal evaluation of BWT could be included in the follow-up assessment in BPH.
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Affiliation(s)
- Kamyar Eghbali
- Department of Urology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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Eghbali K, Shayegan MR, Kianoush S. Investigating the effect of tamsulosin on the measurement of bladder wall thickness and International Prostate Symptom Score in benign prostatic hyperplasia. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.1244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: According to previous studies, aging, gender, bladder volume and pathological states, such as bladder outflow obstruction, affect bladder wall thickness (BWT). The aim of this study was to evaluate the correlation between BWT and the International Prostatic Symptom Score (IPSS) in patients with benign prostatic hyperplasia (BPH) before and after tamsulosin treatment.Methods: In this study, 60 BPH patients were included. After obtaining informed consent, data were gathered using questionnaires to determine IPSS. After that, prostate-specific antigen was measured and a clinical examination, including a digital rectal examination, was performed for all patients. BWT was determined by transabdominal ultrasound. Finally, all patients were treated with tamsulosin (0.4 mg/day) for 2 months. After completing treatment, the IPSS and BWT were measured again and compared with the initial findings.Results: In total, 44 patients completed treatment. Patients aged 61.7 ± 9.2 years old. The mean ± standard deviation of IPSS and BWT were 14.6 ± 5.0 and 5.36 ± 1.28 mm before treatment, while they significantly (p < 0.0001) decreased to 8.2 ± 4.7 and 4.69 ± 1.23 mm, respectively, after treatment. Chi-square test showed that the decrease in BWT was significantly correlated with the improvement in IPSS (p = 0.002; r = 0.449).Conclusion: After treatment with tamsulosin, patients experienced a reduction in their BWT which was significantly correlated with improvement in their IPSS. We conclude that transabdominal evaluation of BWT could be included in the follow-up assessment in BPH.
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Kianoush S, Balali-Mood M, Mousavi SR, Shakeri MT, Dadpour B, Moradi V, Sadeghi M. Clinical, toxicological, biochemical, and hematologic parameters in lead exposed workers of a car battery industry. Iran J Med Sci 2013; 38:30-7. [PMID: 23645955 PMCID: PMC3642942] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 05/12/2012] [Accepted: 06/24/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lead is a toxic element which causes acute, subacute or chronic poisoning through environmental and occupational exposure. The aim of this study was to investigate clinical and laboratory abnormalities of chronic lead poisoning among workers of a car battery industry. METHODS Questionnaires and forms were designed and used to record demographic data, past medical histories and clinical manifestations of lead poisoning. Blood samples were taken to determine biochemical (using Auto Analyzer; Model BT3000) and hematologic (using Cell Counter Sysmex; Model KX21N) parameters. An atomic absorption spectrometer (Perkin-Elmer, Model 3030, USA) was used to determine lead concentration in blood and urine by heated graphite atomization technique. RESULTS A total of 112 men mean age 28.78±5.17 years, who worked in a car battery industry were recruited in the present study. The most common signs/symptoms of lead poisoning included increased excitability 41.9%, arthralgia 41.0%, fatigue 40.1%, dental grey discoloration 44.6%, lead line 24.1%, increased deep tendon reflexes (DTR) 22.3%, and decreased DTR (18.7%). Blood lead concentration (BLC) was 398.95 µg/L±177.40, which was significantly correlated with duration of work (P=0.044) but not with the clinical manifestations of lead poisoning. However, BLC was significantly correlated with urine lead concentration (83.67 µg/L±49.78; r(2)=0.711; P<0.001), mean corpuscular hemoglobin (r=-0.280; P=0.011), mean corpuscular hemoglobin concentration (r=-0.304; P=0.006) and fasting blood sugar or FBS (r=-0.258; P=0.010). CONCLUSION Neuropsychiatric and skeletal findings were common manifestations of chronic occupational lead poisoning. BLC was significantly correlated with duration of work, urine lead concentration, two hemoglobin indices and FBS.
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Affiliation(s)
- Sina Kianoush
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Balali-Mood
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mousavi
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Taghi Shakeri
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Valiollah Moradi
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Sadeghi
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Kianoush S, Balali-Mood M, Mousavi SR, Moradi V, Sadeghi M, Dadpour B, Rajabi O, Shakeri MT. Comparison of therapeutic effects of garlic and d-Penicillamine in patients with chronic occupational lead poisoning. Basic Clin Pharmacol Toxicol 2011; 110:476-81. [PMID: 22151785 DOI: 10.1111/j.1742-7843.2011.00841.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous studies on animals have revealed that garlic (Allium sativum) is effective in reducing blood and tissue lead concentrations. The aim of this study was to investigate therapeutic effects of garlic and compare it with d-penicillamine in patients with chronic lead poisoning. After coordination and obtaining informed consent, clinical examinations and blood lead concentration (BLC) of 117 workers at a car battery industry were investigated. BLC was determined by heated graphite atomization technique of an atomic absorption spectrometer. The workers were randomly assigned into two groups of garlic (1200 μg allicin, three times daily) and d-penicillamine (250 mg, three times daily) and treated for 4 weeks. BLC was determined again 10days post-treatment. Clinical signs and symptoms of lead poisoning were also investigated and compared with the initial findings. Clinical improvement was significant in a number of clinical manifestations including irritability (p = 0.031), headache (p = 0.028), decreased deep tendon reflex (p=0.019) and mean systolic blood pressure (0.021) after treatment with garlic, but not d-penicillamine. BLCs were reduced significantly (p=0.002 and p=0.025) from 426.32±185.128 to 347.34±121.056 μg/L and from 417.47±192.54 to 315.76±140.00μg/L in the garlic and d-penicillamine groups, respectively, with no significant difference (p=0.892) between the two groups. The frequency of side effects was significantly (p=0.023) higher in d-penicillamine than in the garlic group. Thus, garlic seems safer clinically and as effective as d-penicillamine. Therefore, garlic can be recommended for the treatment of mild-to-moderate lead poisoning.
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Affiliation(s)
- Sina Kianoush
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Shayegan MR, Boloorian AA, Kianoush S. Comparative study of topical application of timolol and verapamil in patients with glaucoma within 6 months. J Ocul Pharmacol Ther 2010; 25:551-3. [PMID: 20028263 DOI: 10.1089/jop.2009.0005] [Citation(s) in RCA: 7] [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] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION As glaucoma is one of the most significant causes of blindness, and administration of calcium channel blockers is effective in reducing intraocular pressure (IOP) in rabbits and patients with normotensive glaucoma, we administered topical verapamil 0.25% in the human eye to compare its effect with timolol 0.5% in reducing IOP. PURPOSE To compare the effect of timolol 0.5% and topical verapamil 0.25% in patients with open-angle glaucoma. METHODS It was a double-blinded study in which 118 eyes (59 individuals) were chosen and divided into 2 groups (30 individuals related to timolol and 29 individuals related to verapamil). Patients who used drugs (systemic or topical) that could alter IOP and those with IOP <22 mmHg were excluded from the study (19 eyes). We chose patients who did not use any drugs 24 h prior to the study. Then applanation tonometry was done exactly before the administration of drugs and 90 min later and the results were compared. RESULTS In timolol group, mean intraocular pressure in 52 eyes (27 right eyes and 25 left eyes) decreased from 32.545 to 30.230 and mean pressure in verapamil group decreased from 33.195 to 30.835. CONCLUSION It seems that topical verapamil has a similar effect to timolol in patients with open-angle glaucoma, so it can be considered as a lowering intraocular pressure agent in glaucoma patients.
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Zeraati AA, Naghibi M, Kianoush S, Kianoosh S, Ashraf H. Impact of slow and delayed graft function on kidney graft survival between various subgroups among renal transplant patients. Transplant Proc 2010; 41:2777-80. [PMID: 19765433 DOI: 10.1016/j.transproceed.2009.07.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Renal allografts with excellent graft function show good long-term outcomes, while grafts with delayed function have been associated with poor long-term survivals, although few reports have analyzed outcomes among these groups. We compared first-week postoperative graft function among renal transplant patients to analyze the impact of slow graft function (SGF) and delayed graft function (DGF) on graft survival. MATERIALS AND METHODS Renal transplantations were performed from 362 unrelated, 46 related, and 163 deceased donors. Kidney transplant patients were divided into 3 groups according to their initial graft function. First-week dialyzed patients formed the DGF group. Nondialyzed patients were divided into a SGF or an excellent graft function (EGF) cohort according to whether the serum creatinine at day 7 was higher vs lower than 2.5 mg/dL, respectively. RESULTS Of the 570 renal transplant recipients, DGF was observed in 39 patients (6.8%), SGF in 64 (11.2%), and EGF in 467 (81.8%). There was no significant difference in SGF vs DGF between patients who received kidneys from unrelated vs related living or deceased donors. Graft survival was worse among the DGF than the SGF or EGF patients, with no significant difference between the last 2 groups. The 6-month graft survivals were 74%, 93%, and 96%; the 3-year graft survivals were 70%, 88%, and 90%, respectively (P < .001). CONCLUSIONS We observed a similar impact of EGF and SGF on kidney graft survival. Kidney transplant recipients who developed DGF showed worse graft survival than those with EGF or SGF.
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Affiliation(s)
- A A Zeraati
- Mashhad Transplant Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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