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An J, Fischer H, Ni L, Xia M, Choi SK, Morrissette KL, Wei R, Reynolds K, Muntner P, Safford MM, Moran AE, Bellows BK, Isasi CR, Allen NB, Xanthakis V, Colantonio LD, Zhang Y. Association Between Young Adult Characteristics and Blood Pressure Trajectories. J Am Heart Assoc 2024; 13:e033053. [PMID: 38563367 DOI: 10.1161/jaha.123.033053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Blood pressure (BP) trajectories from young adulthood through middle age are associated with cardiovascular risk. We examined the associations of hypertension risk factors with BP trajectories among a large diverse sample. METHODS AND RESULTS We analyzed data from young adults, aged 18 to 39 years, with untreated BP <140/90 mm Hg at baseline from Kaiser Permanente Southern California (N=355 324). We used latent growth curve models to identify 10-year BP trajectories and to assess the associations between characteristics in young adulthood and BP trajectories. We identified the following 5 distinct systolic BP trajectories, which appeared to be determined mainly by the baseline BP with progressively higher BP at each year: group 1 (lowest BP trajectory, 7.9%), group 2 (26.5%), group 3 (33.0%), group 4 (25.4%), and group 5 (highest BP trajectory, 7.3%). Older age (adjusted odds ratio for 30-39 versus 18-29 years, 1.23 [95% CI, 1.18-1.28]), male sex (13.38 [95% CI, 12.80-13.99]), obesity (body mass index ≥30 versus 18.5-24.9 kg/m2, 14.81 [95% CI, 14.03-15.64]), overweight (body mass index 25-29.9 versus 18.5-24.9 kg/m2, 3.16 [95% CI, 3.00-3.33]), current smoking (1.58 [95% CI, 1.48-1.67]), prediabetes (1.21 [95% CI, 1.13-1.29]), diabetes (1.60 [95% CI, 1.41-1.81]) and high low-density lipoprotein cholesterol (≥160 versus <100 mg/dL, 1.52 [95% CI, 1.37-1.68]) were associated with the highest BP trajectory (group 5) compared with the reference group (group 2). CONCLUSIONS Traditional hypertension risk factors including smoking, diabetes, and elevated lipids were associated with BP trajectories in young adults, with obesity having the strongest association with the highest BP trajectory group.
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Affiliation(s)
- Jaejin An
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
- Department of Health Systems Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA USA
| | - Heidi Fischer
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Liang Ni
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Mengying Xia
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
| | - Soon Kyu Choi
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Kerresa L Morrissette
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Rong Wei
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Kristi Reynolds
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
- Department of Health Systems Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA USA
| | - Paul Muntner
- Department of Epidemiology University of Alabama at Birmingham Birmingham AL USA
| | - Monika M Safford
- Division of General Internal Medicine Weill Cornell Medicine New York NY USA
| | - Andrew E Moran
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
| | - Brandon K Bellows
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY USA
| | - Norrina B Allen
- Division of Epidemiology Northwestern University Chicago IL USA
| | - Vanessa Xanthakis
- Department of Medicine Boston University Chobanian and Avedisian School of Medicine Boston MA USA
- Department of Biostatistics Boston University School of Public Health Boston MA USA
| | | | - Yiyi Zhang
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
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Barton BA, Kronsberg SS, Hariri E, Vasan RS, Rade GA, Xanthakis V, Kickler TS, Rade JJ. Adjustment for Renal Function Improves the Prognostic Performance of Urinary Thromboxane Metabolites. Clin Chem 2024; 70:660-668. [PMID: 38416712 DOI: 10.1093/clinchem/hvae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/26/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Systemic thromboxane A2 generation, assessed by quantifying the concentration of stable thromboxane B2 metabolites (TXB2-M) in the urine adjusted for urinary creatinine, is strongly associated with mortality risk. We sought to define optimal TXB2-M cutpoints for aspirin users and nonusers and determine if adjusting TXB2-M for estimated glomerular filtration rate (eGFR) in addition to urinary creatinine improved mortality risk assessment. METHODS Urinary TXB2-M were measured by competitive ELISA in 1363 aspirin users and 1681 nonusers participating in the Framingham Heart Study. Cutpoints were determined for TXB2-M and TXB2-M/eGFR using log-rank statistics and used to assess mortality risk by Cox proportional hazard modeling and restricted mean survival time. Multivariable models were compared using the Akaike Information Criterion (AIC). A cohort of 105 aspirin users with heart failure was used for external validation. RESULTS Optimized cutpoints of TXB2-M were 1291 and 5609 pg/mg creatinine and of TXB2-M/eGFR were 16.6 and 62.1 filtered prostanoid units (defined as pg·min/creatinine·mL·1.73 m2), for aspirin users and nonusers, respectively. TXB2-M/eGFR cutpoints provided more robust all-cause mortality risk discrimination than TXB2-M cutpoints, with a larger unadjusted hazard ratio (2.88 vs 2.16, AIC P < 0.0001) and greater differences in restricted mean survival time between exposure groups (1.46 vs 1.10 years), findings that were confirmed in the external validation cohort of aspirin users. TXB2-M/eGFR cutpoints also provided better cardiovascular/stroke mortality risk discrimination than TXB2-M cutpoints (unadjusted hazard ratio 3.31 vs 2.13, AIC P < 0.0001). CONCLUSION Adjustment for eGFR strengthens the association of urinary TXB2-M with long-term mortality risk irrespective of aspirin use.
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Affiliation(s)
- Bruce A Barton
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Shari S Kronsberg
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Essa Hariri
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ramachandran S Vasan
- Boston University Framingham Heart Study, Boston, MA, United States
- University of Texas School of Public Health in San Antonio, San Antonio, TX, United States
| | - Grace A Rade
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | | | | | - Jeffrey J Rade
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- Johns Hopkins School of Medicine, Baltimore, MD, United States
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3
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Kim JS, Sun Y, Balte P, Cushman M, Boyle R, Tracy RP, Styer LM, Bell TD, Anderson MR, Allen NB, Schreiner PJ, Bowler RP, Schwartz DA, Lee JS, Xanthakis V, Doyle MF, Regan EA, Make BJ, Kanaya AM, Wenzel SE, Coresh J, Isasi CR, Raffield LM, Elkind MSV, Howard VJ, Ortega VE, Woodruff P, Cole SA, Henderson JM, Mantis NJ, Parker MM, Demmer RT, Oelsner EC. Demographic and Clinical Factors Associated With SARS-CoV-2 Spike 1 Antibody Response Among Vaccinated US Adults: the C4R Study. Nat Commun 2024; 15:1492. [PMID: 38374032 PMCID: PMC10876680 DOI: 10.1038/s41467-024-45468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
This study investigates correlates of anti-S1 antibody response following COVID-19 vaccination in a U.S. population-based meta-cohort of adults participating in longstanding NIH-funded cohort studies. Anti-S1 antibodies were measured from dried blood spots collected between February 2021-August 2022 using Luminex-based microsphere immunoassays. Of 6245 participants, mean age was 73 years (range, 21-100), 58% were female, and 76% were non-Hispanic White. Nearly 52% of participants received the BNT162b2 vaccine and 48% received the mRNA-1273 vaccine. Lower anti-S1 antibody levels are associated with age of 65 years or older, male sex, higher body mass index, smoking, diabetes, COPD and receipt of BNT16b2 vaccine (vs mRNA-1273). Participants with a prior infection, particularly those with a history of hospitalized illness, have higher anti-S1 antibody levels. These results suggest that adults with certain socio-demographic and clinical characteristics may have less robust antibody responses to COVID-19 vaccination and could be prioritized for more frequent re-vaccination.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Yifei Sun
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Pallavi Balte
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Rebekah Boyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Linda M Styer
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Taison D Bell
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - David A Schwartz
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joyce S Lee
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vanessa Xanthakis
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Margaret F Doyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sally E Wenzel
- Department of Medicine, Department of Immunology, and Department of Environmental Medicine and Occupational Health, University of Pittsburgh School of Medicine, School of Public Health, Pittsburgh, PA, USA
| | - Josef Coresh
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor E Ortega
- Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Joel M Henderson
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Nicholas J Mantis
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA
| | - Monica M Parker
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Division of Epidemiology, Department of Quantitative Health Sciences, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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Mitchell GF, Rong J, Larson MG, Korzinski TJ, Xanthakis V, Sigurdsson S, Gudnason V, Launer LJ, Aspelund T, Hamburg NM, Gotal JD, Vasan RS. Vascular Age Assessed From an Uncalibrated, Noninvasive Pressure Waveform by Using a Deep Learning Approach: The AI-VascularAge Model. Hypertension 2024; 81:193-201. [PMID: 37901957 PMCID: PMC10842456 DOI: 10.1161/hypertensionaha.123.21638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Aortic stiffness, assessed as carotid-femoral pulse wave velocity, provides a measure of vascular age and risk for adverse cardiovascular disease outcomes, but it is difficult to measure. The shape of arterial pressure waveforms conveys information regarding aortic stiffness; however, the best methods to extract and interpret waveform features remain controversial. METHODS We trained a convolutional neural network with fixed-scale (time and amplitude) brachial, radial, and carotid tonometry waveforms as input and negative inverse carotid-femoral pulse wave velocity as label. Models were trained with data from 2 community-based Icelandic samples (N=10 452 participants with 31 126 waveforms) and validated in the community-based Framingham Heart Study (N=7208 participants, 21 624 waveforms). Linear regression rescaled predicted negative inverse carotid-femoral pulse wave velocity to equivalent artificial intelligence vascular age (AI-VA). RESULTS The AI-VascularAge model predicted negative inverse carotid-femoral pulse wave velocity with R2=0.64 in a randomly reserved Icelandic test group (n=5061, 16%) and R2=0.60 in the Framingham Heart Study. In the Framingham Heart Study (up to 18 years of follow-up; 479 cardiovascular disease, 200 coronary heart disease, and 213 heart failure events), brachial AI-VA was associated with incident cardiovascular disease adjusted for age and sex (model 1; hazard ratio, 1.79 [95% CI, 1.50-2.40] per SD; P<0.0001) or adjusted for age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, prevalent diabetes, hypertension treatment, and current smoking (model 2; hazard ratio, 1.50 [95% CI, 1.24-1.82] per SD; P<0.0001). Similar hazard ratios were demonstrated for incident coronary heart disease and heart failure events and for AI-VA values estimated from carotid or radial waveforms. CONCLUSIONS Our results demonstrate that convolutional neural network-derived AI-VA is a powerful indicator of vascular health and cardiovascular disease risk in a broad community-based sample.
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Affiliation(s)
| | - Jian Rong
- Boston University and NHLBI’s Framingham Study, Framingham, MA
| | - Martin G. Larson
- Boston University and NHLBI’s Framingham Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | | | - Vanessa Xanthakis
- Boston University and NHLBI’s Framingham Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lenore J. Launer
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD
| | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Naomi M. Hamburg
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | | | - Ramachandran S. Vasan
- Boston University and NHLBI’s Framingham Study, Framingham, MA
- Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston Medical Center, Boston, MA
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
- University of Texas School of Public Health, San Antonio, TX
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5
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Rempakos A, Prescott B, Mitchell GF, Vasan RS, Xanthakis V. Association of Life's Essential 8 With Cardiovascular Disease and Mortality: The Framingham Heart Study. J Am Heart Assoc 2023; 12:e030764. [PMID: 38014669 PMCID: PMC10727315 DOI: 10.1161/jaha.123.030764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The association of the American Heart Association's updated cardiovascular health score, the Life's Essential 8 (LE8), with cardiovascular disease (CVD) and death is not described in the FHS (Framingham Heart Study). METHODS AND RESULTS We evaluated Framingham Offspring participants at examinations 2 and 6 (n=2888 and 1667; and mean age, 44 and 57 years, respectively), free of CVD with information on LE8 components. Using age-sex-adjusted Cox models, we related LE8 and its change (examination 2 to examination 6) with CVD and death risk and compared associations with those of the Life's Simple 7 score. Mean LE8 score at examination 2 was 67 points (minimum, 26 points; maximum, 100 points). At both examinations, participants were reclassified to a different cardiovascular health status, depending on which method (LE8 versus Life's Simple 7) was used (60% of participants in ideal Life's Simple 7 status were in intermediate LE8 category). On follow-up after examination 2 (median, 30 and 33 years for CVD and death, respectively), we observed 966 CVD events, and 1195 participants died. Participants having LE8≥68 (sample median) were at lower CVD and death risk compared with those with LE8<68 (examination 2: CVD hazard ratio [HR], 0.47 [95% CI, 0.41-0.54]; death HR, 0.55 [95% CI, 0.49-0.62]; all P<0.001). Participants maintaining low LE8 scores during life course were at highest CVD and death risk (CVD: HRs ranging from 1.8 to 2.3; P<0.001; death HR, 1.45 [95% CI, 1.13-1.85]; P=0.003 versus high-high group). CONCLUSIONS Further studies are warranted to elucidate whether the LE8 score is a better marker of CVD and death risk, compared with Life's Simple 7 score.
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Affiliation(s)
| | - Brenton Prescott
- Section of Preventive Medicine and Epidemiology, Department of MedicineBoston University School of MedicineBostonMA
| | | | - Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Department of MedicineBoston University School of MedicineBostonMA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart StudyFraminghamMA
- Department of EpidemiologyBoston University School of Public HealthBostonMA
- University of Texas School of Public HealthSan AntonioTX
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of MedicineBoston University School of MedicineBostonMA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart StudyFraminghamMA
- Department of BiostatisticsBoston University School of Public HealthBostonMA
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Mi MY, Gajjar P, Walker ME, Miller P, Xanthakis V, Murthy VL, Larson MG, Vasan RS, Shah RV, Lewis GD, Nayor M. Association of healthy dietary patterns and cardiorespiratory fitness in the community. Eur J Prev Cardiol 2023; 30:1450-1461. [PMID: 37164358 PMCID: PMC10562138 DOI: 10.1093/eurjpc/zwad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/12/2023]
Abstract
AIMS To evaluate the associations of dietary indices and quantitative cardiorespiratory fitness (CRF) measures in a large, community-based sample harnessing metabolomic profiling to interrogate shared biology. METHODS AND RESULTS Framingham Heart Study (FHS) participants underwent maximum effort cardiopulmonary exercise tests for CRF quantification (via peak VO2) and completed semi-quantitative food frequency questionnaires. Dietary quality was assessed by the Alternative Healthy Eating Index (AHEI) and Mediterranean-style Diet Score (MDS), and fasting blood concentrations of 201 metabolites were quantified. In 2380 FHS participants (54 ± 9 years, 54% female, body mass index 28 ± 5 kg/m2), 1 SD higher AHEI and MDS were associated with 5.2% (1.2 mL/kg/min, 95% CI 4.3-6.0%, P < 0.0001) and 4.5% (1.0 mL/kg/min, 95% CI 3.6-5.3%, P < 0.0001) greater peak VO2 in linear models adjusted for age, sex, total daily energy intake, cardiovascular risk factors, and physical activity. In participants with metabolite profiling (N = 1154), 24 metabolites were concordantly associated with both dietary indices and peak VO2 in multivariable-adjusted linear models (FDR < 5%). Metabolites that were associated with lower CRF and poorer dietary quality included C6 and C7 carnitines, C16:0 ceramide, and dimethylguanidino valeric acid, and metabolites that were positively associated with higher CRF and favourable dietary quality included C38:7 phosphatidylcholine plasmalogen and C38:7 and C40:7 phosphatidylethanolamine plasmalogens. CONCLUSION Higher diet quality is associated with greater CRF cross-sectionally in a middle-aged community-dwelling sample, and metabolites highlight potential shared favourable effects on cardiometabolic health.
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Affiliation(s)
- Michael Y Mi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Priya Gajjar
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Suite L-516, Boston, MA 02118, USA
| | - Maura E Walker
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Suite L-516, Boston, MA 02118, USA
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Patricia Miller
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Suite L-516, Boston, MA 02118, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Framingham, 73 Mt. Wayte Avenue, Framingham, MA 01702, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Medicine, and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Framingham, 73 Mt. Wayte Avenue, Framingham, MA 01702, USA
| | - Ramachandran S Vasan
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Suite L-516, Boston, MA 02118, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Suite L-516, Boston, MA 02118, USA
- Framingham Heart Study, Framingham, 73 Mt. Wayte Avenue, Framingham, MA 01702, USA
- University of Texas School of Public Health San Antonio, and Departments of Medicine and Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Ravi V Shah
- Vanderbilt Translational and Clinical Research Center, Cardiology Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory D Lewis
- Cardiology Division and Pulmonary Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Nayor
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Suite L-516, Boston, MA 02118, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Suite L-516, Boston, MA 02118, USA
- Framingham Heart Study, Framingham, 73 Mt. Wayte Avenue, Framingham, MA 01702, USA
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7
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Mossavar-Rahmani Y, Lin J, Pan S, Song RJ, Xue X, Spartano NL, Xanthakis V, Sotres-Alvarez D, Marquez DX, Daviglus M, Carlson JA, Parada H, Evenson KR, Talavera AC, Gellman M, Perreira KM, Gallo LC, Vasan RS, Kaplan RC. Characterizing longitudinal change in accelerometry-based moderate-to-vigorous physical activity in the Hispanic Community Health Study/Study of Latinos and the Framingham Heart Study. BMC Public Health 2023; 23:1614. [PMID: 37620824 PMCID: PMC10464120 DOI: 10.1186/s12889-023-16442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Physical activity promotes health and is particularly important during middle and older age for decreasing morbidity and mortality. We assessed the correlates of changes over time in moderate-to-vigorous physical activity (MVPA) in Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL: mean [SD] age 49.2 y [11.5]) and compared them to a cohort of primarily White adults from the Framingham Heart Study (FHS: mean [SD] 46.9 y [9.2]). METHODS Between 2008 and 2019, we assessed accelerometry-based MVPA at two time points with an average follow-up of: 7.6 y, SD 1.3 for HCHS/SOL, and 7.8 y, SD 0.7 for FHS. We used multinomial logistic regression to relate socio-demographic and health behaviors with changes in compliance with 2018 US recommendations for MVPA from time 1 to time 2 (remained active or inactive; became active or inactive) across the two cohorts. RESULTS In HCHS/SOL mean MVPA was 22.6 (SD, 23.8) minutes at time 1 and dropped to 16.7 (19.0) minutes at time 2. In FHS Mean MVPA was 21.7 min (SD, 17.7) at time 1 and dropped to 21.3 min (SD, 19.2) at time 2. Across both cohorts, odds of meeting MVPA guidelines over time were about 6% lower in individuals who had lower quality diets vs. higher, about half in older vs. younger adults, about three times lower in women vs. men, and 9% lower in individuals who had a higher vs. lower BMI at baseline. Cohorts differed in how age, gender, income, education, depressive symptoms, marital status and perception of general health and pain associated with changes in physical activity. High income older Hispanics/Latino adults were more likely to become inactive at the follow-up visit as were HCHS/SOL women who were retired and FHS participants who had lower levels of education and income. Higher depressive symptomology was associated with becoming active only in HCHS/SOL women. Being male and married was associated with becoming inactive in both cohorts. Higher perception of general health and lower perception of pain were associated with remaining active only in FHS adults. CONCLUSIONS These findings highlight potentially high-risk groups for targeted MVPA intervention.
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Affiliation(s)
- Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Bldg, 1312C, Bronx, NY, 10461, USA.
| | - Juan Lin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Bldg, 1312C, Bronx, NY, 10461, USA
| | - Stephanie Pan
- Section of Preventive Medicine and Epidemiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Rebecca J Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Bldg, 1312C, Bronx, NY, 10461, USA
| | - Nicole L Spartano
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
- Framingham Heart Study, Framingham, MA, 01701, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, Collaborative Studies Coordinating Center, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - David X Marquez
- Department of Kinesiology & Nutrition, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Jordan A Carlson
- Department of Pediatrics, Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - Humberto Parada
- Division of Epidemiology & Biostatistics, San Diego State University School of Public Health, San Diego, CA, 92182, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Ana C Talavera
- South Bay Latino Research Center, College of Sciences, San Diego State University, San Diego, CA, 92182, USA
| | - Marc Gellman
- Department of Psychology, University of Miami, Coral Gables, Florida, 33136, USA
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, 91910, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
- Framingham Heart Study, Framingham, MA, 01701, USA
- University of Texas School of Public Health, San Antonio and University of Texas Health Science Center, San Antonio, TX, 78229, USA
- Section of Cardiovascular Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Robert C Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Bldg, 1312C, Bronx, NY, 10461, USA
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, 98109, USA
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8
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Li Y, Gray A, Xue L, Farb MG, Ayalon N, Andersson C, Ko D, Benjamin EJ, Levy D, Vasan RS, Larson MG, Rong J, Xanthakis V, Liu C, Fetterman JL, Gopal DM. Metabolomic Profiles, Ideal Cardiovascular Health, and Risk of Heart Failure and Atrial Fibrillation: Insights From the Framingham Heart Study. J Am Heart Assoc 2023; 12:e028022. [PMID: 37301766 PMCID: PMC10356055 DOI: 10.1161/jaha.122.028022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/13/2023] [Indexed: 06/12/2023]
Abstract
Background The American Heart Association's framework "ideal cardiovascular health" (CVH) focuses on modifiable risk factors to reduce cardiovascular disease (CVD). Metabolomics provides important pathobiological insights into risk factors and CVD development. We hypothesized that metabolomic signatures associate with CVH status, and that metabolites, at least partially, mediate the association of CVH score with atrial fibrillation (AF) and heart failure (HF). Methods and Results We studied 3056 adults in the FHS (Framingham Heart Study) cohort to evaluate CVH score and incident outcomes of AF and HF. Metabolomics data were available in 2059 participants; mediation analysis was performed to evaluate the mediation of metabolites in the association of CVH score and incident AF and HF. In the smaller cohort (mean age, 54 years; 53% women), CVH score was associated with 144 metabolites, with 64 metabolites shared across key cardiometabolic components (body mass index, blood pressure, and fasting blood glucose) of the CVH score. In mediation analyses, 3 metabolites (glycerol, cholesterol ester 16:1, and phosphatidylcholine 32:1) mediated the association of CVH score with incident AF. Seven metabolites (glycerol, isocitrate, asparagine, glutamine, indole-3-proprionate, phosphatidylcholine C36:4, and lysophosphatidylcholine 18:2), partly mediated the association between CVH score and incident HF in multivariable-adjusted models. Conclusions Most metabolites that associated with CVH score were shared the most among 3 cardiometabolic components. Three main pathways: (1) alanine, glutamine, and glutamate metabolism; (2) citric acid cycle metabolism; and (3) glycerolipid metabolism mediated CVH score with HF. Metabolomics provides insights into how ideal CVH status contributes to the development of AF and HF.
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Affiliation(s)
- Yi Li
- Department of Biostatistics, School of Public HealthBoston UniversityBostonMAUSA
| | | | - Liying Xue
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Melissa G. Farb
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Nir Ayalon
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
| | - Charlotte Andersson
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
| | - Darae Ko
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
| | - Emelia J. Benjamin
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
- Evans Department of Medicine, Section of Cardiovascular Medicine and Department of EpidemiologyBoston UniversityBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Daniel Levy
- Population Sciences Branch, Division of Intramural ResearchNational Heart, Lung, and Blood Institute, National Institutes of HealthBethesdaMDUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Ramachandran S. Vasan
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
- Evans Department of Medicine, Section of Cardiovascular Medicine and Department of EpidemiologyBoston UniversityBostonMAUSA
- Section of Preventive Medicine and Epidemiology, Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Martin G. Larson
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Jian Rong
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Chunyu Liu
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Jessica L. Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Deepa M. Gopal
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
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9
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Mitchell GF, Rong J, Larson MG, Cooper LL, Xanthakis V, Benjamin EJ, Hamburg NM, Vasan RS. Longitudinal Hemodynamic Correlates of and Sex Differences in the Evolution of Blood Pressure Across the Adult Lifespan: The Framingham Heart Study. J Am Heart Assoc 2023:e027329. [PMID: 37318016 DOI: 10.1161/jaha.122.027329] [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: 10/31/2022] [Accepted: 05/24/2023] [Indexed: 06/16/2023]
Abstract
Background Systolic blood pressure increases with age after midlife, particularly in women, and contributes to development of wide pulse pressure hypertension in middle-aged and older adults. Relative contributions of aortic stiffness and premature wave reflection to increases in pulse pressure remain controversial. Methods and Results We evaluated visit-specific values and change in key correlates of pulse pressure, aortic characteristic impedance, forward and backward wave amplitude, and global reflection coefficient, at 3 sequential examinations of the Framingham Generation 3 (N=4082), Omni-2 (N=410), and New Offspring Spouse (N=103) cohorts (53% women). Data were analyzed using repeated-measures linear mixed models adjusted for age, sex, and risk factor exposures. Pulse pressure increased markedly with age after midlife (age and age-squared terms, P<0.0001), particularly in women (age slope 3.1±0.2 mm Hg/decade higher in women, P<0.0001). In sex-specific models, change in pulse pressure was closely related (all P<0.0001) to baseline (6.7±0.2 and 7.3±0.2 mm Hg/SD in men and women, respectively) and change (11.8±0.1 and 11.7±0.1 mm Hg/SD) in forward wave amplitude, whereas relations with baseline (2.1±0.15 and 2.0±0.14 mm Hg/SD) and change (4.0±0.13 and 3.4±0.11 mm Hg/SD) in global reflection coefficient were weaker. Global reflection coefficient fell as aortic characteristic impedance increased (P<0.0001), consistent with the hypothesis that impedance matching reduces relative wave reflection in the arterial system. Conclusions Proximal aortic stiffening, as assessed by higher aortic characteristic impedance and larger forward wave amplitude, is strongly associated with longitudinal increase in pulse pressure, especially in women, whereas wave reflection has more modest relations.
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Affiliation(s)
| | - Jian Rong
- Boston University and NHLBI's Framingham Study Framingham MA
| | - Martin G Larson
- Boston University and NHLBI's Framingham Study Framingham MA
- Department of Biostatistics Boston University School of Public Health Boston MA
| | | | - Vanessa Xanthakis
- Cardiovascular Engineering Inc. Norwood MA
- Boston University and NHLBI's Framingham Study Framingham MA
| | - Emelia J Benjamin
- Boston University and NHLBI's Framingham Study Framingham MA
- Cardiology and Preventive Medicine Sections, Department of Medicine Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center Boston MA
- Department of Epidemiology Boston University School of Public Health Boston MA
- Evans Department of Medicine Boston MA
- Whitaker Cardiovascular Institute Boston University Chobanian and Avedisian School of Medicine Boston MA
| | - Naomi M Hamburg
- Evans Department of Medicine Boston MA
- Whitaker Cardiovascular Institute Boston University Chobanian and Avedisian School of Medicine Boston MA
| | - Ramachandran S Vasan
- Boston University and NHLBI's Framingham Study Framingham MA
- Cardiology and Preventive Medicine Sections, Department of Medicine Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center Boston MA
- Department of Epidemiology Boston University School of Public Health Boston MA
- Evans Department of Medicine Boston MA
- Whitaker Cardiovascular Institute Boston University Chobanian and Avedisian School of Medicine Boston MA
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10
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Lin H, Kwan AC, Castro-Diehl C, Short MI, Xanthakis V, Yola IM, Salto G, Mitchell GF, Larson MG, Vasan RS, Cheng S. Sex-specific differences in the genetic and environmental effects on cardiac phenotypic variation assessed by echocardiography. Sci Rep 2023; 13:5786. [PMID: 37031215 PMCID: PMC10082757 DOI: 10.1038/s41598-023-32577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/29/2023] [Indexed: 04/10/2023] Open
Abstract
The drivers of sexual dimorphism in heart failure phenotypes are currently poorly understood. Divergent phenotypes may result from differences in heritability and genetic versus environmental influences on the interplay of cardiac structure and function. To assess sex-specific heritability and genetic versus environmental contributions to variation and inter-relations between echocardiography traits in a large community-based cohort. We studied Framingham Heart Study participants of Offspring Cohort examination 8 (2005-2008) and Third Generation Cohort examination 1 (2002-2005). Five cardiac traits and six functional traits were measured using standardized echocardiography. Sequential Oligogenic Linkage Analysis Routines (SOLAR) software was used to perform singular and bivariate quantitative trait linkage analysis. In our study of 5674 participants (age 49 ± 15 years; 54% women), heritability for all traits was significant for both men and women. There were no significant differences in traits between men and women. Within inter-trait correlations, there were two genetic, and four environmental trait pairs with sex-based differences. Within both significant genetic trait pairs, men had a positive relation, and women had no significant relation. We observed significant sex-based differences in inter-trait genetic and environmental correlations between cardiac structure and function. These findings highlight potential pathways of sex-based divergent heart failure phenotypes.
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Affiliation(s)
- Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Alan C Kwan
- Department of Cardiology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3100, Los Angeles, CA, 90048, USA
| | - Cecilia Castro-Diehl
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Meghan I Short
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Biostatistics, Boston University School of Public Heath, Boston, MA, USA
| | - Vanessa Xanthakis
- Framingham Heart Study, Framingham, MA, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Heath, Boston, MA, USA
| | - Ibrahim M Yola
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gerran Salto
- Department of Cardiology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3100, Los Angeles, CA, 90048, USA
| | | | - Martin G Larson
- Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Heath, Boston, MA, USA
| | - Ramachandran S Vasan
- Framingham Heart Study, Framingham, MA, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Heath, Boston, MA, USA
- Center for Computing and Data Sciences, Boston University, Boston, MA, USA
| | - Susan Cheng
- Framingham Heart Study, Framingham, MA, USA.
- Department of Cardiology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3100, Los Angeles, CA, 90048, USA.
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11
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Kim JS, Sun Y, Balte P, Cushman M, Tracy RP, Styer L, Anderson MR, Allen NB, Schreiner P, Bowler RP, Schwartz D, Lee J, Xanthakis V, Doyle M, Kanaya AM, Elkind MS, Howard VJ, Ortega V, Woodruff P, Cole S, Mantis N, Parker M, Barr RG, Oelsner E, Demmer R. Abstract P540: Cardiovascular Disease Risk Factors and Antibody Response to COVID-19 Vaccination: The C4R Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p540] [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: 03/17/2023]
Abstract
Background:
Adults with cardiovascular co-morbidities and risk factors are at greater risk of severe COVID-19. These same risk factors may also be associated with an attenuated antibody response to COVID-19 vaccines, although studies in diverse, U.S. population-based cohorts have been limited.
Methods:
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) conducted a serosurvey for SARS-CoV-2 antibodies via dried blood spot (DBS) in 14 U.S. cohorts. IgG antibodies to SARS-CoV-2 spike subunit 1 (S1) and nucleocapsid (N) were measured from DBS using a semi-quantitative microsphere immunoassay and reported as median fluorescence intensity (MFI). Multivariable adjusted linear models regressed log-transformed anti-S1 MFI on age, sex, race/ethnicity, education attainment, self-reported diabetes, hypertension, cardiovascular disease (CVD), chronic kidney disease, smoking history, body mass index (BMI), asthma, obstructive lung diseases, DBS batch, anti-N MFI, vaccine type, time between vaccine and DBS, and vaccine dose at time of DBS collection. Results are presented as the percent difference in anti-S1 MFI compared with a reference group.
Results:
There were 6614 vaccinated participants prior to booster regimens and DBS collection (April 2021-July 2022) with 50%, 48%, and 2% of the cohort who received BNT162b2, mRNA-1273, or other vaccines, respectively. The mean (SD) time between vaccination and DBS was 3.8 (1.8) months. Over 10% of the cohort had self-reported a history of diabetes, 55% had hypertension, and 74% had a BMI>25 kg/m
2
. Anti-S1 MFI decreased as the time between vaccine dose and DBS collection increased. Diabetes was associated with a 16.1% lower anti-S1 MFI (95%CI:-22.4,-9.5) whereas neither hypertension (-3.8%;95%CI:-9.3,2.1), nor cardiovascular disease history (-5.3%;95%CI:-16.3,7.4) were associated with anti-S1 MFI. Former and current smoking history were each associated with a lower anti-S1 MFI: (-6.6%;95%CI:-12.1,-0.8) and (-16.1%;95%CI:-24.7,-6.6), respectively. Participants with a BMI 25-29.9 kg/m
2
had a 7.6% higher anti-S1 MFI (95%CI:0.3,15.4) whereas those with a BMI of 30-35 kg/m
2
and >35 kg/m
2
had 6.2% (95%CI:-2.4,15.5) higher and 8.9% lower (95%CI:-17.6,0.7) MFI levels, respectively. Older age and male sex were each associated with a lower anti-S1 MFI and mRNA-1273 vaccine, Asian subgroup, higher anti-N titer, and prior COVID-19 infection were each associated with higher anti-S1 MFI. Chronic kidney disease, education attainment, and lung disease were not associated with anti-S1 MFI.
Conclusions:
Several traditional cardiovascular disease risk factors were associated with diminished humoral responses to the initial COVID-19 vaccine regimens in a diverse U.S. population-based cohort and may have implications on strategies to improve vaccine responses.
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Affiliation(s)
| | | | | | | | | | - Linda Styer
- New York State Dept of Health Wadsworth Cntr, Albany, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shelley Cole
- Texas Biomedical Rsch Institute, San Antonio, TX
| | | | - Monica Parker
- New York State Dept of Health Wadsworth Cntr, Albany, NY
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12
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He WJ, Prescott B, Xanthakis V, Cheng S, Ramachandran VS. Abstract P112: Association of Obesity Sub-Phenotypes With Indices of Cardiac Remodeling in the Framingham Heart Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p112] [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: 03/15/2023]
Abstract
Introduction:
Many studies have reported that obesity-related metabolic abnormalities (such as diabetes and hypertension) lead to myocardial dysfunction and adverse cardiac remodeling. However, it is challenging to disentangle the effects of obesity from those of its associated metabolic comorbidities. Comparing metabolically healthy adults across different body mass index (BMI) categories can help delineate the independent effect of obesity on cardiac remodeling from the impact of metabolic comorbidities.
Hypothesis:
We hypothesized that metabolically healthy overweight (MHOW) and obese (MHO) participants will manifest echocardiographic measures consistent with adverse cardiac remodeling relative to their metabolically healthy counterparts with a normal BMI.
Methods:
A total of 6,639 participants of the Framingham Heart Study (mean age of 49 years, 55% women) underwent routine physical examinations and echocardiography. Participants who had prevalent cardiovascular disease were excluded. Individuals were classified into obesity sub-phenotypes based on their metabolic health (metabolically healthy or metabolic unhealthy) and BMI categories (normal weight, overweight, or obese). Obesity sub-phenotypes were related to echocardiographic measures using multivariable regression models adjusting for age, sex, smoking, resting systolic blood pressure (BP), resting diastolic BP, and resting heart rate.
Results:
Compared to metabolically healthy normal weight, MHOW and MHO were associated with increased left ventricular mass (LVM), left atrium end-systolic dimension (LAD), global longitudinal strain (GLS), and the ratio of early trans-mitral flow velocity to early diastolic mitral annulus velocity (E/e’) (
Table
).
Conclusions:
Evidence of adverse cardiac remodeling was seen in individuals with increasing BMI regardless of metabolic health classification. These findings indicate that MHOW and MHO states are associated with adverse cardiac remodeling.
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13
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Mi MY, Gajjar P, Walker ME, Miller P, Xanthakis V, Murthy VL, Larson MG, Vasan RS, Shah RV, Lewis GD, Nayor M. Association of Healthy Dietary Patterns and Cardiorespiratory Fitness in the Community. medRxiv 2023:2023.02.09.23285714. [PMID: 36798343 PMCID: PMC9934801 DOI: 10.1101/2023.02.09.23285714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Aims To evaluate the associations of dietary indices and quantitative CRF measures in a large, community-based sample harnessing metabolomic profiling to interrogate shared biology. Methods Framingham Heart Study (FHS) participants underwent maximum effort cardiopulmonary exercise tests for CRF quantification (via peak VO 2 ) and completed semi-quantitative FFQs. Dietary quality was assessed by the Alternative Healthy Eating Index (AHEI) and Mediterranean-style Diet Score (MDS), and fasting blood concentrations of 201 metabolites were quantified. Results In 2380 FHS participants (54±9 years, 54% female, BMI 28±5 kg/m 2 ), 1-SD higher AHEI and MDS were associated with 5.1% (1.2 ml/kg/min, p<0.0001) and 4.4% (1.0 ml/kg/min, p<0.0001) greater peak VO 2 in linear models adjusted for age, sex, total energy intake, cardiovascular risk factors, and physical activity. In participants with metabolite profiling (N=1154), 24 metabolites were concordantly associated with both dietary indices and peak VO 2 in multivariable-adjusted linear models (FDR<5%). These metabolites included C6 and C7 carnitines, C16:0 ceramide, and dimethylguanidino valeric acid, which were higher with lower CRF and poorer dietary quality and are known markers of insulin resistance and cardiovascular risk. Conversely, C38:7 phosphatidylcholine plasmalogen and C38:7 and C40:7 phosphatidylethanolamine plasmalogens were associated with higher CRF and favorable dietary quality and may link to lower cardiometabolic risk. Conclusion Higher diet quality is associated with greater CRF cross-sectionally in a middle-aged community-dwelling sample, and metabolites highlight potential shared favorable effects on health.
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14
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Liu X, Pan S, Xanthakis V, Ramachandran V, Newman A, Sanders J, Austin T, Odden M. PLASMA PROTEOMIC SIGNATURE OF DECLINE IN GAIT SPEED AND GRIP STRENGTH. Innov Aging 2022. [PMCID: PMC9770158 DOI: 10.1093/geroni/igac059.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Physical function predicts health-related quality of life. The biological mechanisms underlying declines in physical function with age remain unclear. We examined the plasma proteomic profile associated with longitudinal changes of physical functions measured by gait speed and grip strength in community-dwelling adults. We applied aptamer-based platform to assay 1,161 plasma proteins on 2,871 participants (60% women, aged 76 years) in Cardiovascular Health Study (CHS) in 1992/1993 and 1,550 participants (55% women, aged 54 years) in Framingham Offspring Study (FOS) in 1991-1995. Gait speed and grip strength were measured annually for 6 years in CHS and at cycles 7 (1998-2001) and 8 (2005-2008) in FOS. The associations of individual protein levels (log-transformed and standardized) with longitudinal changes of gait speed and grip strength in two populations were examined separately by linear mixed effect models. Meta-analyses were implemented using random effect models with a Bonferroni correction for multiple testing. We found that plasma levels of 18 and 12 proteins were associated with changes in gait speed and grip strength, respectively (Bonferroni-corrected p < .05). The proteins most strongly associated with gait speed decline were growth/differentiation factor 15 (GDF-15) (uncorrected Meta-analytic p = 1.60E-15), pleiotrophin (PTN) (1.29E-08), and metalloproteinase inhibitor 1 (TIMP-1) (2.02E-08). For grip strength decline, the strongest associations were for GDF-15 (1.39E-07), carbonic anhydrase III (6.60E-07), and TIMP-1 (3.21E-06). Several statistically significant proteins are involved in the alternative complement pathway, extracellular matrix remodeling or immune function. These novel proteomic biomarkers may inform our understanding of the pathophysiology of functional decline.
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Affiliation(s)
- Xiaojuan Liu
- Stanford University, Stanford, California, United States
| | - Stephanie Pan
- Boston University School of Public Health, Boston, Massachusetts, United States
| | - Vanessa Xanthakis
- Boston University School of Public Health, Boston, Massachusetts, United States
| | - Vasan Ramachandran
- Boston University School of Public Health, Boston, Massachusetts, United States
| | - Anne Newman
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jason Sanders
- Vertex Pharmaceuticals, Boston, Massachusetts, United States
| | - Thomas Austin
- University of Washington, Seattle, Washington, United States
| | - Michelle Odden
- Stanford University, Stanford, California, United States
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15
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Liu X, Pan S, Xanthakis V, Vasan RS, Psaty BM, Austin TR, Newman AB, Sanders JL, Wu C, Tracy RP, Gerszten RE, Odden MC. Plasma proteomic signature of decline in gait speed and grip strength. Aging Cell 2022; 21:e13736. [PMID: 36333824 PMCID: PMC9741503 DOI: 10.1111/acel.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 11/08/2022] Open
Abstract
The biological mechanisms underlying decline in physical function with age remain unclear. We examined the plasma proteomic profile associated with longitudinal changes in physical function measured by gait speed and grip strength in community-dwelling adults. We applied an aptamer-based platform to assay 1154 plasma proteins on 2854 participants (60% women, aged 76 years) in the Cardiovascular Health Study (CHS) in 1992-1993 and 1130 participants (55% women, aged 54 years) in the Framingham Offspring Study (FOS) in 1991-1995. Gait speed and grip strength were measured annually for 7 years in CHS and at cycles 7 (1998-2001) and 8 (2005-2008) in FOS. The associations of individual protein levels (log-transformed and standardized) with longitudinal changes in gait speed and grip strength in two populations were examined separately by linear mixed-effects models. Meta-analyses were implemented using random-effects models and corrected for multiple testing. We found that plasma levels of 14 and 18 proteins were associated with changes in gait speed and grip strength, respectively (corrected p < 0.05). The proteins most strongly associated with gait speed decline were GDF-15 (Meta-analytic p = 1.58 × 10-15 ), pleiotrophin (1.23 × 10-9 ), and TIMP-1 (5.97 × 10-8 ). For grip strength decline, the strongest associations were for carbonic anhydrase III (1.09 × 10-7 ), CDON (2.38 × 10-7 ), and SMOC1 (7.47 × 10-7 ). Several statistically significant proteins are involved in the inflammatory responses or antagonism of activin by follistatin pathway. These novel proteomic biomarkers and pathways should be further explored as future mechanisms and targets for age-related functional decline.
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Affiliation(s)
- Xiaojuan Liu
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Stephanie Pan
- Framingham Heart Study and Section of Preventive Medicine and EpidemiologyBoston University School of MedicineBostonMassachusettsUSA,Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Vanessa Xanthakis
- Framingham Heart Study and Section of Preventive Medicine and EpidemiologyBoston University School of MedicineBostonMassachusettsUSA,Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Ramachandran S. Vasan
- Framingham Heart Study and Section of Preventive Medicine and EpidemiologyBoston University School of MedicineBostonMassachusettsUSA,Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA,Section of Cardiovascular Medicine, Department of MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Thomas R. Austin
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Anne B. Newman
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Chenkai Wu
- Global Health Research CenterDuke Kunshan UniversityKunshanChina
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, The Robert Larner M.D. College of MedicineUniversity of VermontBurlingtonVermontUSA,Department of Biochemistry, The Robert Larner M.D. College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Robert E. Gerszten
- Division of Cardiovascular MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Michelle C. Odden
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
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16
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Kwan A, Demosthenes E, Salto G, Ouyang D, Nguyen T, Nwabuo CC, Luong E, Hoang A, Osypiuk E, Stantchev P, Kim EH, Hiremath P, Li D, Vasan R, Xanthakis V, Cheng S. Cardiac microstructural alterations measured by echocardiography identify sex-specific risk for heart failure. Heart 2022; 108:1800-1806. [PMID: 35680379 PMCID: PMC9626911 DOI: 10.1136/heartjnl-2022-320876] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/16/2022] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Established preclinical imaging assessments of heart failure (HF) risk are based on macrostructural cardiac remodelling. Given that microstructural alterations may also influence HF risk, particularly in women, we examined associations between microstructural alterations and incident HF. METHODS We studied N=2511 adult participants (mean age 65.7±8.8 years, 56% women) of the Framingham Offspring Study who were free of cardiovascular disease at baseline. We employed texture analysis of echocardiography to quantify microstructural alteration, based on the high spectrum signal intensity coefficient (HS-SIC). We examined its relations to incident HF in sex-pooled and sex-specific Cox models accounting for traditional HF risk factors and macrostructural alterations. RESULTS We observed 94 new HF events over 7.4±1.7 years. Individuals with higher HS-SIC had increased risk for incident HF (HR 1.67 per 1-SD in HS-SIC, 95% CI 1.31 to 2.13; p<0.0001). Adjusting for age and antihypertensive medication use, this association was significant in women (p=0.02) but not men (p=0.78). Adjusting for traditional risk factors (including body mass index, total/high-density lipoprotein cholesterol, blood pressure traits, diabetes and smoking) attenuated the association in women (HR 1.30, p=0.07), with mediation of HF risk by the HS-SIC seen for a majority of these risk factors. However, the HS-SIC association with HF in women remained significant after adjusting for relative wall thickness (representing macrostructure alteration) in addition to these risk factors (HR 1.47, p=0.02). CONCLUSIONS Cardiac microstructural alterations are associated with elevated risk for HF, particularly in women. Microstructural alteration may identify sex-specific pathways by which individuals progress from risk factors to clinical HF.
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Affiliation(s)
- Alan Kwan
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Gerran Salto
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Framingham Heart Study, Framingham, Massachusetts, USA
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor Nguyen
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Chike C Nwabuo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Ronin Institute, Montclair, New Jersey, USA
| | - Eric Luong
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Hoang
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ewa Osypiuk
- Framingham Heart Study, Framingham, Massachusetts, USA
| | | | - Elizabeth H Kim
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pranoti Hiremath
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Debiao Li
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ramachandran Vasan
- Framingham Heart Study, Framingham, Massachusetts, USA
- Departments of Medicine, Biostatistics, and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
| | - Vanessa Xanthakis
- Framingham Heart Study, Framingham, Massachusetts, USA
- Departments of Medicine, Biostatistics, and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Framingham Heart Study, Framingham, Massachusetts, USA
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17
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Hermann EA, Lee B, Balte PP, Xanthakis V, Kirkpatrick BD, Cushman M, Oelsner E. Association of Symptoms After COVID-19 Vaccination With Anti-SARS-CoV-2 Antibody Response in the Framingham Heart Study. JAMA Netw Open 2022; 5:e2237908. [PMID: 36269359 PMCID: PMC9587476 DOI: 10.1001/jamanetworkopen.2022.37908] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023] Open
Abstract
This cohort study examines the association of self-reported postvaccination symptoms with anti–SARS-CoV-2 antibody response among Framingham Heart Study participants contributing to the Collaborative Cohort of Cohorts for COVID-19 Research study.
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Affiliation(s)
- Emilia A. Hermann
- Division of General Medicine, Department of Medicine, Columbia University, New York, New York
| | - Benjamin Lee
- Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington
| | - Pallavi P. Balte
- Division of General Medicine, Department of Medicine, Columbia University, New York, New York
| | - Vanessa Xanthakis
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Beth D. Kirkpatrick
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington
- Department of Microbiology and Molecular Genetics, Larner College of Medicine, University of Vermont, Burlington
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington
| | - Elizabeth Oelsner
- Division of General Medicine, Department of Medicine, Columbia University, New York, New York
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18
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Oelsner EC, Krishnaswamy A, Balte PP, Allen NB, Ali T, Anugu P, Andrews H, Arora K, Asaro A, Barr RG, Bertoni AG, Bon J, Boyle R, Chang AA, Chen G, Coady S, Cole SA, Coresh J, Cornell E, Correa A, Couper D, Cushman M, Demmer RT, Elkind MSV, Folsom AR, Fretts AM, Gabriel KP, Gallo L, Gutierrez J, Han MLK, Henderson JM, Howard VJ, Isasi CR, Jacobs Jr DR, Judd SE, Mukaz DK, Kanaya AM, Kandula NR, Kaplan R, Kinney GL, Kucharska-Newton A, Lee JS, Lewis CE, Levine DA, Levitan EB, Levy B, Make B, Malloy K, Manly JJ, Mendoza-Puccini C, Meyer KA, Min YI, Moll M, Moore WC, Mauger D, Ortega VE, Palta P, Parker MM, Phipatanakul W, Post WS, Postow L, Psaty BM, Regan EA, Ring K, Roger VL, Rotter JI, Rundek T, Sacco RL, Schembri M, Schwartz DA, Seshadri S, Shikany JM, Sims M, Hinckley Stukovsky KD, Talavera GA, Tracy RP, Umans JG, Vasan RS, Watson K, Wenzel SE, Winters K, Woodruff PG, Xanthakis V, Zhang Y, Zhang Y, C4R Investigators FT. Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study: Study Design. Am J Epidemiol 2022; 191:1153-1173. [PMID: 35279711 PMCID: PMC8992336 DOI: 10.1093/aje/kwac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/26/2022] [Accepted: 02/09/2022] [Indexed: 01/26/2023] Open
Abstract
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) is a national prospective study of adults comprising 14 established US prospective cohort studies. Starting as early as 1971, investigators in the C4R cohort studies have collected data on clinical and subclinical diseases and their risk factors, including behavior, cognition, biomarkers, and social determinants of health. C4R links this pre-coronavirus disease 2019 (COVID-19) phenotyping to information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and acute and postacute COVID-related illness. C4R is largely population-based, has an age range of 18-108 years, and reflects the racial, ethnic, socioeconomic, and geographic diversity of the United States. C4R ascertains SARS-CoV-2 infection and COVID-19 illness using standardized questionnaires, ascertainment of COVID-related hospitalizations and deaths, and a SARS-CoV-2 serosurvey conducted via dried blood spots. Master protocols leverage existing robust retention rates for telephone and in-person examinations and high-quality event surveillance. Extensive prepandemic data minimize referral, survival, and recall bias. Data are harmonized with research-quality phenotyping unmatched by clinical and survey-based studies; these data will be pooled and shared widely to expedite collaboration and scientific findings. This resource will allow evaluation of risk and resilience factors for COVID-19 severity and outcomes, including postacute sequelae, and assessment of the social and behavioral impact of the pandemic on long-term health trajectories.
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Affiliation(s)
- Elizabeth C Oelsner
- Correspondence to Dr. Elizabeth C Oelsner, MD MPH, Herbert Irving Associate Professor of Medicine, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168 Street, PH9-105K New York, NY 10032 Tel: 917-880-7099
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19
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Guardino CE, Pan S, Vasan RS, Xanthakis V. Multi-system trajectories and the incidence of heart failure in the Framingham Offspring Study. PLoS One 2022; 17:e0268576. [PMID: 35617332 PMCID: PMC9135195 DOI: 10.1371/journal.pone.0268576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart failure is a multi-system disease, with non-cardiac systems playing a key role in disease pathogenesis. OBJECTIVE Investigate whether longitudinal multi-system trajectories incrementally predict heart failure risk compared to single-occasion traits. METHODS We evaluated 3,412 participants from the Framingham Heart Study Offspring cohort, free of heart failure, who attended examination cycle 5 and at least one examination between 1995-2008 (mean age 67 years, 54% women). We related trajectories for the following organ systems and metabolic functions to heart failure risk using Cox regression: kidney (estimated glomerular filtration rate), lung (forced vital capacity and the ratio of forced expiratory volume in one second/forced vital capacity), neuromotor (gait time), muscular (grip strength), cardiac (left ventricular mass index and heart rate), vascular function (pulse pressure), cholesterol (ratio of total/high-density lipoprotein), adiposity (body mass index), inflammation (C-reactive protein) and glucose homeostasis (hemoglobin A1c). Using traits selected via forward selection, we derived a trajectory risk score and related it to heart failure risk. RESULTS We observed 276 heart failure events during a median follow up of 10 years. Participants with the 'worst' multi-system trajectory profile had the highest heart failure risk. A one-unit increase in the trajectory risk score was associated with a 2.72-fold increase in heart failure risk (95% CI 2.21-3.34; p<0.001). The mean c-statistics for models including the trajectory risk score and single-occasion traits were 0.87 (95% CI 0.83-0.91) and 0.83 (95% CI 0.80-0.86), respectively. CONCLUSION Incorporating multi-system trajectories reflective of the aging process may add incremental information to heart failure risk assessment when compared to using single-occasion traits.
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Affiliation(s)
- Cara E. Guardino
- Division of Cardiology, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island, United States of America
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Section of Cardiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vanessa Xanthakis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
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20
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Kaplan RC, Song RJ, Lin J, Xanthakis V, Hua S, Chernofsky A, Evenson KR, Walker ME, Cuthbertson C, Murabito JM, Cordero C, Daviglus M, Perreira KM, Gellman M, Sotres-Alvarez D, Vasan RS, Xue X, Spartano NL, Mossavar-Rahmani Y. Predictors of incident diabetes in two populations: framingham heart study and hispanic community health study / study of latinos. BMC Public Health 2022; 22:1053. [PMID: 35619100 PMCID: PMC9137165 DOI: 10.1186/s12889-022-13463-8] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Non-genetic factors contribute to differences in diabetes risk across race/ethnic and socioeconomic groups, which raises the question of whether effects of predictors of diabetes are similar across populations. We studied diabetes incidence in the primarily non-Hispanic White Framingham Heart Study (FHS, N = 4066) and the urban, largely immigrant Hispanic Community Health Study/Study of Latinos (HCHS/SOL, N = 6891) Please check if the affiliations are captured and presented correctly. METHODS Clinical, behavioral, and socioeconomic characteristics were collected at in-person examinations followed by seven-day accelerometry. Among individuals without diabetes, Cox proportional hazards regression models (both age- and sex-adjusted, and then multivariable-adjusted for all candidate predictors) identified predictors of incident diabetes over a decade of follow-up, defined using clinical history or laboratory assessments. RESULTS Four independent predictors were shared between FHS and HCHS/SOL. In each cohort, the multivariable-adjusted hazard of diabetes increased by approximately 50% for every ten-year increment of age and every five-unit increment of body mass index (BMI), and was 50-70% higher among hypertensive than among non-hypertensive individuals (all P < 0.01). Compared with full-time employment status, the multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for part-time employment was 0.61 (0.37,1.00) in FHS and 0.62 (0.41,0.95) in HCHS/SOL. Moderate-to-vigorous physical activity (MVPA) was an additional predictor in common observed in age- and sex-adjusted models, which did not persist after adjustment for other covariates (compared with MVPA ≤ 5 min/day, HR for MVPA level ≥ 30 min/day was 0.48 [0.31,0.74] in FHS and 0.74 [0.56,0.97] in HCHS/SOL). Additional predictors found in sex- and age-adjusted analyses among the FHS participants included male gender and lower education, but these predictors were not found to be independent of others in multivariable adjusted models, nor were they associated with diabetes risk among HCHS/SOL adults. CONCLUSIONS The same four independent predictors - age, body mass index, hypertension and employment status - were associated with diabetes risk across two disparate US populations. While the reason for elevated diabetes risk in full-time workers is unclear, the findings suggest that diabetes may be part of the work-related burden of disease. Our findings also support prior evidence that differences by gender and socioeconomic position in diabetes risk are not universally present across populations.
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Affiliation(s)
- Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue. Belfer building, Room 1315, Bronx, NY, 10461, USA.
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Rebecca J Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue. Belfer building, Room 1315, Bronx, NY, 10461, USA
| | - Vanessa Xanthakis
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue. Belfer building, Room 1315, Bronx, NY, 10461, USA
| | | | - Kelly R Evenson
- Department of Epidemiology Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maura E Walker
- Department of Health Sciences, Boston University College of Health & Rehabilitation Sciences, Boston, MA, USA
| | - Carmen Cuthbertson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanne M Murabito
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christina Cordero
- Department of Psychology, Don Soffer Clinical Research Center, University of Miami, Miami, FL, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Marc Gellman
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue. Belfer building, Room 1315, Bronx, NY, 10461, USA
| | - Nicole L Spartano
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue. Belfer building, Room 1315, Bronx, NY, 10461, USA
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21
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Rade JJ, Barton BA, Vasan RS, Kronsberg SS, Xanthakis V, Keaney JF, Hamburg NM, Kakouros N, Kickler TA. Association of Thromboxane Generation With Survival in Aspirin Users and Nonusers. J Am Coll Cardiol 2022; 80:233-250. [PMID: 35660296 DOI: 10.1016/j.jacc.2022.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Persistent systemic thromboxane generation, predominantly from nonplatelet sources, in aspirin (ASA) users with cardiovascular disease (CVD) is a mortality risk factor. OBJECTIVES This study sought to determine the mortality risk associated with systemic thromboxane generation in an unselected population irrespective of ASA use. METHODS Stable thromboxane B2 metabolites (TXB2-M) were measured by enzyme-linked immunosorbent assay in banked urine from 3,044 participants (mean age 66 ± 9 years, 53.8% women) in the Framingham Heart Study. The association of TXB2-M to survival over a median observation period of 11.9 years (IQR: 10.6-12.7 years) was determined by multivariable modeling. RESULTS In 1,363 (44.8%) participants taking ASA at the index examination, median TXB2-M were lower than in ASA nonusers (1,147 pg/mg creatinine vs 4,179 pg/mg creatinine; P < 0.0001). TXB2-M were significantly associated with all-cause and cardiovascular mortality irrespective of ASA use (HR: 1.96 and 2.41, respectively; P < 0.0001 for both) for TXB2-M in the highest quartile based on ASA use compared with lower quartiles, and remained significant after adjustment for mortality risk factors for similarly aged individuals (HR: 1.49 and 1.82, respectively; P ≤ 0.005 for both). In 2,353 participants without CVD, TXB2-M were associated with cardiovascular mortality in ASA nonusers (adjusted HR: 3.04; 95% CI: 1.29-7.16) but not in ASA users, while ASA use was associated with all-cause mortality in those with low (adjusted HR: 1.46; 95% CI: 1.14-1.87) but not elevated TXB2-M. CONCLUSIONS Systemic thromboxane generation is an independent risk factor for all-cause and cardiovascular mortality irrespective of ASA use, and its measurement may be useful for therapy modification, particularly in those without CVD.
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Affiliation(s)
- Jeffrey J Rade
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA; Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Bruce A Barton
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Shari S Kronsberg
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - John F Keaney
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA; Boston University School of Medicine, Boston, Massachusetts, USA
| | - Naomi M Hamburg
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nikolaos Kakouros
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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22
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Bourdillon MT, Gaye B, Song RJ, Vasan RS, Xanthakis V. Notable paradoxical phenomena in associations between cardiovascular health score, subclinical and clinical cardiovascular disease in the community: The Framingham Heart Study. PLoS One 2022; 17:e0267267. [PMID: 35511823 PMCID: PMC9070900 DOI: 10.1371/journal.pone.0267267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
Importance Cardiovascular Health (CVH) scores are inversely associated with prevalent subclinical (SubDz) and incident cardiovascular disease (CVD). However, the majority of people who develop CVD have intermediate or ideal CVH scores, while many with poor CVH profiles escape CVD development. Objective To describe the prevalence of paradoxical relations among CVH, SubDz, and CVD. Design Cohort study, Framingham Study data collected prospectively (1995–2016). Setting Population-based. Participants 7,627 participants (mean age 49 years, 53% women) attending Offspring examinations 6/7 and Third Generation examinations 1/2. Exposures CVH score (range 0–14) constructed from poor, intermediate, or ideal status for each metric (smoking, diet, physical activity, blood pressure, body mass index, fasting glucose, total cholesterol); and prevalent SubDz (≥1 of: increased carotid intimal media thickness, CIMT; left ventricular hypertrophy, LVH; microalbuminuria, MA; elevated ankle brachial index, ABI; coronary artery calcium score ≥100,CAC). Main outcome(s) and measure(s) Ideal CVH (scores 12–14), intermediate CVH (scores 8–11), and poor CVH (0–7). We described three distinct paradoxical phenomena, involving combinations of CVH, SubDz, and CVD, and generated CVD incidence rates and predicted CVD probabilities for all combinations. Results We observed 842 CVD events (median follow-up 13.7 years); 1,663 participants had SubDz. Most individuals with poor CVH (78%) or SubDz (57% for CIMT to 77% for LVH) did not develop CVD on follow-up. Among participants with incident CVD, the majority had intermediate or ideal CVH (68%) or absent SubDz (46% for CAC to 96% for ABI) at baseline. We observed similar paradoxical results in relations between CVH and prevalent SubDz. Poor CVH and prevalent SubDz were each associated with higher CVD incidence rates compared to intermediate or ideal CVH and absent SubDz, respectively. The predicted CVD probability was nearly three-times greater among participants with poor (22%) versus intermediate or ideal CVH (8%). Mean CVD predicted probabilities were nearly three (26% vs. 10% for MA) to six-times (29% vs. 5% for CAC) greater among participants with SubDz versus without SubDz. Findings were consistent within age and sex strata. Conclusions and relevance Although poor CVH and SubDz presence are associated with CVD incidence, paradoxical phenomena involving CVH, SubDz, and CVD are frequently prevalent in the community. Further studies to elucidate biological mechanisms underlying these phenomena are warranted.
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Affiliation(s)
| | - Bamba Gaye
- INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Ramachandran S. Vasan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, United States of America
- Section of Cardiology, Boston University School of Medicine, Boston, MA, United States of America
- Center for Computing and Data Sciences, Boston University, Boston, MA, United States of America
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, United States of America
| | - Vanessa Xanthakis
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, United States of America
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
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23
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Abstract
BACKGROUND Arterial stiffness increases with age and is associated with an increased risk of adverse outcomes on short-term follow-up (typically <10 years). Data regarding associations of arterial stiffness with health outcomes on longer-term follow-up are lacking. METHODS We evaluated 7283 Framingham Study participants (mean age 50 years, 53% women) who underwent assessment of carotid-femoral pulse wave velocity (a marker of arterial stiffness) via applanation tonometry at one or more routine examinations. We used time-dependent Cox proportional hazards regression models to relate carotid-femoral pulse wave velocity to the incidence of health outcomes (updating carotid-femoral pulse wave velocity and all covariates at serial examinations). RESULTS On long-term follow-up (median 15 years; minimum-maximum, 0-20), participants developed cardiometabolic disease (hypertension [1255 events]; diabetes [381 events]), chronic kidney disease (529 events), dementia (235 events), cardiovascular disease (684 events) and its components (coronary heart disease [314 events], heart failure [191 events], transient ischemic attacks or stroke [250 events]), and death (1086 events). In multivariable-adjusted models, each SD increment in carotid-femoral pulse wave velocity was associated with increased risk of hypertension (hazard ratio [HR], 1.32 [95% CI, 1.21-1.44]), diabetes (HR, 1.32 [95% CI, 1.11-1.58]), chronic kidney disease (1.19 [95% CI, 1.05-1.34]), dementia (HR 1.27 [95% CI, 1.06-1.53]), cardiovascular disease (HR, 1.20 [95% CI, 1.06-1.36]) and its components (coronary heart disease, HR 1.37 [95% CI, 1.13-1.65]; transient ischemic attack/stroke, HR, 1.24 [95% CI, 1.00-1.53]), and death (HR, 1.29 [95% CI, 1.17-1.43]). The association with heart failure was borderline nonsignificant (HR, 1.21 [95% CI, 0.98-1.51], P=0.08). CONCLUSIONS Our prospective observations of a large community-based sample establish the long-term prognostic importance of arterial stiffness for multiple health outcomes.
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Affiliation(s)
- Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Alexa Beiser
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Biggs Institute for Alzheimer’s Disease, University of Texas Health Sciences Center at San Antonio, Texas
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Vasan RS, Enserro DM, Xanthakis V, Beiser AS, Seshadri S. Temporal Trends in the Remaining Lifetime Risk of Cardiovascular Disease Among Middle-Aged Adults Across 6 Decades: The Framingham Study. Circulation 2022; 145:1324-1338. [PMID: 35430874 PMCID: PMC9038688 DOI: 10.1161/circulationaha.121.057889] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The remaining lifetime risk (RLR) is the probability of developing an outcome over the remainder of one's lifespan at any given age. The RLR for atherosclerotic cardiovascular disease (ASCVD) in three 20-year periods were assessed using data from a single community-based cohort study of predominantly White participants. METHODS Longitudinal data from the Framingham study in 3 epochs (epoch 1, 1960-1979; epoch 2, 1980-1999; epoch 3, 2000-2018) were evaluated. The RLR of a first ASCVD event (myocardial infarction, coronary heart disease death, or stroke) from 45 years of age (adjusting for competing risk of death) in the 3 epochs were compared overall, and according to the following strata: sex, body mass index, blood pressure and cholesterol categories, diabetes, smoking, and Framingham risk score groups. RESULTS There were 317 849 person-years of observations during the 3 epochs (56% women; 94% White) and 4855 deaths occurred. Life expectancy rose by 10.1 years (men) to 11.9 years (women) across the 3 epochs. There were 1085 ASCVD events over the course of 91 330 person-years in epoch 1, 1330 ASCVD events over the course of 107 450 person-years in epoch 2, and 775 ASCVD events over the course of 119 069 person-years in epoch 3. The mean age at onset of first ASCVD event was greater in the third epoch by 8.1 years (men) to 10.3 years (women) compared with the first epoch. The RLR of ASCVD from 45 years of age declined from 43.7% in epoch 1 to 28.1% in epoch 3 (P<0.0001), a finding that was consistent in both sexes (RLR [epoch 1 versus epoch 3], 36.3% versus 26.5% [women]; 52.5% versus 30.1% [men]; P<0.001 for both). The lower RLR of ASCVD in the last 2 epochs was observed consistently across body mass index, blood pressure, cholesterol, diabetes, smoking, and Framingham risk score strata (P<0.001 for all). The RLR of coronary heart disease events and stroke declined in both sexes (P<0.001). CONCLUSIONS Over the past 6 decades, mean life expectancy increased and the RLR of ASCVD decreased in the community-based, predominantly White Framingham study. The residual burden of ASCVD underscores the importance of continued and effective primary prevention efforts with better screening for risk factors and their effective treatment.
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Affiliation(s)
- Ramachandran S. Vasan
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Danielle M. Enserro
- NRG Oncology; Clinical Trials Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Vanessa Xanthakis
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexa S. Beiser
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sudha Seshadri
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
- Biggs Institute for Alzheimer’s Disease, University of Texas Health Sciences Center at San Antonio, Texas
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Bourdillon MT, Song RJ, Musa Yola I, Xanthakis V, Vasan RS. Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study. J Am Heart Assoc 2022; 11:e024202. [PMID: 35261291 PMCID: PMC9075287 DOI: 10.1161/jaha.121.024202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The epidemiology of hypertension subtypes has not been well characterized in the recent era. Methods and Results We delineated the prevalence, predictors, progression, and prognostic significance of hypertension subtypes in 8198 Framingham Heart Study participants (mean age, 46.5 years; 54% women). The prevalence of hypertension subtypes was as follows: nonhypertensive (systolic blood pressure [SBP] <140 mm Hg and diastolic blood pressure [DBP] <90 mm Hg), 79%; isolated systolic hypertension (ISH; SBP ≥140 mm Hg and DBP <90 mm Hg), 8%; isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg), 4%; and systolic‐diastolic hypertension (SDH; SBP ≥140 mm Hg and DBP ≥90 mm Hg), 9%. The prevalence of ISH and SDH increased with age. Analysis of a subsample of nonhypertensive participants demonstrated that increasing age, female sex, higher heart rate, left ventricular mass, and greater left ventricular concentricity were predictors of incident ISH and SDH. Higher baseline DBP was associated with the risk of developing isolated diastolic hypertension and SDH, whereas higher SBP was associated with all 3 hypertension subtypes. On follow‐up (median, 5.5 years), isolated diastolic hypertension often reverted to nonhypertensive BP (in 42% of participants) and ISH progressed to SDH (in 26% of participants), whereas SDH frequently transitioned to ISH (in 20% of participants). During follow‐up (median, 14.6 years), 889 participants developed cardiovascular disease. Compared with the nonhypertensive group (referent), ISH (adjusted hazard ratio [HR], 1.57; 95% CI, 1.30–1.90) and SDH (HR, 1.66; 95% CI, 1.36–2.01) were associated with increased cardiovascular disease risk, whereas isolated diastolic hypertension was not (HR, 1.03; 95% CI, 0.68–1.57). Conclusions Hypertension subtypes vary in prevalence with age, are dynamic during short‐term follow‐up, and exhibit distinctive prognoses, underscoring the importance of blood pressure subphenotyping.
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Affiliation(s)
| | - Rebecca J Song
- Department of Epidemiology Boston University School of Public Health Boston MA
| | - Ibrahim Musa Yola
- Section of Preventive Medicine and Epidemiology Department of Medicine Boston University School of Medicine Boston MA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology Department of Medicine Boston University School of Medicine Boston MA.,Framingham Heart Study Framingham MA.,Department of Biostatistics Boston University School of Public Health Boston MA
| | - Ramachandran S Vasan
- Department of Epidemiology Boston University School of Public Health Boston MA.,Section of Preventive Medicine and Epidemiology Department of Medicine Boston University School of Medicine Boston MA.,Framingham Heart Study Framingham MA
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Vasan RS, Song RJ, Xanthakis V, Beiser A, DeCarli C, Mitchell GF, Seshadri S. Hypertension-Mediated Organ Damage: Prevalence, Correlates, and Prognosis in the Community. Hypertension 2022; 79:505-515. [PMID: 35138872 PMCID: PMC8849561 DOI: 10.1161/hypertensionaha.121.18502] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Guidelines emphasize screening people with elevated BP for the presence of end-organ damage. METHODS We characterized the prevalence, correlates, and prognosis of hypertension-mediated organ damage (HMOD) in the community-based Framingham Study. 7898 participants (mean age 51.6 years, 54% women) underwent assessment for the following HMOD: electrocardiographic and echocardiographic left ventricular hypertrophy, abnormal brain imaging findings consistent with vascular injury, increased carotid intima-media thickness, elevated carotid-femoral pulse wave velocity, reduced kidney function, microalbuminuria, and low ankle-brachial index. We characterized HMOD prevalence according to blood pressure (BP) categories defined by four international BP guidelines. Participants were followed up for incidence of cardiovascular disease. RESULTS The prevalence of HMOD varied positively with systolic BP and pulse pressure but negatively with diastolic BP; it increased with age, was similar in both sexes, and varied across BP guidelines based on their thresholds defining hypertension. Among participants with hypertension, elevated carotid-femoral pulse wave velocity was the most prevalent HMOD (40%-60%), whereas low ankle-brachial index was the least prevalent (<5%). Left ventricular hypertrophy, reduced kidney function, microalbuminuria, increased carotid intima-media thickness, and abnormal brain imaging findings had an intermediate prevalence (20%-40%). HMOD frequently clustered within individuals. On follow-up (median, 14.1 years), there were 384 cardiovascular disease events among 5865 participants with concurrent assessment of left ventricular mass, carotid-femoral pulse wave velocity, kidney function, and microalbuminuria. For every BP category above optimal (referent group), the presence of HMOD increased cardiovascular disease risk compared with its absence. CONCLUSIONS The prevalence of HMOD varies across international BP guidelines based on their different thresholds for defining hypertension. The presence of HMOD confers incremental prognostic information regarding cardiovascular disease risk at every BP category.
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Affiliation(s)
- Ramachandran S. Vasan
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Vanessa Xanthakis
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Alexa Beiser
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | | | | | - Sudha Seshadri
- Biggs Institute for Alzheimer’s Disease, University of Texas Health Sciences Center at San Antonio, Texas
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Lieb W, de Oliveira CM, Pan S, Echouffo-Tcheugui JB, Weber KS, Vasan RS, Xanthakis V. Clinical correlates of plasma insulin levels over the life course and association with incident type 2 diabetes: the Framingham Heart Study. BMJ Open Diabetes Res Care 2022; 10:10/1/e002581. [PMID: 35190401 PMCID: PMC8862500 DOI: 10.1136/bmjdrc-2021-002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/15/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Insulin is a glucose-lowering hormone that affects carbohydrate, lipid, and protein metabolism. Limited data exist on the correlates of insulin levels over the life course in healthy community-dwelling individuals. RESEARCH DESIGN AND METHODS Using multilevel modeling of multiple serial observations over 21 years, we assessed the longitudinal correlates of fasting insulin and the cross-sectional correlates of fasting and 2-hour (2h, post 75 g glucose challenge) plasma insulin concentrations in 2140 relatively healthy Framingham Heart Study participants without diabetes (61% women; mean age, 42 years). We used multivariable-adjusted Cox regression to relate glycemic markers (fasting and 2h-insulin, fasting glucose, 2h-glucose, and hemoglobin A1C) to the risk of type 2 diabetes during follow-up. RESULTS Over the life course, fasting insulin concentrations were inversely associated with age, male sex, and physical activity, whereas waist circumference, the total/high-density lipoprotein (HDL) cholesterol ratio, and blood triglycerides were positively associated with insulin levels (p<0.005 for all). Male sex (inversely related) and the total/HDL cholesterol ratio (positively related) emerged as the most important cross-sectional correlates of 2h-insulin (p<0.005 for all). All markers were associated with higher risk of type 2 diabetes (352 cases, median follow-up 18 years, p<0.001 for all). CONCLUSIONS We observed common and distinct correlates of fasting and 2h-insulin levels. Our findings highlight a potential role of insulin in lipid and lipoprotein metabolism. Furthermore, fasting and 2h-insulin are critical markers of future diabetes risk. Further studies are needed to confirm our findings.
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Affiliation(s)
- Wolfgang Lieb
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Institute for Epidemiology, Kiel University, Kiel, Germany
| | | | - Stephanie Pan
- Section of of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University, School of Public Health, Boston, Massachusetts, USA
| | - Justin Basile Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Ramachandran S Vasan
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Section of of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts, USA
- Boston University Center for Computing and Data Sciences, Boston, Massachusetts, USA
| | - Vanessa Xanthakis
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Section of of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University, School of Public Health, Boston, Massachusetts, USA
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Vasan RS, Enserro DM, Beiser AS, Xanthakis V. Lifetime Risk of Heart Failure Among Participants in the Framingham Study. J Am Coll Cardiol 2022; 79:250-263. [PMID: 35057911 PMCID: PMC8820638 DOI: 10.1016/j.jacc.2021.10.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The residual lifetime risk (RLR) of developing heart failure (HF) may have changed over time because of the increasing population burden of hypertension, obesity, and diabetes; greater survival after myocardial infarction; and a greater lifespan. OBJECTIVES The authors assessed changes in the RLR for HF in two 25-year epochs (1965-1989 and 1990-2014). METHODS We compared the RLR of HF at age 50 years (adjusting for competing risk of death) in the 2 epochs in Framingham Study participants overall and in the following strata: sex, body mass index, blood pressure, and diabetes. RESULTS Mean life expectancy increased from 75.9 to 82.1 years in women and 72.5 to 78.1 years in men. We observed 624 HF events over 111,351 person-observations in epoch 1, and 875 HF events over 128,903 person-observations in epoch 2. The mean age at onset of HF increased across the epochs by 6.6 years (women) to 7.2 years (men). The RLR of HF at age 50 years increased across epochs from 18.86% to 22.55% (absolute increase 3.69; 95% CI: 0.90-6.49; P = 0.01) in women, and from 19.19% to 25.25% (absolute increase 6.06; 95% CI: 3.08-9.04; P < 0.001) in men. The increase in RLR of HF in the second epoch was consistent across strata with excess body mass index or higher blood pressure (relative increase of 28%-47%) and in participants without prior myocardial infarction (relative increase of 23%). CONCLUSIONS The RLR of HF has increased in our community-based sample of White individuals over the last 5 decades, possibly caused by an increase in life expectancy.
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Affiliation(s)
- Ramachandran S. Vasan
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA,Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Danielle M. Enserro
- NRG Oncology; Clinical Trials Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Alexa S. Beiser
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Vanessa Xanthakis
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA,Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
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29
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Shrout TA, Pan S, Mitchell GF, Vasan RS, Xanthakis V. Association of orthostatic blood pressure response with incident heart failure: The Framingham Heart Study. PLoS One 2022; 17:e0267057. [PMID: 35452474 PMCID: PMC9032405 DOI: 10.1371/journal.pone.0267057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)]. OBJECTIVE Relate OH and OHT with HF risk and its subtypes. DESIGN Prospective observational cohort. SETTING Community-based individuals in the Framingham Heart Study Original Cohort. PARTICIPANTS 1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death. EXPOSURES OH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position. OUTCOMES AND MEASURES At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein. RESULTS On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk. CONCLUSIONS AND RELEVANCE Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF.
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Affiliation(s)
- Tara A. Shrout
- Department of Internal Medicine, Residency Program, Boston Medical Center, Boston, MA, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Gary F. Mitchell
- Cardiovascular Engineering, Norwood, MA, United States of America
| | - Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
- Boston University Center for Computing and Data Sciences, Boston, MA, United States of America
- Framingham Heart Study, Framingham, MA, United States of America
| | - Vanessa Xanthakis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, United States of America
- Framingham Heart Study, Framingham, MA, United States of America
- * E-mail:
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30
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Walker RL, Vlamakis H, Lee JWJ, Besse LA, Xanthakis V, Vasan RS, Shaw SY, Xavier RJ. Population study of the gut microbiome: associations with diet, lifestyle, and cardiometabolic disease. Genome Med 2021; 13:188. [PMID: 34915914 PMCID: PMC8680346 DOI: 10.1186/s13073-021-01007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The human gut harbors trillions of microbes that play dynamic roles in health. While the microbiome contributes to many cardiometabolic traits by modulating host inflammation and metabolism, there is an incomplete understanding regarding the extent that and mechanisms by which individual microbes impact risk and development of cardiovascular disease (CVD). The Framingham Heart Study (FHS) is a multi-generational observational study following participants over decades to identify risk factors for CVD by correlating genetic and phenotypic factors with clinical outcomes. As a large-scale population-based cohort with extensive clinical phenotyping, FHS provides a rich landscape to explore the relationships between the gut microbiome and cardiometabolic traits. METHODS We performed 16S rRNA gene sequencing on stool from 1423 participants of the FHS Generation 3, OMNI2, and New Offspring Spouse cohorts. Data processing and taxonomic assignment were performed with the 16S bioBakery workflow using the UPARSE pipeline. We conducted statistical analyses to investigate trends in overall microbiome composition and diversity in relation to disease states and systematically examined taxonomic associations with a variety of clinical traits, disease phenotypes, clinical blood markers, and medications. RESULTS We demonstrate that overall microbial diversity decreases with increasing 10-year CVD risk and body mass index measures. We link lifestyle factors, especially diet and exercise, to microbial diversity. Our association analyses reveal both known and unreported microbial associations with CVD and diabetes, related prescription medications, as well as many anthropometric and blood test measurements. In particular, we observe a set of microbial species that demonstrate significant associations with CVD risk, metabolic syndrome, and type 2 diabetes as well as a number of shared associations between microbial species and cardiometabolic subphenotypes. CONCLUSIONS The identification of significant microbial taxa associated with prevalent CVD and diabetes, as well as risk for developing CVD, adds to increasing evidence that the microbiome may contribute to CVD pathogenesis. Our findings support new hypothesis generation around shared microbe-mediated mechanisms that influence metabolic syndrome, diabetes, and CVD risk. Further investigation of the gut microbiomes of CVD patients in a targeted manner may elucidate microbial mechanisms with diagnostic and therapeutic implications.
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Affiliation(s)
| | - Hera Vlamakis
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Jonathan Wei Jie Lee
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
| | - Luke A Besse
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Vanessa Xanthakis
- Boston University and NHLBI's Framingham Heart Study, Framingham, MA, USA
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ramachandran S Vasan
- Boston University and NHLBI's Framingham Heart Study, Framingham, MA, USA
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA
- Department of Medicine, Section of Cardiology, Boston University School of Medicine, Boston, MA, USA
| | - Stanley Y Shaw
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ramnik J Xavier
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Center for Computational and Integrative Biology, Department of Molecular Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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Yiannakou I, Singer MR, Jacques PF, Xanthakis V, Ellison RC, Moore LL. Adherence to a Mediterranean-Style Dietary Pattern and Cancer Risk in a Prospective Cohort Study. Nutrients 2021; 13:nu13114064. [PMID: 34836319 PMCID: PMC8622098 DOI: 10.3390/nu13114064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022] Open
Abstract
A Mediterranean-style diet is a healthy eating pattern that may benefit cancer risk, but evidence among Americans is scarce. We examined the prospective association between adherence to such a diet pattern and total cancer risk. A Mediterranean-style dietary pattern (MSDP) score was derived from a semi-quantitative food frequency questionnaire at exam 5 (1991–1995). Subjects included 2966 participants of the Framingham Offspring Study who were free of prevalent cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, lifestyle, and anthropometric measures. Cox-models were also used to examine effect modification by lifestyle and anthropometric measures. During 18 years of median follow-up, 259 women and 352 men were diagnosed with cancer. Women with moderate or higher adherence to the MSDP had ≥25% lower risks of cancer than women with the lowest MSDP (HR (moderate vs. lowest): 0.71, 95% CI: 0.52–0.97 and HR (highest vs. lowest): 0.74; 95% CI: 0.55–0.99). The association between MSDP score and cancer risk in men was weaker except in non-smokers. Beneficial effects of the MSDP in women were stronger among those who were not overweight. In this study, higher adherence to MSDP was associated with lower cancer risk, especially among women.
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Affiliation(s)
- Ioanna Yiannakou
- Department of Medicine, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA 02118, USA; (I.Y.); (M.R.S.); (V.X.); (R.C.E.)
- Graduate Programs in Nutrition and Metabolism, Boston University School of Medicine, Boston, MA 02118, USA
| | - Martha R. Singer
- Department of Medicine, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA 02118, USA; (I.Y.); (M.R.S.); (V.X.); (R.C.E.)
| | - Paul F. Jacques
- Nutritional Epidemiology, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA;
| | - Vanessa Xanthakis
- Department of Medicine, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA 02118, USA; (I.Y.); (M.R.S.); (V.X.); (R.C.E.)
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - R. Curtis Ellison
- Department of Medicine, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA 02118, USA; (I.Y.); (M.R.S.); (V.X.); (R.C.E.)
| | - Lynn L. Moore
- Department of Medicine, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA 02118, USA; (I.Y.); (M.R.S.); (V.X.); (R.C.E.)
- Graduate Programs in Nutrition and Metabolism, Boston University School of Medicine, Boston, MA 02118, USA
- Correspondence: ; Tel.: +1-617-358-1325
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Vasan RS, Pan S, Larson MG, Mitchell GF, Xanthakis V. Arteriosclerosis, Atherosclerosis, and Cardiovascular Health: Joint Relations to the Incidence of Cardiovascular Disease. Hypertension 2021; 78:1232-1240. [PMID: 34601961 PMCID: PMC8516717 DOI: 10.1161/hypertensionaha.121.18075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | | | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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Vasan RS, Song RJ, Xanthakis V, Mitchell GF. Aortic Root Diameter and Arterial Stiffness: Conjoint Relations to the Incidence of Cardiovascular Disease in the Framingham Heart Study. Hypertension 2021; 78:1278-1286. [PMID: 34601969 PMCID: PMC8516742 DOI: 10.1161/hypertensionaha.121.17702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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Nayor M, Shah RV, Tanguay M, Blodgett JB, Chernofsky A, Miller PE, Xanthakis V, Malhotra R, Houstis NE, Velagaleti RS, Larson MG, Vasan RS, Lewis GD. Feasibility, Methodology, and Interpretation of Broad-Scale Assessment of Cardiorespiratory Fitness in a Large Community-Based Sample. Am J Cardiol 2021; 157:56-63. [PMID: 34391575 DOI: 10.1016/j.amjcard.2021.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
Cardiorespiratory fitness (CRF) is intricately related to health status. The optimal approach for CRF quantification is through assessment of peak oxygen uptake (VO2), but such measurements have been largely confined to small referral populations. Here we describe protocols and methodological considerations for peak VO2 assessment and determination of volitional effort in a large community-based sample. Maximum incremental ramp cycle ergometry cardiopulmonary exercise testing (CPET) was performed by Framingham Heart Study participants at a routine study visit (2016 to 2019). Of 3,486 individuals presenting for a multicomponent study visit, 3,116 (89%) completed CPET. The sample was middle-aged (54 ± 9 years), with 53% women, body mass index 28.3 ± 5.6 kg/m2, 48% with hypertension, 6% smokers, and 8% with diabetes. Exercise duration was 12.0 ± 2.1 minutes (limits 3.7to20.5). No major cardiovascular events occurred. A total of 98%, 96%, 90%, 76%, and 57% of the sample reached peak respiratory exchange ratio (RER) values of ≥1.0, ≥1.05, ≥1.10, ≥1.15, and ≥1.20, respectively (mean peak RER = 1.21 ± 0.10). With rising peak RER values up to ≈1.10, steep changes were observed for percent predicted peak VO2, VO2 at the ventilatory threshold/peak VO2, heart rate response, and Borg (subjective dyspnea) scores. More shallow changes for effort dependent CPET variables were observed with higher achieved RER values. In conclusion, measurement of peak VO2 is feasible and safe in a large sample of middle-aged, community-dwelling individuals with heterogeneous cardiovascular risk profiles. Peak RER ≥1.10 was achievable by the majority of middle-aged adults and RER values beyond this threshold did not necessarily correspond to higher peak VO2 values.
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Lee J, Song RJ, Musa Yola I, Shrout TA, Mitchell GF, Vasan RS, Xanthakis V. Association of Estimated Cardiorespiratory Fitness in Midlife With Cardiometabolic Outcomes and Mortality. JAMA Netw Open 2021; 4:e2131284. [PMID: 34714339 PMCID: PMC8556623 DOI: 10.1001/jamanetworkopen.2021.31284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE The associations of estimated cardiorespiratory fitness (eCRF) during midlife with subclinical atherosclerosis, arterial stiffness, incident cardiometabolic disease, and mortality are not well understood. OBJECTIVE To examine associations of midlife eCRF with subclinical atherosclerosis, arterial stiffness, incident cardiometabolic disease, and mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 2962 participants in the Framingham Study Second Generation (conducted between 1979 and 2001). Data were analyzed from January 2020 to June 2020. EXPOSURES eCRF was calculated using sex-specific algorithms (including age, body mass index, waist circumference, physical activity, resting heart rate, and smoking) and was categorized as: (1) tertiles of standardized eCRF at examination cycle 7 (1998 to 2001); (2) tertiles of standardized average eCRF between examination cycles 2 and 7 (1979 to 2001); and (3) eCRF trajectories between examination cycles 2 and 7, with the lowest tertile or trajectory (ie, low eCRF) as referent group. MAIN OUTCOMES AND MEASURES Subclinical atherosclerosis (carotid intima-media thickness [CIMT], coronary artery calcium [CAC] score); arterial stiffness (carotid-femoral pulse wave velocity [-1000/CFPWV]); incident hypertension, diabetes, chronic kidney disease (CKD), cardiovascular disease (CVD), and mortality after examination cycle 7. RESULTS A total of 2962 participants were included in this cohort study (mean [SD] age, 61.5 [9.2] years; 1562 [52.7%] women). The number of events or participants at risk after examination cycle 7 (at a mean follow-up of 15 years) was 728 of 1506 for hypertension, 214 of 2268 for diabetes, 439 of 2343 for CKD, 500 of 2608 for CVD, and 770 of 2962 for mortality. Compared with the low eCRF reference value, high single examination eCRF was associated with lower CFPWV (β [SE], -11.13 [1.33] ms/m) and CIMT (β [SE], -0.12 [0.05] mm), and lower risk of hypertension (hazard ratio [HR], 0.63; 95% CI, 0.46-0.85), diabetes (HR, 0.38; 95% CI, 0.23-0.62), and CVD (HR, 0.71; 95% CI, 0.53-0.95), although it was not associated with CKD or mortality. Similarly, compared with the low eCRF reference, high eCRF trajectories and mean eCRF were associated with lower CFPWV (β [SE], -11.85 [1.89] ms/m and -10.36 [1.54] ms/m), CIMT (β [SE], -0.19 [0.06] mm and -0.15 [0.05] mm), CAC scores (β [SE], -0.67 [0.25] AU and -0.63 [0.20] AU), and lower risk of hypertension (HR, 0.54; 95% CI, 0.34-0.87 and HR, 0.48; 95% CI, 0.34-0.68), diabetes (HR, 0.27; 95% CI, 0.15-0.48 and HR, 0.31; 95% CI, 0.18-0.54), CKD (HR, 0.63; 95% CI, 0.40-0.97 and HR, 0.64; 95% CI, 0.44-0.94), and CVD (HR, 0.46; 95% CI, 0.31-0.68 and HR, 0.43; 95% CI, 0.30-0.60). Compared with the reference value, a high eCRF trajectory was associated with lower risk of mortality (HR, 0.69; 95% CI, 0.50-0.95). CONCLUSIONS AND RELEVANCE In this cohort study, higher midlife eCRF was associated with lower burdens of subclinical atherosclerosis and vascular stiffness, and with a lower risk of hypertension, diabetes, chronic kidney disease, cardiovascular disease, and mortality. These findings suggest that midlife eCRF may serve as a prognostic marker for subclinical atherosclerosis, arterial stiffness, cardiometabolic health, and mortality in later life.
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Affiliation(s)
- Joowon Lee
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Ibrahim Musa Yola
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
| | - Tara A. Shrout
- Residency Program, Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | | | - Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Center for Computing and Data Sciences, Boston University, Boston, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
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Yola IM, Moser C, Duncan MS, Schwedhelm E, Atzler D, Maas R, Hannemann J, Böger RH, Vasan RS, Xanthakis V. Associations of circulating dimethylarginines with the metabolic syndrome in the Framingham Offspring study. PLoS One 2021; 16:e0254577. [PMID: 34492019 PMCID: PMC8423279 DOI: 10.1371/journal.pone.0254577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
Background Circulating levels of the endogenous inhibitor of nitric oxide synthase, asymmetric dimethylarginine (ADMA), are positively associated with the prevalence of metabolic syndrome (MetS) in cross-sectional investigations. It is unclear if circulating ADMA and other methylarginines are associated with incident MetS prospectively. Methods We related circulating ADMA, symmetric dimethylarginine (SDMA), L-arginine (ARG) concentrations (measured with a validated tandem mass spectrometry assay) and the ARG/ADMA ratio to MetS and its components in 2914 (cross-sectional analysis, logistic regression; mean age 58 years, 55% women) and 1656 (prospective analysis, Cox regression; mean age 56 years, 59% women) individuals from the Framingham Offspring Study who attended a routine examination. Results Adjusting for age, sex, smoking, and eGFR, we observed significant associations of ADMA (direct) and ARG/ADMA (inverse) with odds of MetS (N = 1461 prevalent cases; Odds Ratio [OR] per SD increment 1.13, 95%CI 1.04–1.22; and 0.89, 95%CI 0.82–0.97 for ADMA and ARG/ADMA, respectively). Upon further adjustment for waist circumference, systolic and diastolic blood pressure, glucose, high-density lipoprotein cholesterol, and triglycerides, we observed a positive relation between SDMA and MetS (OR per SD increment 1.15, 95% CI 1.01–1.30) but the other associations were rendered statistically non-significant. We did not observe statistically significant associations between any of the methylarginines and the risk of new-onset MetS (752 incident events) over a median follow-up of 11 years. Conclusion It is unclear whether dimethylarginines play an important role in the incidence of cardiometabolic risk in the community, notwithstanding cross-sectional associations. Further studies of larger samples are needed to replicate our findings.
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Affiliation(s)
- Ibrahim Musa Yola
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Carlee Moser
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Meredith S. Duncan
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States of America
| | - Edzard Schwedhelm
- Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dorothee Atzler
- Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität, Munich, Germany
- Walther Straub Institute of Pharmacology and Toxicology, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - Renke Maas
- Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Juliane Hannemann
- Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer H. Böger
- Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
- Framingham Heart Study, Framingham, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
- Boston University Center for Computing and Data Sciences, Boston, MA, United States of America
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
- Framingham Heart Study, Framingham, MA, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
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Ataklte F, Song RJ, Upadhyay A, Musa Yola I, Vasan RS, Xanthakis V. Association of Mildly Reduced Kidney Function With Cardiovascular Disease: The Framingham Heart Study. J Am Heart Assoc 2021; 10:e020301. [PMID: 34387110 PMCID: PMC8475034 DOI: 10.1161/jaha.120.020301] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Data are limited on the association of mildly reduced estimated glomerular filtration rate (eGFR 60-89 mL/min per 1.73 m2) with cardiovascular disease (CVD) in the community. Methods and Results We evaluated 3066 Framingham Offspring Study participants (55% women, mean age 58 years), without clinical CVD. Using multivariable regression, we related categories of mildly reduced eGFR (80-89, 70-79, or 60-69 versus ≥90 mL/min per 1.73 m2 [referent]) to prevalent coronary artery calcium, carotid intima media thickness, and left ventricular hypertrophy, and to circulating concentrations of cardiac stress biomarkers. We related eGFR categories to CVD incidence and to progression to ≥Stage 3 chronic kidney disease (eGFR <60 mL/min per 1.73 m2) using Cox regression. Individuals with eGFR 60-69 mL/min per 1.73 m2 (n=320) had higher coronary artery calcium score (odds ratio 1.69; 95% CI 1.02-2.80) compared with the referent group. Individuals with eGFR 60-69 and 70-79 mL/min per 1.73 m2 had higher blood growth differentiating factor-15 concentrations (β=0.131 and 0.058 per unit-increase in log-biomarker, respectively). Participants with eGFR 60-69 and 80-89 mL/min per 1.73 m2 had higher blood B-type natriuretic peptide concentrations (β=0.119 and 0.116, respectively). On follow-up (median 16 years; 691 incident CVD and 252 chronic kidney disease events), individuals with eGFR 60-69 and 70-79 mL/min per 1.73 m2 experienced higher CVD incidence (hazard ratio [HR], 1.40; 95% CI, 1.02-1.93 and 1.45, 95% CI, 1.05-2.00, respectively, versus referent). Participants with eGFR 60-69 mL/min per 1.73 m2 experienced higher chronic kidney disease incidence (HR, 2.94; 95% CI, 1.80-4.78 versus referent). Conclusions Individuals with mildly reduced eGFR 60-69 mL/min per 1.73 m2 have a higher burden of subclinical atherosclerosis cross-sectionally, and a greater risk of CVD and chronic kidney disease progression prospectively. Additional studies are warranted to confirm our findings.
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Affiliation(s)
- Feven Ataklte
- Department of Internal MedicineBoston Medical Center and Boston University School of MedicineBostonMA
| | - Rebecca J. Song
- Department of EpidemiologyBoston University School of Public HealthBostonMA
| | - Ashish Upadhyay
- Section of NephrologyBoston Medical Center and Boston University School of MedicineBostonMA
| | - Ibrahim Musa Yola
- Section of Preventive Medicine and EpidemiologyDepartment of MedicineBoston University School of MedicineBostonMA
| | - Ramachandran S. Vasan
- Department of EpidemiologyBoston University School of Public HealthBostonMA,Section of Preventive Medicine and EpidemiologyDepartment of MedicineBoston University School of MedicineBostonMA,Framingham Heart StudyFraminghamMA,Boston University Center for Computing and Data SciencesBostonMA
| | - Vanessa Xanthakis
- Department of BiostatisticsBoston University School of Public HealthBostonMA,Section of Preventive Medicine and EpidemiologyDepartment of MedicineBoston University School of MedicineBostonMA,Framingham Heart StudyFraminghamMA
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Xanthakis V, Sung JH, Samdarshi TE, Hill AN, Musani SK, Sims M, Gharaibeh KA, Liebson PR, Taylor HA, Vasan RS, Fox ER. Erratum. Relations Between Subclinical Disease Markers and Type 2 Diabetes, Metabolic Syndrome, and Incident Cardiovascular Disease: The Jackson Heart Study. Diabetes Care 2015;38:1082-1088. Diabetes Care 2021; 44:1455. [PMID: 33958426 PMCID: PMC8247512 DOI: 10.2337/dc21-er06a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Introduction:
The Framingham Risk Score (FRS) has been widely used to predict cardiovascular disease (CVD) risk. However, a comparison of the incremental prognostic utility of different subclinical disease (SubDz) measures is not clear.
Methods:
We evaluated participants aged 40-79 years (mean age 55 years, 56% women) from the Framingham Offspring (Exam 8, 2005-2008) and Third Generation cohorts (Exam 1, 2002-2005), free of CVD and diabetes, with data on coronary artery calcium (CAC, n=2497), and two measures of target organ damage: urine albumin-to-creatinine ratio (UACR, n=4011) and left ventricular mass (LVM, n=3770). We categorized FRS: <10%, 10-19%, and ≥20% and defined high CAC as CAC≥100, microalbuminuria (MA) as UACR ≥25mg/g in men and ≥35mg/g in women, and left ventricular hypertrophy (LVH) as LVM/body surface area>115 g/m
2
(men) and >95g/m
2
(women). We created 6 cross-classified groups: FRS <10%-No SubDz; FRS <10% + SubDz; FRS 10-19%-No SubDz; FRS 10-19% + SubDz; FRS ≥20%-No SubDz; and FRS ≥20% + SubDz. We related the groups to CVD risk using Cox regression adjusting for age, sex, and cohort and plotted Kaplan-Meier curves to display CVD cumulative incidence by each SubDz cross-classified group.
Results:
Over a median follow-up of 12 years, 7% of participants developed CVD. Comparing FRS 10-19%-No SubDz and FRS 10-19% + SubDz to FRS <10%-No SubDz (referent), we observed hazards ratios (95% CI) for CVD of 1.68 (0.99-2.83) and 6.50 (3.64-11.61) for high CAC; 1.33 (0.95-1.85) and 2.15 (1.10-4.18) for MA; and 1.43 (0.99-2.07) and 2.18 (1.33-3.57) for LVH. Each SubDz measure predicted CVD risk incrementally over the FRS. In a sub-sample with all three SubDz measures, the model c-statistic with FRS only was 0.725, increasing to 0.773, 0.726, and 0.728 when adding CAC, MA, and LVH, respectively.
Conclusion:
Presence of a high CAC score outperformed other measures of target organ damage (MA or LVH) for predicting CVD risk, regardless of FRS. Additional studies of larger multi-ethnic samples are warranted to confirm our findings.
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Castro-Diehl C, Ehrbar R, Obas V, Oh A, Vasan RS, Xanthakis V. Biomarkers representing key aging-related biological pathways are associated with subclinical atherosclerosis and all-cause mortality: The Framingham Study. PLoS One 2021; 16:e0251308. [PMID: 33989340 PMCID: PMC8121535 DOI: 10.1371/journal.pone.0251308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/24/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Increased oxidative stress, leukocyte telomere length (LTL) shortening, endothelial dysfunction, and lower insulin-like growth factor (IGF)-1 concentrations reflect key molecular mechanisms of aging. We hypothesized that biomarkers representing these pathways are associated with measures of subclinical atherosclerosis and all-cause mortality. METHODS AND RESULTS We evaluated up to 2,314 Framingham Offspring Study participants (mean age 61 years, 55% women) with available biomarkers of aging: LTL, circulating concentrations of IGF-1, asymmetrical dimethylarginine (ADMA), and urinary F2-Isoprostanes indexed to urinary creatinine. We evaluated the association of each biomarker with coronary artery calcium [ln (CAC+1)] and carotid intima-media thickness (IMT). In multivariable-adjusted linear regression models, higher ADMA levels were associated with higher CAC values (βADMA per 1-SD increase 0.25; 95% confidence interval [CI] [0.11, 0.39]). Additionally, shorter LTL and lower IGF-1 values were associated with higher IMT values (βLTL -0.08, 95%CI -0.14, -0.02, and βIGF-1 -0.04, 95%CI -0.08, -0.01, respectively). During a median follow-up of 15.5 years, 593 subjects died. In multivariable-adjusted Cox regression models, LTL and IGF-1 values were inversely associated with all-cause mortality (hazard ratios [HR] per SD increase in biomarker, 0.85, 95% CI 0.74-0.99, and 0.90, 95% CI 0.82-0.98 for LTL and IGF-1, respectively). F2-Isoprostanes and ADMA values were positively associated with all-cause mortality (HR per SD increase in biomarker, 1.15, 95% CI, 1.10-1.22, and 1.10, 95% CI, 1.02-1.20, respectively). CONCLUSION In our prospective community-based study, aging-related biomarkers were associated with measures of subclinical atherosclerosis cross-sectionally and with all-cause mortality prospectively, supporting the concept that these biomarkers may reflect the aging process in community-dwelling adults.
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Affiliation(s)
- Cecilia Castro-Diehl
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Rachel Ehrbar
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vanesa Obas
- Department of Medicine, Internal Medicine Residency Program, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Albin Oh
- Department of Medicine, Internal Medicine Residency Program, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Ramachandran S. Vasan
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Lung, and Blood Institute’s Framingham Heart Study, Boston University’s and National Heart, Framingham, Massachusetts, United States of America
- Department of Medicine, Section of Cardiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vanessa Xanthakis
- Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Lung, and Blood Institute’s Framingham Heart Study, Boston University’s and National Heart, Framingham, Massachusetts, United States of America
- * E-mail:
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Lin H, Castro-Diehl C, Short MI, Xanthakis V, Yola IM, Kwan AC, Mitchell GF, Larson MG, Vasan RS, Cheng S. Shared Genetic and Environmental Architecture of Cardiac Phenotypes Assessed via Echocardiography: The Framingham Heart Study. Circ Genom Precis Med 2021; 14:e003244. [PMID: 33866821 DOI: 10.1161/circgen.120.003244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Honghuang Lin
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (H.L., V.X., M.G.L., R.S.V.)
- Section of Computational Biomedicine, Department of Medicine (H.L.), Boston University School of Medicine, MA
| | - Cecilia Castro-Diehl
- Section of Preventive Medicine and Epidemiology, Department of Medicine (C.C.-D., V.X., I.M.Y., R.S.V.), Boston University School of Medicine, MA
| | - Meghan I Short
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio (M.I.S.)
- Department of Biostatistics (M.I.S., V.X., M.G.L.), Boston University School of Public Health, MA
| | - Vanessa Xanthakis
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (H.L., V.X., M.G.L., R.S.V.)
- Section of Preventive Medicine and Epidemiology, Department of Medicine (C.C.-D., V.X., I.M.Y., R.S.V.), Boston University School of Medicine, MA
- Department of Biostatistics (M.I.S., V.X., M.G.L.), Boston University School of Public Health, MA
| | - Ibrahim M Yola
- Section of Preventive Medicine and Epidemiology, Department of Medicine (C.C.-D., V.X., I.M.Y., R.S.V.), Boston University School of Medicine, MA
| | - Alan C Kwan
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.C.K., S.C.)
| | | | - Martin G Larson
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (H.L., V.X., M.G.L., R.S.V.)
- Department of Biostatistics (M.I.S., V.X., M.G.L.), Boston University School of Public Health, MA
| | - Ramachandran S Vasan
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (H.L., V.X., M.G.L., R.S.V.)
- Section of Preventive Medicine and Epidemiology, Department of Medicine (C.C.-D., V.X., I.M.Y., R.S.V.), Boston University School of Medicine, MA
- Section of Cardiovascular Medicine, Department of Medicine (R.S.V.), Boston University School of Medicine, MA
- Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA
- Center for Computing and Data Sciences, Boston University, MA (R.S.V.)
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.C.K., S.C.)
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Lee J, Walker ME, Bourdillon MT, Spartano NL, Rogers GT, Jacques PF, Vasan RS, Xanthakis V. Conjoint Associations of Adherence to Physical Activity and Dietary Guidelines With Cardiometabolic Health: The Framingham Heart Study. J Am Heart Assoc 2021; 10:e019800. [PMID: 33784828 PMCID: PMC8174320 DOI: 10.1161/jaha.120.019800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The conjoint associations of adherence to the recent physical activity and dietary guidelines with the metabolic syndrome (MetS) are incompletely understood. Methods and Results We evaluated 2379 FHS (Framingham Heart Study) Third Generation participants (mean age, 47 years; 54.4% women) attending examination cycle 2. We examined the cross‐sectional relations of adherence to the 2018 Physical Activity Guidelines for Americans (binary; moderate‐to‐vigorous physical activity ≥150 versus <150 min/wk) and 2015 Dietary Guidelines for Americans (binary; 2015 Dietary Guidelines for Americans Adherence Index ≥median versus <median [score, 62.1/100]) with prevalence of the MetS using generalized linear models. We also related adherence to guidelines with the incidence of MetS prospectively, using Cox proportional hazards regression with discrete time intervals. Adherence rates to the 2018 Physical Activity Guidelines for Americans (odds ratio [OR], 0.49; 95% CI, 0.40–0.60) and 2015 Dietary Guidelines for Americans (OR, 0.67; 95% CI, 0.51–0.90) were individually associated with lower odds of prevalent MetS, whereas conjoint adherence to both guidelines was associated with the lowest odds of MetS (OR, 0.35; 95% CI, 0.26–0.47) compared with the referent group (nonadherence to both guidelines). Adherence rates to the 2018 Physical Activity Guidelines for Americans (hazard ratio [HR], 0.66; 95% CI, 0.50–0.88) and 2015 Dietary Guidelines for Americans (HR, 0.68; 95% CI, 0.51–0.90) were associated with lower risk of MetS, prospectively. In addition, we observed a 52% lower risk of MetS in individuals who adhered to both guidelines compared with the referent group. Conclusions Maintaining both regular physical activity and a healthy diet in midlife may be required for optimal cardiometabolic health in later life.
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Affiliation(s)
- Joowon Lee
- Section of Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA
| | - Maura E Walker
- Section of Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA.,Department of Health Sciences Sargent College of Health and Rehabilitation SciencesBoston University Boston MA
| | | | - Nicole L Spartano
- Section of Endocrinology Diabetes, Nutrition, and Weight Management Boston University School of Medicine Boston MA.,FHS (Framingham Heart Study) Framingham MA
| | - Gail T Rogers
- Nutritional Epidemiology Program Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University Boston MA
| | - Paul F Jacques
- Nutritional Epidemiology Program Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University Boston MA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA.,FHS (Framingham Heart Study) Framingham MA.,Department of Epidemiology Boston University School of Public Health Boston MA.,Section of Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Center for Computing and Data Sciences Boston University Boston MA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA.,FHS (Framingham Heart Study) Framingham MA.,Department of Biostatistics Boston University School of Public Health Boston MA
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Carneiro HA, Song RJ, Lee J, Schwartz B, Vasan RS, Xanthakis V. Association of Blood Pressure and Heart Rate Responses to Submaximal Exercise With Incident Heart Failure: The Framingham Heart Study. J Am Heart Assoc 2021; 10:e019460. [PMID: 33759543 PMCID: PMC8174367 DOI: 10.1161/jaha.120.019460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Exercise stress tests are conventionally performed to assess risk of coronary artery disease. Using the FHS (Framingham Heart Study) Offspring cohort, we related blood pressure (BP) and heart rate responses during and after submaximal exercise to the incidence of heart failure (HF). Methods and Results We evaluated Framingham Offspring Study participants (n=2066; mean age, 58 years; 53% women) who completed 2 stages of an exercise test (Bruce protocol) at their seventh examination (1998-2002). We measured pulse pressure, systolic BP, diastolic BP, and heart rate responses during stage 2 exercise (2.5 mph at 12% grade). We calculated the changes in systolic BP, diastolic BP, and heart rate from stage 2 to recovery 3 minutes after exercise. We used Cox proportional hazards regression to relate each standardized exercise variable (during stage 2, and at 3 minutes of recovery) individually to HF incidence, adjusting for standard risk factors. On follow-up (median, 16.8 years), 85 participants developed new-onset HF. Higher exercise diastolic BP was associated with higher HF with reduced ejection fraction (ejection fraction <50%) risk (hazard ratio [HR] per SD increment, 1.26; 95% CI, 1.01-1.59). Lower stage 2 pulse pressure and rapid postexercise recovery of heart rate and systolic BP were associated with higher HF with reduced ejection fraction risk (HR per SD increment, 0.73 [95% CI, 0.57-0.94]; 0.52 [95% CI, 0.35-0.76]; and 0.63 [95% CI, 0.47-0.84], respectively). BP and heart rate responses to submaximal exercise were not associated with risk of HF with preserved ejection fraction (ejection fraction ≥50%). Conclusions Accentuated diastolic BP during exercise with slower systolic BP and heart rate recovery after exercise are markers of HF with reduced ejection fraction risk.
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Affiliation(s)
- Herman A Carneiro
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Rebecca J Song
- Department of Epidemiology Boston University School of Public Health Boston MA
| | - Joowon Lee
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
| | - Brian Schwartz
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Ramachandran S Vasan
- Department of Epidemiology Boston University School of Public Health Boston MA.,Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston UniversityCenter for Computing and Data Sciences Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA
| | - Vanessa Xanthakis
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA.,Department of Biostatistics Boston University School of Public Health Boston MA
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Oelsner EC, Allen NB, Ali T, Anugu P, Andrews H, Asaro A, Balte PP, Barr RG, Bertoni AG, Bon J, Boyle R, Chang AA, Chen G, Cole SA, Coresh J, Cornell E, Correa A, Couper D, Cushman M, Demmer RT, Elkind MSV, Folsom AR, Fretts AM, Gabriel KP, Gallo L, Gutierrez J, Han MK, Henderson JM, Howard VJ, Isasi CR, Jacobs DR, Judd SE, Mukaz DK, Kanaya AM, Kandula NR, Kaplan R, Krishnaswamy A, Kinney GL, Kucharska-Newton A, Lee JS, Lewis CE, Levine DA, Levitan EB, Levy B, Make B, Malloy K, Manly JJ, Meyer KA, Min YI, Moll M, Moore WC, Mauger D, Ortega VE, Palta P, Parker MM, Phipatanakul W, Post W, Psaty BM, Regan EA, Ring K, Roger VL, Rotter JI, Rundek T, Sacco RL, Schembri M, Schwartz DA, Seshadri S, Shikany JM, Sims M, Hinckley Stukovsky KD, Talavera GA, Tracy RP, Umans JG, Vasan RS, Watson K, Wenzel SE, Winters K, Woodruff PG, Xanthakis V, Zhang Y, Zhang Y. Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study: Study Design. medRxiv 2021:2021.03.19.21253986. [PMID: 33758891 PMCID: PMC7987050 DOI: 10.1101/2021.03.19.21253986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) is a national prospective study of adults at risk for coronavirus disease 2019 (COVID-19) comprising 14 established United States (US) prospective cohort studies. For decades, C4R cohorts have collected extensive data on clinical and subclinical diseases and their risk factors, including behavior, cognition, biomarkers, and social determinants of health. C4R will link this pre-COVID phenotyping to information on SARS-CoV-2 infection and acute and post-acute COVID-related illness. C4R is largely population-based, has an age range of 18-108 years, and broadly reflects the racial, ethnic, socioeconomic, and geographic diversity of the US. C4R is ascertaining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 illness using standardized questionnaires, ascertainment of COVID-related hospitalizations and deaths, and a SARS-CoV-2 serosurvey via dried blood spots. Master protocols leverage existing robust retention rates for telephone and in-person examinations, and high-quality events surveillance. Extensive pre-pandemic data minimize referral, survival, and recall bias. Data are being harmonized with research-quality phenotyping unmatched by clinical and survey-based studies; these will be pooled and shared widely to expedite collaboration and scientific findings. This unique resource will allow evaluation of risk and resilience factors for COVID-19 severity and outcomes, including post-acute sequelae, and assessment of the social and behavioral impact of the pandemic on long-term trajectories of health and aging.
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Yola IM, Oh A, Mitchell GF, O’Connor G, Cheng S, Vasan RS, Xanthakis V. Association of lung diffusion capacity with cardiac remodeling and risk of heart failure: The Framingham heart study. PLoS One 2021; 16:e0246355. [PMID: 33592021 PMCID: PMC7886141 DOI: 10.1371/journal.pone.0246355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Lung function abnormalities are ubiquitous in heart failure (HF). It is unclear, however, if abnormal lung diffusion capacity is associated with cardiac remodeling and antedates HF. We hypothesized that lower lung diffusion capacity for carbon monoxide (DLCO) is associated with worse left ventricular (LV) systolic and diastolic function cross-sectionally, and with higher risk of HF prospectively. Methods We evaluated 2423 Framingham Study participants (mean age 66 years, 55% women) free of HF who underwent routine echocardiography and pulmonary function tests. We used multivariable regression models to relate DLCO, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) to left ventricular ejection fraction (LVEF), left atrial (LA) emptying fraction (LAEF), E/e’, E/A, LV mass, and LA diameter (LAD). Multivariable-adjusted Cox proportional hazards regression was used to relate DLCO, FEV1, and FVC to incident HF. Results In multivariable-adjusted cross-sectional analyses, DLCO, FEV1, and FVC (dependent variables) were associated positively with LVEF (βDLCO = 0.208, βFEV1 = 0.021, and βFVC = 0.025 per 5% increment in LVEF; p<0.005 for all), and LAEF (βDLCO = 0.707, βFEV1 = 0.058 and βFVC = 0.058 per 5% increment in LAEF; p<0.002 for all). DLCO and FVC were inversely related to E/A (βDLCO = -0.289, βFVC = -0.047 per SD increment in E/A; p<0.001 for all). Additionally, DLCO, FEV1 and FVC were inversely related to HF risk (108 events, median follow-up 9.7 years; multivariable-adjusted hazard ratios per SD increment 0.90, 95% CI 0.86–0.95; 0.42, 95% CI 0.28–0.65, and 0.51, 95% CI 0.36–0.73, respectively). These results remained robust in analyses restricted to non-smokers. Conclusions Our large community-based observations are consistent with the concept that lower lung diffusion capacity and expiratory flow rates are associated with cardiac remodeling and may antedate HF. Additional studies are needed to confirm our findings and to evaluate the prognostic utility of pulmonary function testing for predicting HF.
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Affiliation(s)
- Ibrahim Musa Yola
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Albin Oh
- Department of Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Gary F. Mitchell
- Cardiovascular Engineering, Inc., Norwood, MA, United States of America
| | - George O’Connor
- Department of Medicine, Pulmonary Center, Boston Medical Center, Boston University, Boston, MA, United States of America
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
- National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
- National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, MA, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
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Corlin L, Short MI, Vasan RS, Xanthakis V. Association of the Duration of Ideal Cardiovascular Health Through Adulthood With Cardiometabolic Outcomes and Mortality in the Framingham Offspring Study. JAMA Cardiol 2021; 5:549-556. [PMID: 32159731 DOI: 10.1001/jamacardio.2020.0109] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance The American Heart Association ideal cardiovascular health (CVH) score is associated with the risk of cardiovascular disease (CVD) and mortality. However, it is unclear whether the number of years spent in ideal CVH is associated with morbidity or with mortality. Objective To evaluate whether living longer with a higher CVH score in midlife is associated with lower risk of hypertension, diabetes, chronic kidney disease, CVD and its subtypes (coronary heart disease, stroke, congestive heart failure, and peripheral artery disease), or all-cause mortality in later life. Design, Setting, and Participants This prospective cohort study used data from 1445 participants from 1991 to 2015 who participated in the community-based Framingham Heart Study Offspring investigation conducted in Massachusetts. The CVH scores of participants were assessed at examination cycles 5, 6, and 7 (1991-1995; 1995-1998; and 1998-2001, respectively). Individuals were excluded from analyses of the association between duration of CVH score and outcomes if they had the outcome of interest at the seventh examination. The median follow-up was approximately 16 years. Data were analyzed from April 2018 to October 2019. The CVH score categories were poor for scores 0 to 7, intermediate for scores 8 to 11, and ideal for scores 12 to 14. A composite score was derived based on smoking status, diet, physical activity, resting blood pressure levels, body mass index, fasting blood glucose levels, and total serum cholesterol levels. Main Outcomes and Measures Number of events and number at risk for each main outcome, including incident hypertension, diabetes, chronic kidney disease, CVD, and all-cause mortality, after the seventh examination. Results Of 1445 eligible participants, the mean (SD) age was 60 (9) years, and 751 (52%) were women. Number of events/number at risk for each main outcome after the seventh examination were 348/795 for incident hypertension, 104/1304 for diabetes, 198/918 for chronic kidney disease, 210/1285 for CVD, and 300/1445 for all-cause mortality. At the seventh examination, participants mostly had poor (568 [39%]) or intermediate (782 [54%]) CVH scores. For each antecedent (before examination cycle 7) 5-year duration that participants had intermediate or ideal CVH, they were less likely to develop adverse outcomes (hazards ratios of 0.67 [95% CI, 0.56-0.80] for incident hypertension, 0.73 [95% CI, 0.57-0.93] for diabetes, 0.75 [95% CI, 0.63-0.89] for chronic kidney disease, 0.73 [95% CI, 0.63-0.85] for CVD, and 0.86 [95% CI, 0.76-0.97] for all-cause mortality) relative to living the same amount of time in poor CVH (referent group). No effect modification was observed by age or by sex. Conclusions and Relevance These results suggest that more time spent in better CVH in midlife may have salutary cardiometabolic benefits and may be associated with lower mortality later in life.
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Affiliation(s)
- Laura Corlin
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Meghan I Short
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.,Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.,Framingham Heart Study, Framingham, Massachusetts
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.,Framingham Heart Study, Framingham, Massachusetts
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Castro-Diehl C, Song RJ, Sawyer DB, Wollert KC, Mitchell GF, Cheng S, Vasan RS, Xanthakis V. Circulating growth factors and cardiac remodeling in the community: The Framingham Heart Study. Int J Cardiol 2021; 329:217-224. [PMID: 33422565 DOI: 10.1016/j.ijcard.2020.12.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Cardiac and vascular growth factors (GF) may influence myocardial remodeling through cardiac growth and angiogenic effects. We hypothesized that concentrations of circulating GF are associated with cardiac remodeling traits. METHODS We related blood concentrations of vascular endothelial GF (VEGF), VEGFR-1 (sFlt1), angiopoietin 2 (Ang-2), soluble angiopoietin type-2 receptor (sTie2), hepatocyte GF (HGF), insulin-like GF (IGF)-1, IGF binding protein (IGFBP)-3, and growth differentiation factor-15 (GDF-15) to echocardiographic traits in 3151 Framingham Study participants (mean age 40 years, 55% women). We evaluated the following measures: left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral E/e', and aortic root diameter (AoR). All biomarker values were sex-standardized. RESULTS In multivariable-adjusted analyses, higher GDF-15 concentrations were associated with higher log-LVMi (β = 0.009 per SD, P = 0.01). Similarly, sTie2 concentrations were positively associated with log-E/e' (β = 0.011 per SD, P = 0.04). IGF-1 and Ang-2 concentrations were positively and negatively associated with GLS, respectively (βIGF-1 = 0.16 per SD and βAng-2 = -0.15 per SD, both P < 0.05), whereas higher sFlt1 and Ang-2 levels were associated with smaller log-AoR (βsFlt1 = -0.004 per SD and β Ang-2 = -0.005 per SD, respectively; P < 0.05). CONCLUSION In our large community-based sample, we observed patterns of associations between several circulating vascular GF and cardiac remodeling indices that are consistent with the known biological effects of these pro- and anti-angiogenic factors on the myocardium and conduit arteries. Additional studies are warranted to replicate our findings and assess their prognostic significance.
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Affiliation(s)
- Cecilia Castro-Diehl
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Rebecca J Song
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Douglas B Sawyer
- Department of Cardiovascular Medicine, Maine Medical Center, Portland, ME, USA
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA; Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA..
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von Jeinsen B, Vasan RS, McManus DD, Mitchell GF, Cheng S, Xanthakis V. Joint influences of obesity, diabetes, and hypertension on indices of ventricular remodeling: Findings from the community-based Framingham Heart Study. PLoS One 2020; 15:e0243199. [PMID: 33301464 PMCID: PMC7728232 DOI: 10.1371/journal.pone.0243199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/17/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction Obesity, hypertension, and diabetes are independently associated with cardiac remodeling and frequently co-cluster. The conjoint and separate influences of these conditions on cardiac remodeling have not been investigated. Materials and methods We evaluated 5,741 Framingham Study participants (mean age 50 years, 55% women) who underwent echocardiographic measurements of left ventricular (LV) mass (LVM), LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral E/e’, left atrial end-systolic (peak) dimension (LASD) and emptying fraction (LAEF). We used multivariable generalized linear models to estimate the adjusted-least square means of these measures according to cross-classified categories of body mass index (BMI; normal, overweight and obese), hypertension (yes/no), and diabetes (yes/no). Results We observed statistically significant interactions of BMI category, hypertension, and diabetes with LVM, LVEF, GLS, and LAEF (p for all 3-way interactions <0.01). Overweight and obesity (compared to normal BMI), hypertension, and diabetes status were individually and conjointly associated with higher LVM and worse GLS (p<0.01 for all). We observed an increase of 34% for LVM and of 9% for GLS between individuals with a normal BMI and without hypertension or diabetes compared to obese individuals with hypertension and diabetes. Presence of hypertension was associated with higher LVEF, whereas people with diabetes had lower LVEF. Conclusions Obesity, hypertension, and diabetes interact synergistically to influence cardiac remodeling. These findings may explain the markedly heightened risk of heart failure and cardiovascular disease when these factors co-cluster.
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Affiliation(s)
- Beatrice von Jeinsen
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States of America
| | - Ramachandran S. Vasan
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts, United States of America
| | - Gary F. Mitchell
- Cardiovascular Engineering, Inc, Norwood, Massachusetts, United States of America
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Vanessa Xanthakis
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Vasan RS, Zachariah JP, Xanthakis V. Life Course Developmental Approach to Cardiovascular Health and Cardiovascular Disease Prevention: Opportunities and Unanswered Questions. J Am Coll Cardiol 2020; 76:2708-2711. [PMID: 33272364 PMCID: PMC8297517 DOI: 10.1016/j.jacc.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ramachandran S Vasan
- Framingham Heart Study and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
| | - Justin P Zachariah
- Section of Pediatric Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Vanessa Xanthakis
- Framingham Heart Study and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
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Tun B, Ehrbar R, Short M, Cheng S, Vasan RS, Xanthakis V. Association of Exhaled Carbon Monoxide With Ideal Cardiovascular Health, Circulating Biomarkers, and Incidence of Heart Failure in the Framingham Offspring Study. J Am Heart Assoc 2020; 9:e016762. [PMID: 33100134 PMCID: PMC7763395 DOI: 10.1161/jaha.120.016762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Exhaled carbon monoxide (eCO) is directly associated with traditional cardiovascular disease risk factors and incident cardiovascular disease. However, its relation with the cardiovascular health score and incidence of heart failure (HF) has not been investigated. Methods and Results We measured eCO in 3521 Framingham Heart Study Offspring participants attending examination cycle 6 (mean age 59 years, 53% women). We related the cardiovascular health score (composite of blood pressure, fasting plasma glucose, total cholesterol, body mass index, smoking, diet, and physical activity) to eCO adjusting for age, sex, and smoking. Higher cardiovascular health scores were associated with lower eCO (β=-0.02, P<0.0001), even among nonsmokers. Additionally, C-reactive protein, plasminogen activator inhibitor-1, fibrinogen, growth differentiation factor-15, homocysteine, and asymmetrical dimethylarginine were positively associated with eCO (P≤0.003 for all). The age- and sex-adjusted and multivariable-adjusted heritabilities of eCO were 49.5% and 31.4%, respectively. Over a median follow-up of 18 years, 309 participants (45% women) developed HF. After multivariable adjustment, higher eCO was associated with higher risk of HF (hazards ratio per SD increment: 1.39; 95% CI, 1.19-1.62 [P<0.001]) and with higher risk of HF with reduced ejection fraction (N=144 events; hazard ratio per SD increment in eCO: 1.43; 95% CI, 1.15-1.77 [P=0.001]). Conclusions In our community-based sample, higher levels of eCO were associated with lower cardiovascular health scores, an adverse cardiovascular biomarker profile, and a higher risk of HF, specifically HF with reduced ejection fraction. Our findings suggest that carbon monoxide may identify a novel pathway to HF development.
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Affiliation(s)
- Bradley Tun
- Department of Medicine Boston University School of Medicine and Boston Medical Center Boston MA
| | - Rachel Ehrbar
- Department of Biostatistics Boston University School of Public Health Boston MA
| | - Meghan Short
- Glenn Biggs Institute for Alzheimer's Disease & Neurodegenerative Diseases University of Texas Health Sciences Center San Antonio TX
| | - Susan Cheng
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Ramachandran S Vasan
- National Heart, Blood and Lung Institute Framingham Heart Study Framingham MA.,Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Department of Epidemiology Boston University School of Public Health Boston MA
| | - Vanessa Xanthakis
- Department of Biostatistics Boston University School of Public Health Boston MA.,National Heart, Blood and Lung Institute Framingham Heart Study Framingham MA.,Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
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