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Boakye E, Oyeka CP, Kwapong YA, Metlock FE, Khan SS, Mamas MA, Perak AM, Douglas PS, Honigberg MC, Nasir K, Blaha MJ, Sharma G. Cardiovascular Risk Profile Among Reproductive-Aged Women in the U.S.: The Behavioral Risk Factor Surveillance System, 2015-2020. AJPM Focus 2024; 3:100210. [PMID: 38766464 PMCID: PMC11096844 DOI: 10.1016/j.focus.2024.100210] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Suboptimal cardiovascular health is associated with adverse pregnancy outcomes and long-term cardiovascular risk. The authors examined trends in cardiovascular risk factors and correlates of suboptimal cardiovascular risk profiles among reproductive-aged U.S. women. Methods With data from 335,959 women in the Behavioral Risk Factor Surveillance System (2015-2020), the authors conducted serial cross-sectional analysis among nonpregnant reproductive-aged women (18-44 years) without cardiovascular disease who self-reported information on 8 cardiovascular risk factors selected on the basis of Life's Essential 8 metrics. The authors estimated the prevalence of each risk factor and suboptimal cardiovascular risk profile (≥2 risk factors) and examined trends overall and by age and race/ethnicity. Using multivariable Poisson regression, the authors assessed the sociodemographic correlates of suboptimal cardiovascular risk profile. Results The weighted prevalence of women aged <35 years was approximately 64% in each survey year. The prevalence of suboptimal cardiovascular risk profile increased modestly from 72.4% (71.6%-73.3%) in 2015 to 75.9% (75.0%-76.7%) in 2019 (p<0.001). This increase was mainly driven by increases in overweight/obesity (53.1%-58.4%; p<0.001). Between 2015 and 2019, significant increases in suboptimal cardiovascular risk profile were observed among non-Hispanic White (69.8%-72.6%; p<0.001) and Hispanic (75.1%-80.3%; p<0.001) women but not among non-Hispanic Black (82.7%-83.7%; p=0.48) or Asian (68.1%-73.2%; p=0.09) women. Older age, rural residence, and non-Hispanic Black and Hispanic race and ethnicity were associated with a higher prevalence of suboptimal cardiovascular risk profile. Conclusions There has been a modest but significant increase in suboptimal cardiovascular risk profile among U.S. women of reproductive age. Urgent preventive efforts are needed to reverse this trend and improve cardiovascular health, particularly among subgroups at increased risk, to mitigate its implications.
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Affiliation(s)
- Ellen Boakye
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Chigolum P. Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Yaa A. Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | | | - Sadiya S. Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mamas A. Mamas
- Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Staffordshire, United Kingdom
| | - Amanda M. Perak
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Pamela S. Douglas
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael C. Honigberg
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist, Houston, Texas
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, Virginia
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Obisesan OH, Boakye E, Wang FM, Dardari Z, Dzaye O, Cainzos-Achirica M, Meyer ML, Gottesman R, Palta P, Coresh J, Howard-Claudio CM, Lin FR, Punjabi N, Nasir K, Matsushita K, Blaha MJ. Coronary artery calcium as a marker of healthy and unhealthy aging in adults aged 75 and older: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2024; 392:117475. [PMID: 38408881 PMCID: PMC11088977 DOI: 10.1016/j.atherosclerosis.2024.117475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND AIMS Coronary artery calcium (CAC) is validated for risk prediction among middle-aged adults, but there is limited research exploring implications of CAC among older adults. We used data from the Atherosclerosis Risk in Communities (ARIC) study to evaluate the association of CAC with domains of healthy and unhealthy aging in adults aged ≥75 years. METHODS We included 2,290 participants aged ≥75 years free of known coronary heart disease who underwent CAC scoring at study visit 7. We examined the cross-sectional association of CAC = 0, 1-999 (reference), and ≥1000 with seven domains of aging: cognitive function, hearing, ankle-brachial index (ABI), pulse-wave velocity (PWV), forced vital capacity (FVC), physical functioning, and grip strength. RESULTS The mean age was 80.5 ± 4.3 years, 38.6% male, and 77.7% White. 10.3% had CAC = 0 and 19.2% had CAC≥1000. Individuals with CAC = 0 had the lowest while those with CAC≥1000 had the highest proportion with dementia (2% vs 8%), hearing impairment (46% vs 67%), low ABI (3% vs 18%), high PWV (27% vs 41%), reduced FVC (34% vs 42%), impaired grip strength (66% vs 74%), and mean composite abnormal aging score (2.6 vs 3.7). Participants with CAC = 0 were less likely to have abnormal ABI (aOR:0.15, 95%CI:0.07-0.34), high PWV (aOR:0.57, 95%CI:0.41-0.80), and reduced FVC (aOR:0.69, 95%CI:0.50-0.96). Conversely, participants with CAC≥1000 were more likely to have low ABI (aOR:1.74, 95%CI:1.27-2.39), high PWV (aOR:1.52, 95%CI:1.15-2.00), impaired physical functioning (aOR:1.35, 95%CI:1.05-1.73), and impaired grip strength (aOR:1.46, 95%CI:1.08-1.99). CONCLUSIONS Our findings highlight CAC as a simple measure broadly associated with biological aging, with clinical and research implications for estimating the physical and physiological aging trajectory of older individuals.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Frances M Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Division of Cardiology, Hospital del Mar- Parc de Salut Mar, Barcelona, Spain
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Gottesman
- Stroke, Cognition, and Neuroepidemiology Section of the National Institutes of Health, Bethesda, MD, USA
| | - Priya Palta
- Department of Medicine, Columbia University School of Medicine, New York, NY, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Frank R Lin
- Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, MD, USA
| | - Naresh Punjabi
- Division of Critical Care Medicine, Pulmonology, Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Erhabor J, Boakye E, Dardari Z, Dzaye O, Soroosh G, Berman DS, Budoff MJ, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Johansen MC, Blaha MJ. Coronary artery calcium for stroke mortality prediction. Vasc Med 2024; 29:213-214. [PMID: 38334053 DOI: 10.1177/1358863x231226217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Med Center, Los Angeles, CA, USA
- Department of Cardiology, Cedars-Sinai Med Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Michael D Miedema
- Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, NJ, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Michelle C Johansen
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Whelton SP, Jha K, Dardari Z, Razavi AC, Boakye E, Dzaye O, Verghese D, Shah S, Budoff MJ, Matsushita K, Carr JJ, Vasan RS, Blumenthal RS, Anchouche K, Thanassoulis G, Guo X, Rotter JI, McClelland RL, Post WS, Blaha MJ. Prevalence of Aortic Valve Calcium and the Long-Term Risk of Incident Severe Aortic Stenosis. JACC Cardiovasc Imaging 2024; 17:31-42. [PMID: 37178073 PMCID: PMC10902718 DOI: 10.1016/j.jcmg.2023.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Aortic valve calcification (AVC) is a principal mechanism underlying aortic stenosis (AS). OBJECTIVES This study sought to determine the prevalence of AVC and its association with the long-term risk for severe AS. METHODS Noncontrast cardiac computed tomography was performed among 6,814 participants free of known cardiovascular disease at MESA (Multi-Ethnic Study of Atherosclerosis) visit 1. AVC was quantified using the Agatston method, and normative age-, sex-, and race/ethnicity-specific AVC percentiles were derived. The adjudication of severe AS was performed via chart review of all hospital visits and supplemented with visit 6 echocardiographic data. The association between AVC and long-term incident severe AS was evaluated using multivariable Cox HRs. RESULTS AVC was present in 913 participants (13.4%). The probability of AVC >0 and AVC scores increased with age and were generally highest among men and White participants. In general, the probability of AVC >0 among women was equivalent to men of the same race/ethnicity who were approximately 10 years younger. Incident adjudicated severe AS occurred in 84 participants over a median follow-up of 16.7 years. Higher AVC scores were exponentially associated with the absolute risk and relative risk of severe AS with adjusted HRs of 12.9 (95% CI: 5.6-29.7), 76.4 (95% CI: 34.3-170.2), and 380.9 (95% CI: 169.7-855.0) for AVC groups 1 to 99, 100 to 299, and ≥300 compared with AVC = 0. CONCLUSIONS The probability of AVC >0 varied significantly by age, sex, and race/ethnicity. The risk of severe AS was exponentially higher with higher AVC scores, whereas AVC = 0 was associated with an extremely low long-term risk of severe AS. The measurement of AVC provides clinically relevant information to assess an individual's long-term risk for severe AS.
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Kunal Jha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dhiran Verghese
- Department of Medicine, Harbor University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Sanjiv Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J Budoff
- Department of Medicine, Harbor University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J Jeffery Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ramachandran S Vasan
- University of Texas School of Public Health San Antonio, San Antonio, Texas, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Khalil Anchouche
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Wendy S Post
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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5
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Erhabor J, Boakye E, Obisesan O, Osei AD, Tasdighi E, Mirbolouk H, DeFilippis AP, Stokes AC, Hirsch GA, Benjamin EJ, Rodriguez CJ, El Shahawy O, Robertson RM, Bhatnagar A, Blaha MJ. E-Cigarette Use Among US Adults in the 2021 Behavioral Risk Factor Surveillance System Survey. JAMA Netw Open 2023; 6:e2340859. [PMID: 37921768 PMCID: PMC10625038 DOI: 10.1001/jamanetworkopen.2023.40859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/17/2023] [Indexed: 11/04/2023] Open
Abstract
Importance After the initial disruption from the COVID-19 pandemic, it is unclear how patterns of e-cigarette use in the US have changed. Objective To examine recent patterns in current and daily e-cigarette use among US adults in 2021. Design, Setting, and Participants This cross-sectional study used data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) database. The BRFSS is the largest national telephone-based survey of randomly sampled adults in the US. Adults aged 18 years or older, residing in 49 US states (all except Florida), the District of Columbia, and 3 US territories (Guam, Puerto Rico, and the US Virgin Islands), were included in the data set. Data analysis was performed in January 2023. Main Outcomes and Measures The main outcome was age-adjusted prevalence of current and daily e-cigarette use overall and by participant characteristics, state, and territory. Descriptive statistical analysis was conducted, applying weights to account for population representation. Results This study included 414 755 BRFSS participants with information on e-cigarette use. More than half of participants were women (51.3%). In terms of race and ethnicity, 0.9% of participants were American Indian or Alaska Native, 5.8% were Asian, 11.5% were Black, 17.3% were Hispanic, 0.2% were Native Hawaiian or Other Pacific Islander, 62.2% were White, 1.4% were of multiple races or ethnicities, and 0.6% were of other race or ethnicity. Individuals aged 18 to 24 years comprised 12.4% of the study population. The age-standardized prevalence of current e-cigarette use was 6.9% (95% CI, 6.7%-7.1%), with almost half of participants using e-cigarettes daily (3.2% [95% CI, 3.1%-3.4%]). Among individuals aged 18 to 24 years, there was a consistently higher prevalence of e-cigarette use, with more than 18.6% reporting current use and more than 9.0% reporting daily use. Overall, among individuals reporting current e-cigarette use, 42.2% (95% CI, 40.7%-43.7%) indicated former combustible cigarette use, 37.1% (95% CI, 35.6%-38.6%) indicated current combustible cigarette use, and 20.7% (95% CI, 19.7%-21.8%) indicated never using combustible cigarettes. Although relatively older adults (aged ≥25 years) who reported current e-cigarette use were more likely to report former or current combustible cigarette use, younger adults (aged 18-24 years) were more likely to report never using combustible cigarettes. Notably, the proportion of individuals who reported current e-cigarette use and never using combustible cigarettes was higher in the group aged 18 to 20 years (71.5% [95% CI, 66.8%-75.7%]) compared with those aged 21 to 24 years (53.0% [95% CI, 49.8%-56.1%]). Conclusion and Relevance These findings suggest that e-cigarette use remained common during the COVID-19 pandemic, particularly among young adults aged 18 to 24 years (18.3% prevalence). Notably, 71.5% of individuals aged 18 to 20 years who reported current e-cigarette use had never used combustible cigarettes. These results underscore the rationale for the implementation and enforcement of public health policies tailored to young adults.
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Affiliation(s)
- John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | | | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Hassan Mirbolouk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Andrew P. DeFilippis
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew C. Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Glenn A. Hirsch
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Emelia J. Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Carlos J. Rodriguez
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Albert Einstein College of Medicine, Bronx, New York, New York
| | - Omar El Shahawy
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Rose Marie Robertson
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
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Rao SJ, Kwapong YA, Boakye E, Mallya P, Zhao J, Akel W, Hong H, Li S, Oyeka CP, Metlock FE, Ouyang P, Blumenthal RS, Nasir K, Khandelwal A, Kinzy C, Mehta LS, Roger VL, Hall JL, Sharma G. Reproductive Experiences and Cardiovascular Disease Care in Pregnancy-Capable and Postmenopausal Individuals: Insights From the American Heart Association Research Goes Red Registry. Curr Probl Cardiol 2023; 48:101853. [PMID: 37302649 PMCID: PMC10710519 DOI: 10.1016/j.cpcardiol.2023.101853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
To evaluate preconception health and adverse pregnancy outcome (APO) awareness in a large population-based registry. We examined data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry to questions regarding prenatal health care experiences, postpartum health, and awareness of the association of APOs with cardiovascular disease (CVD) risk. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk, significantly varying by race-ethnicity. Fifty-nine percent of participants were not educated regarding this association by their providers, and 37% reported providers not assessing pregnancy history during current visits, significantly varying by race-ethnicity, income, and access to care. Only 37.1% of respondents were aware that CVD was the leading cause of maternal mortality. There is an urgent, ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.
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Affiliation(s)
- Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | - Yaa A Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ellen Boakye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Juan Zhao
- American Heart Association, Dallas, TX
| | | | | | - Shen Li
- American Heart Association, Dallas, TX
| | - Chigolum P Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Abha Khandelwal
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | | | - Laxmi S Mehta
- Division of Cardiology, The Ohio State University, Columbus, OH
| | - Veronique L Roger
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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7
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Boakye E, Grandhi GR, Dardari Z, Adhikari R, Soroosh G, Jha K, Dzaye O, Tasdighi E, Erhabor J, Kumar SJ, Whelton S, Blumenthal RS, Albert M, Rozanski A, Berman DS, Budoff MJ, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Blaha M. Cardiovascular risk stratification among individuals with obesity: The Coronary Artery Calcium Consortium. Obesity (Silver Spring) 2023; 31:2240-2248. [PMID: 37534563 PMCID: PMC10524261 DOI: 10.1002/oby.23832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied. METHODS Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. RESULTS Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1-99, 100-299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49-2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81-6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02-14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2 , CAC ≥ 300 remained significantly associated with the highest risk. CONCLUSIONS Among individuals with obesity, including moderate-severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gowtham R Grandhi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rishav Adhikari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kunal Jha
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sant J Kumar
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Seamus Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Albert
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St. Luke's Hospital, New York, New York, USA
| | - Daniel S Berman
- Departments of Imaging and Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, New Jersey, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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8
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Marrero N, Razavi AC, Boakye E, Anchouche K, Dardari Z, Dzaye O, Jha K, Budoff MJ, Tsai MY, Rotter JI, Blumenthal RS, Thanassoulis G, Post WS, Blaha MJ, Whelton SP. Association of Inflammation and Lipoprotein(a) With Aortic Valve Calcification. JACC Cardiovasc Imaging 2023; 16:1230-1232. [PMID: 37052566 DOI: 10.1016/j.jcmg.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 04/14/2023]
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9
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Obisesan OH, Orimoloye OA, Wang FM, Dardari ZA, Selvin E, Boakye E, Osei AD, Honda Y, Dzaye O, Pankow J, Coresh J, Howard-Claudio CM, Nasir K, Matsushita K, Blaha MJ. Coronary Artery Calcium Scores in Older Adults With Diabetes and Their Association With Diabetes-Specific Risk Enhancers (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2023; 201:219-223. [PMID: 37385177 PMCID: PMC10526640 DOI: 10.1016/j.amjcard.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/12/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
Coronary artery calcium (CAC) is a validated marker of atherosclerotic cardiovascular disease (ASCVD) risk; however, it is not routinely incorporated in ASCVD risk prediction in older adults with diabetes. We sought to assess the CAC distribution among this demographic and its association with "diabetes-specific risk enhancers," which are known to be associated with increased ASCVD risk. We used the ARIC (Atherosclerosis Risk in Communities) study data, including adults aged >75 years with diabetes, who had their CAC measured at ARIC visit 7 (2018 to 2019). The demographic characteristics of participants and their CAC distribution were analyzed using descriptive statistics. Multivariable-adjusted logistic regression models were used to estimate the association between diabetes-specific risk enhancers (duration of diabetes, albuminuria, chronic kidney disease, retinopathy, neuropathy, and ankle-brachial index) and elevated CAC, adjusting for age, gender, race, education level, dyslipidemia, hypertension, physical activity, smoking status, and family history of coronary heart disease. The mean age in our sample was 79.9 (SD 3.97) years, with 56.6% women and 62.1% White. The CAC scores were heterogenous, and the median CAC score was higher in participants with a greater number of diabetes risk enhancers, regardless of gender. In the multivariable-adjusted logistic regression models, participants with ≥2 diabetes-specific risk enhancers had greater odds of elevated CAC than those with <2 (odds ratio 2.31, 95% confidence interval 1.34 to 3.98). In conclusion, the distribution of CAC was heterogeneous among older adults with diabetes, with the CAC burden associated with the number of diabetes risk-enhancing factors present. These data may have implications for prognostication in older patients with diabetes and supports the possible incorporation of CAC in the assessment of cardiovascular disease risk in this population.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland; Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Olusola A Orimoloye
- Division of Medicine, Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Frances M Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Zeina A Dardari
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen Boakye
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Albert D Osei
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Yasuyuki Honda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Omar Dzaye
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - James Pankow
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Josef Coresh
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Khurram Nasir
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael J Blaha
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland.
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10
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Tasdighi E, Jha KK, Dardari ZA, Osuji N, Rajan T, Boakye E, Hall ME, Rodriguez CJ, Stokes AC, El Shahawy O, Benjamin EJ, Bhatnagar A, DeFilippis AP, Blaha MJ. Investigating the association of traditional and non-traditional tobacco product use with subclinical and clinical cardiovascular disease: The Cross-Cohort Collaboration-Tobacco working group rationale, design, and methodology. Tob Induc Dis 2023; 21:89. [PMID: 37427074 PMCID: PMC10326890 DOI: 10.18332/tid/166517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 07/11/2023] Open
Abstract
While the impact of combustible cigarette smoking on cardiovascular disease (CVD) is well-established, the longitudinal association of non-traditional tobacco products with subclinical and clinical CVD has not been fully explored due to: 1) limited data availability; and 2) the lack of well-phenotyped prospective cohorts. Therefore, there is the need for sufficiently powered well-phenotyped datasets to fully elucidate the CVD risks associated with non-cigarette tobacco products. The Cross-Cohort Collaboration (CCC)-Tobacco is a harmonized dataset of 23 prospective cohort studies predominantly in the US. A priori defined variables collected from each cohort included baseline characteristics, details of traditional and non-traditional tobacco product use, inflammatory markers, and outcomes including subclinical and clinical CVD. The definitions of the variables in each cohort were systematically evaluated by a team of two physician-scientists and a biostatistician. Herein, we describe the method of data acquisition and harmonization and the baseline sociodemographic and risk profile of participants in the combined CCC-Tobacco dataset. The total number of participants in the pooled cohort is 322782 (mean age: 59.7 ± 11.8 years) of which 76% are women. White individuals make up the majority (73.1%), although there is good representation of other race and ethnicity groups including African American (15.6%) and Hispanic/Latino individuals (6.4%). The prevalence of participants who never smoked, formerly smoked, and currently smoke combustible cigarettes is 50%, 36%, and 14%, respectively. The prevalence of current and former cigar, pipe, and smokeless tobacco is 7.3%, 6.4%, and 8.6%, respectively. E-cigarette use was measured only in follow-up visits of select studies, totaling 1704 former and current users. CCC-Tobacco is a large, pooled cohort dataset that is uniquely designed with increased power to expand knowledge regarding the association of traditional and non-traditional tobacco use with subclinical and clinical CVD, with extension to understudied groups including women and individuals from underrepresented racial-ethnic groups.
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Affiliation(s)
- Erfan Tasdighi
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, United States
| | - Kunal K. Jha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, United States
| | - Zeina A. Dardari
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, United States
| | - Ngozi Osuji
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, United States
| | - Tanuja Rajan
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, United States
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, United States
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
| | - Michael E. Hall
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Medicine, University of Mississippi Medical Center, Jackson, United States
| | - Carlos J. Rodriguez
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, United States
| | - Andrew C. Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Global Health, School of Public Health, Boston University, Boston, United States
| | - Omar El Shahawy
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, United States
| | - Emelia J. Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, United States
- Department of Epidemiology, School of Public Health, Boston University, Boston, United States
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- School of Medicine, University of Louisville, Louisville, United States
| | - Andrew P. DeFilippis
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, United States
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, United States
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
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11
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Boakye E, Erhabor J, Obisesan O, Tasdighi E, Mirbolouk M, Osuji N, Osei AD, Lee J, DeFilippis AP, Stokes AC, Hirsch GA, Benjamin EJ, Robertson RM, Bhatnagar A, El Shahawy O, Blaha MJ. Comprehensive review of the national surveys that assess E-cigarette use domains among youth and adults in the United States. Lancet Reg Health Am 2023; 23:100528. [PMID: 37497394 PMCID: PMC10366460 DOI: 10.1016/j.lana.2023.100528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
Surveillance of e-cigarette use among different population groups is important for the timely implementation and evaluation of tobacco regulatory policies. In this review, we identified 13 nationally representative, repeatedly conducted epidemiologic surveys that assess e-cigarette use among U.S. youth and/or adults and have been instrumental in e-cigarette surveillance. These surveys included National Youth Tobacco Survey, Youth Risk Behavior Surveillance System, Monitoring the Future Survey, International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, Tobacco Use Supplement of the Current Population Survey, Health Information National Trends Survey, Tobacco Products and Risk Perception Surveys, ITC Four Country Smoking and Vaping Survey, National Health and Nutrition Examination Survey, National Survey on Drug Use and Health, and Population Assessment of Tobacco and Health. These surveys vary in scope and detail, with their unique strengths and the regulatory questions that can be answered using each survey data. We also highlighted the gaps in these surveys and made recommendations for improvement.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | | | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | | | - Ngozi Osuji
- Department of Internal Medicine, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Jieun Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew C. Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Glenn A. Hirsch
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
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12
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Boakye E, Uddin SMI, Osuji N, Meinert J, Obisesan OH, Mirbolouk M, Tasdighi E, El-Shahawy O, Erhabor J, Osei AD, Rajan T, Patatanian M, Holbrook JT, Bhatnagar A, Biswal SS, Blaha MJ. Examining the association of habitual e-cigarette use with inflammation and endothelial dysfunction in young adults: The VAPORS-Endothelial function study. Tob Induc Dis 2023; 21:75. [PMID: 37305426 PMCID: PMC10257221 DOI: 10.18332/tid/162327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Acute exposure to e-cigarette aerosol has been shown to have potentially deleterious effects on the cardiovascular system. However, the cardiovascular effects of habitual e-cigarette use have not been fully elucidated. Therefore, we aimed to assess the association of habitual e-cigarette use with endothelial dysfunction and inflammation - subclinical markers known to be associated with increased cardiovascular risk. METHODS In this cross-sectional study, we analyzed data from 46 participants (23 exclusive e-cigarette users; 23 non-users) enrolled in the VAPORS-Endothelial function study. E-cigarette users had used e-cigarettes for ≥6 consecutive months. Non-users had used e-cigarettes <5 times and had a negative urine cotinine test (<30 ng/mL). Flow-mediated dilation (FMD) and reactive hyperemia index (RHI) were used to assess endothelial dysfunction, and we assayed high-sensitivity C-reactive protein, interleukin-6, fibrinogen, p-selectin, and myeloperoxidase as serum measures of inflammation. We used multivariable linear regression to assess the association of e-cigarette use with the markers of endothelial dysfunction and inflammation. RESULTS Of the 46 participants with mean age of 24.3 ± 4.0 years, the majority were males (78%), non-Hispanic (89%), and White (59%). Among non-users, 6 had cotinine levels <10 ng/mL while 17 had levels 10-30 ng/mL. Conversely, among e-cigarette users, the majority (14 of 23) had cotinine ≥500 ng/mL. At baseline, the systolic blood pressure was higher among e-cigarette users than non-users (p=0.011). The mean FMD was slightly lower among e-cigarette users (6.32%) compared to non-users (6.53%). However, in the adjusted analysis, current e-cigarette users did not differ significantly from non-users in their mean FMD (Coefficient=2.05; 95% CI: -2.52-6.63) or RHI (Coefficient= -0.20; 95% CI: -0.88-0.49). Similarly, the levels of inflammatory markers were generally low and did not differ between e-cigarette users and non-users. CONCLUSIONS Our findings suggest that e-cigarette use may not be significantly associated with endothelial dysfunction and systemic inflammation in relatively young and healthy individuals. Longer term studies with larger sample sizes are needed to validate these findings.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
| | - S. M. Iftekhar Uddin
- Department of Medicine, Brookdale University Hospital Medical Center, New York City, United States
| | - Ngozi Osuji
- Department of Internal Medicine, University of Pittsburg Medical Center, Pittsburg, United States
| | - Jill Meinert
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | | | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
| | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
| | - Omar El-Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, United States
| | - John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
| | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, United States
| | - Tanuja Rajan
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
| | - Michael Patatanian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Janet T. Holbrook
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
- Department of Medicine, University of Louisville School of Medicine, Louisville, United States
| | - Shyam S. Biswal
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
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13
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Erhabor J, Boakye E, Osuji N, Obisesan O, Osei AD, Mirbolouk H, Stokes AC, Dzaye O, El-Shahawy O, Rodriguez CJ, Hirsch GA, Benjamin EJ, DeFilippis AP, Robertson RM, Bhatnagar A, Blaha MJ. Psychosocial stressors and current e-cigarette use in the youth risk behavior survey. BMC Public Health 2023; 23:1080. [PMID: 37280552 PMCID: PMC10242777 DOI: 10.1186/s12889-023-16031-w] [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: 11/30/2022] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND This study explores the association between psychosocial stressors and current e-cigarette use among adolescents in the United States. METHODS We used data from 12,767 participants in the 2019 National Youth Risk Behavioral Survey to examine the association between psychosocial stressors (bullying, sexual assault, safety-related absence from school, depressive symptoms, suicidal ideation, physical altercation, and weapon threats) and past-30-day e-cigarette use using multivariable-adjusted logistic regression models. We examined the association for each stressor and then as a burden score (0-7). To compare the strength of the association between stressors and current e-cigarette use to current combustible cigarette use, we additionally examined the association between each stressor and current combustible cigarette use. RESULTS Approximately 32.7% reported current e-cigarette use. The weighted prevalence of current e-cigarette use was higher among individuals who experienced stressors than those who did not. For example, bullying (43.9% vs. 29.0%). Similar prevalence patterns were seen among other stressors. Individuals who experienced stressors had significantly higher adjusted odds of current e-cigarette use than those who did not (OR [Odds Ratio] range: 1.47-1.75). Similarly, individuals with higher burden scores had a higher prevalence (zero [20.5%], one [32.8%], two [41.4%], three [49.6%], four to seven [60.9%]) and higher odds of current e-cigarette use (OR range: 1.43-2.73) than those with a score of zero. The strength of the association between the stressors and e-cigarette use was similar to that between the stressors and combustible cigarette use. CONCLUSION The study demonstrates a significant association between psychosocial stressors and adolescent e-cigarette use, highlighting the potential importance of interventions, such as targeted school-based programs that address stressors and promote stress management, as possible means of reducing adolescent e-cigarette use. Future research directions include exploring underlying mechanisms linking stressors to e-cigarette use and evaluating the effectiveness of interventions addressing stressors in reducing adolescent e-cigarette use.
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Affiliation(s)
- John Erhabor
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Ellen Boakye
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Ngozi Osuji
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | | | - Albert D Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Hassan Mirbolouk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrew C Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Omar Dzaye
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Omar El-Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Carlos J Rodriguez
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Glenn A Hirsch
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Michael J Blaha
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA.
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
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14
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Erhabor J, Boakye E, Osuji N, Obisesan O, Osei AD, Mirbolouk H, Stokes AC, Dzaye O, El-Shahawy O, Rodriguez CJ, Hirsch GA, Benjamin EJ, DeFilippis AP, Robertson RM, Bhatnagar A, Blaha MJ. Patterns of tobacco product use and substance misuse among adolescents in the United States. Prev Med Rep 2023; 33:102207. [PMID: 37223579 PMCID: PMC10201858 DOI: 10.1016/j.pmedr.2023.102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/21/2023] [Accepted: 04/11/2023] [Indexed: 05/25/2023] Open
Abstract
Among adolescents, sole use is the most common pattern of e-cigarette use. However, concurrent use of e-cigarettes with other tobacco products is not uncommon and may be associated with high-risk behaviors. We used data from 12,767 participants in the 2019 Youth Risk Behavior Survey to examine the patterns of tobacco product use among youth in the US. First, we examined the prevalence of e-cigarette-specific patterns of tobacco use (nonuse[no tobacco product use], sole use[sole e-cigarette use], dual-use[e-cigarette and one other tobacco product], and poly use[e-cigarette and two or more other tobacco products]). Then, using multivariable Poisson regression, we assessed how the tobacco use patterns were associated with the misuse of nine substances of abuse (alcohol, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, injectables, and methamphetamines). 62.9% of youth reported nonuse of any tobacco product. The weighted prevalence of sole e-cigarette use, dual use, and poly use was 23.2%, 4.2%, and 3.3%, respectively. Across all the substances explored, the prevalence was highest among poly users, followed by dual users, sole users, and non-users. Compared to non-users, sole, dual, and poly users had 7.8(95 %CI:6.1-10.0), 14.3(95 %CI:10.8-18.8), and 19.7(95 %CI:15.0-25.9) times higher adjusted prevalence of reporting past-30-day binge drinking, after adjusting for age, sex, race/ethnicity, sexual orientation, and depressive symptoms. This pattern was seen across all the different substances explored. These findings highlight the high prevalence of substance misuse among youth who use tobacco products and the need to educate and counsel on substances of abuse among this population, particularly among poly-tobacco users.
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Affiliation(s)
- John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Ngozi Osuji
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | | | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Hassan Mirbolouk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrew C. Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Omar El-Shahawy
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Carlos J. Rodriguez
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Glenn A. Hirsch
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Emelia J. Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Andrew P. DeFilippis
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rose Marie Robertson
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
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Boakye E, Osuji N, Erhabor J, Obisesan O, Osei AD, El Shahawy O, Blaha MJ. Healthcare Provider Screening for Tobacco Product and Electronic Cigarette Use Among Youth in the United States. J Adolesc Health 2023; 72:819-822. [PMID: 36621392 PMCID: PMC10121729 DOI: 10.1016/j.jadohealth.2022.12.004] [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: 06/22/2022] [Revised: 11/02/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Healthcare providers play a critical role in curbing youth tobacco use through screening and counseling. Current rates of tobacco use screening by healthcare providers among US youth are unknown. METHODS We used 2020 National Youth Tobacco Survey data to examine the prevalence of healthcare provider screening for tobacco and e-cigarette use among US youth. Using multivariable logistic regression, we examined the factors associated with being screened for tobacco use. RESULTS Of 13,434 individuals who reported past 12-month visits to any healthcare professional, 47.5% (44.8%-50.1%) reported being screened for any tobacco use, while 31.5% (29.2%-40.0%) reported e-cigarette-specific screening. The odds of tobacco use screening were lower among males (odds ratio [OR]: 0.81 [0.73-0.89]) and middle schoolers (OR: 0.39 [0.33-0.44]) compared to females and high schoolers, respectively. In addition, non-Hispanic Black (OR: 0.71 [0.56-0.89]), Hispanic (OR: 0.76 [0.63-0.92]), and Asian youth (OR: 0.48 [0.37-0.63]) had lower odds of being screened than non-Hispanic White youth. DISCUSSION There are missed opportunities in tobacco screening by healthcare providers, particularly among males, middle schoolers, and racial/ethnic minority youth.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Ngozi Osuji
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | | | - Albert Danso Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Omar El Shahawy
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas; Department of Population Health, New York University School of Medicine, New York, New York
| | - Michael Joseph Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas.
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Rao SJ, Kwapong YA, Boakye E, Mallya P, Zhao J, Akel W, Hong H, Li S, Oyeka CP, Metlock FE, Ouyang P, Blumenthal RS, Nasir K, Khandelwal A, Kinzy C, Mehta LS, Roger VL, Hall JL, Sharma G. Reproductive Experiences and Cardiovascular Disease Care in Pregnancy Capable and Post-Menopausal Individuals: Insights from the American Heart Association Research Goes Red Registry. medRxiv 2023:2023.03.14.23287279. [PMID: 36993300 PMCID: PMC10055463 DOI: 10.1101/2023.03.14.23287279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Information on reproductive experiences and awareness of adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD) risk among pregnancy-capable and post-menopausal individuals has not been well described. We sought to evaluate preconception health and APO awareness in a large population-based registry. Methods Data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry (AHA-RGR) were used. Responses to questions pertaining to prenatal health care experiences, postpartum health, and awareness of the association of APOs with CVD risk were used. We summarized responses using proportions for the overall sample and by stratifications, and we tested differences using the Chi-squared test. Results Of 4,651individuals in the AHA-RGR registry, 3,176 were of reproductive age, and 1,475 were postmenopausal. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk. This varied by different racial/ethnic groups (non-Hispanic White: 38%, non-Hispanic Black: 29%, Asian: 18%, Hispanic: 41%, Other: 46%; P = 0.03). Fifty-nine percent of the participants were not educated regarding the association of APOs with long-term CVD risk by their providers. Thirty percent of the participants reported that their providers did not assess pregnancy history during current visits; this varied by race-ethnicity ( P = 0.02), income ( P = 0.01), and access to care ( P = 0.02). Only 37.1% of the respondents were aware that CVD was the leading cause of maternal mortality. Conclusions Considerable knowledge gaps exist in the association of APOs with CVD risk, with disparities by race/ethnicity, and most patients are not educated on this association by their health care professionals. There is an urgent and ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.
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Obisesan OH, Uddin SMI, Boakye E, Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, El Shahawy O, Stokes A, DeFilippis AP, Benjamin EJ, Blaha MJ. Pod-based e-cigarette use among US college-aged adults: A survey on the perception of health effects, sociodemographic correlates, and interplay with other tobacco products. Tob Induc Dis 2023; 21:34. [PMID: 36875734 PMCID: PMC9983309 DOI: 10.18332/tid/159177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION E-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the US. Using an online survey, we explored the socio-behavioral correlates, predisposing factors, and addictive behaviors, among young adult pod-mod users within a University in Maryland, USA. METHODS In total, 112 eligible college students aged 18-24 years, recruited from a University in Maryland, who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past-30-day use. Descriptive statistics were used to analyze participants' responses. RESULTS The mean age of the survey participants was 20.5 ± 1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8 ± 1.4 years, while the mean age of regular use was 18.5 ± 1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of the current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were aged <21 years. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio, AOR=4.52; 95% CI: 1.76-11.64), JUUL use (AOR=2.56; 95% CI: 1.08-6.03), and menthol flavor (AOR=6.52; 95% CI: 1.38-30.89) were associated with reduced nicotine autonomy, a measure of addiction. CONCLUSIONS Our findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Medicine, Medstar Union Memorial Hospital, Baltimore, United States
| | - S. M. Iftekhar Uddin
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
| | - Ellen Boakye
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
| | - Albert D. Osei
- Department of Medicine, Medstar Union Memorial Hospital, Baltimore, United States
| | | | - Olusola A. Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, United States
| | - Omar Dzaye
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Population Health, New York University School of Medicine, New York, United States
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- School of Medicine, Boston University, Boston, United States
- School of Public Health, Boston University, Boston, United States
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, United States
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
- School of Medicine, Boston University, Boston, United States
- School of Public Health, Boston University, Boston, United States
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, United States
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Kwapong YA, Boakye E, Khan SS, Honigberg MC, Martin SS, Oyeka CP, Hays AG, Natarajan P, Mamas MA, Blumenthal RS, Blaha MJ, Sharma G. Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States. J Am Heart Assoc 2023; 12:e028332. [PMID: 36688365 PMCID: PMC9973664 DOI: 10.1161/jaha.122.028332] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 01/24/2023]
Abstract
Background Depression is a nontraditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods and Results We used data from 593 616 young adults (aged 18-49 years) from the 2017 to 2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of noninstitutionalized US adults. Exposures were self-reported depression and poor mental health days (PMHDs; categorized as 0, 1-13, and 14-30 days of poor mental health in the past 30 days). Outcomes were self-reported CVD (composite of myocardial infarction, angina, or stroke) and suboptimal CVH (≥2 cardiovascular risk factors: hypertension, hypercholesterolemia, overweight/obesity, smoking, diabetes, physical inactivity, and inadequate fruit and vegetable intake). Using logistic regression, we investigated the association of depression and PMHDs with CVD and suboptimal CVH, adjusting for sociodemographic factors (and cardiovascular risk factors for the CVD outcome). Of the 593 616 participants (mean age, 34.7±9.0 years), the weighted prevalence of depression was 19.6% (95% CI, 19.4-19.8), and the weighted prevalence of CVD was 2.5% (95% CI, 2.4-2.6). People with depression had higher odds of CVD than those without depression (odds ratio [OR], 2.32 [95% CI, 2.13-2.51]). There was a graded association of PMHDs with CVD. Compared with individuals with 0 PMHDs, the odds of CVD in those with 1 to 13 PMHDs and 14 to 30 PHMDs were 1.48 (95% CI, 1.34-1.62) and 2.29 (95% CI, 2.08-2.51), respectively, after adjusting for sociodemographic and cardiovascular risk factors. The associations did not differ significantly by sex or urban/rural status. Individuals with depression had higher odds of suboptimal CVH (OR, 1.79 [95% CI, 1.65-1.95]) compared with those without depression, with a similar graded relationship between PMHDs and suboptimal CVH. Conclusions Depression and poor mental health are associated with premature CVD and suboptimal CVH among young adults. Although this association is likely bidirectional, prioritizing mental health may help reduce CVD risk and improve CVH in young adults.
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Affiliation(s)
- Yaa A. Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
| | | | - Michael C. Honigberg
- Department of MedicineMassachusetts General HospitalBostonMA
- Cardiovascular Research Center and Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Cardiovascular Disease Initiative and Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of TechnologyCambridgeMA
| | - Seth S. Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
| | - Chigolum P. Oyeka
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
| | - Allison G. Hays
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
| | - Pradeep Natarajan
- Department of MedicineMassachusetts General HospitalBostonMA
- Cardiovascular Research Center and Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Cardiovascular Disease Initiative and Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of TechnologyCambridgeMA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityKeeleUnited Kingdom
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseasesJohns Hopkins School of MedicineBaltimoreMD
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Boakye E, Dzaye O, Erhabor J, Osuji N, Obisesan O, Osei AD, Bhatnagar A, Robertson RM, Blaha MJ. Impact of the Food and Drug Administration enforcement policy on flavored e-cigarettes on the online popularity of disposable e-cigarettes: analyses of Google search query data. BMC Public Health 2022; 22:1937. [PMID: 36258175 PMCID: PMC9580152 DOI: 10.1186/s12889-022-14367-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of the U.S. Food and Drug Administration's (FDA) initial enforcement policy on flavored cartridge-based e-cigarettes and subsequent notice for the removal of flavored disposable electronic cigarettes (e-cigarettes) such as Puff Bar from the market has not been well evaluated. We, therefore, sought to examine the impact of the e-cigarette flavor-related policy changes on the online popularity of Puff Bar, a prototypic disposable e-cigarette. METHODS We tabulated the total weekly Google search queries originating from the U.S. for "Puff Bar" and "Puff Bars" from January 1, 2019, to December 31, 2021. We divided the three years into four (4) distinct periods using the dates of the initial announcement to ban non-tobacco flavored e-cigarettes (September 11, 2019), the finalization of the FDA enforcement policy on cartridge-based flavors (January 2, 2020), and the notice for the market withdrawal of flavored disposable e-cigarettes (July 20, 2020) as reference time points. Then, we used piecewise linear regression and autoregressive integrated moving average (ARIMA) to compare the trends in searches for Puff Bar for the four (4) periods. RESULTS Before the initial announcement to ban non-tobacco flavored e-cigarettes, online search queries (per 10 million Google searches) for Puff Bar were slowly rising at a rate of 0.58 queries per week (95%CI: -0.80 - 1.97). Following the announcement, searches for Puff Bar increased significantly at a rate of 16.61 queries per week (95%CI: 12.13 - 21.10). The rate of searches for Puff Bar then increased exponentially at 40.08 queries per week (95%CI: 27.32 - 52.84) following the FDA flavor ban, which excluded disposable e-cigarettes. Then, the rate of increase declined but remained relatively stable at 3.67 queries per week (95%CI: 0.69-6.65) until the FDA's notice to remove flavored Puff Bar products from the market. Following this notice, the rate of searches for Puff Bar significantly declined (rate: -4.97 queries per week; 95%CI: -5.40--4.54). CONCLUSIONS The tracking of online search data demonstrates rapid public recognition of the FDA's announcements of tobacco regulatory actions.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Ngozi Osuji
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | | | - Albert D Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA.
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
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20
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Boakye E, El Shahawy O, Obisesan O, Dzaye O, Osei AD, Erhabor J, Uddin SMI, Blaha MJ. The inverse association of state cannabis vaping prevalence with the e-cigarette or vaping product-use associated lung injury. PLoS One 2022; 17:e0276187. [PMID: 36251673 PMCID: PMC9576092 DOI: 10.1371/journal.pone.0276187] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
The e-cigarette or vaping product-use-associated lung injury (EVALI) epidemic was primarily associated with the use of e-cigarettes containing tetrahydrocannabinol (THC)- the principal psychoactive substance in cannabis, and vitamin-E-acetate- an additive sometimes used in informally sourced THC-containing e-liquids. EVALI case burden varied across states, but it is unclear whether this was associated with state-level cannabis vaping prevalence. We, therefore, used linear regression models to assess the cross-sectional association between state-level cannabis vaping prevalence (obtained from the 2019 behavioral Risk Factor Surveillance System) and EVALI case burden (obtained from the Centers for Disease Control and Prevention) adjusted for state cannabis policies. Cannabis vaping prevalence ranged from 1.14%(95%CI, 0.61%-2.12%) in Wyoming to 3.11%(95%CI, 2.16%-4.44%) in New Hampshire. EVALI cases per million population ranged from 1.90(0.38-3.42) in Oklahoma to 59.10(19.70-96.53) in North Dakota. There was no significant positive association but an inverse association between state cannabis vaping prevalence and EVALI case burden (Coefficient, -18.6; 95%CI, -37.5-0.4; p-value, 0.05). Thus, state-level cannabis vaping prevalence was not positively associated with EVALI prevalence, suggesting that there may not be a simple direct link between state cannabis vaping prevalence and EVALI cases, but rather the relationship is likely more nuanced and possibly reflective of access to informal sources of THC-containing e-cigarettes.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Olufunmilayo Obisesan
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States of America
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
| | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States of America
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
| | - S. M. Iftekhar Uddin
- Department of Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
- * E-mail:
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Boakye E, Dardari Z, Obisesan OH, Osei AD, Wang FM, Honda Y, Dzaye O, Osuji N, Carr JJ, Howard-Claudio CM, Wagenknecht L, Konety S, Coresh J, Matsushita K, Blaha MJ, Whelton SP. Sex-and race-specific burden of aortic valve calcification among older adults without overt coronary heart disease: The Atherosclerosis Risk in Communities Study. Atherosclerosis 2022; 355:68-75. [PMID: 35718559 DOI: 10.1016/j.atherosclerosis.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/20/2022] [Accepted: 06/03/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS The prevalence of aortic valve calcification (AVC) increases with age. However, the sex-and race-specific burden of AVC and associated cardiovascular risk factors among adults ≥75 years are not well studied. METHODS We calculated the sex-and race-specific burden of AVC among 2283 older Black and White adults (mean age:80.5 [SD:4.3] years) without overt coronary heart disease from the Atherosclerosis Risk in Communities Study who underwent non-contrast cardiac-gated CT-imaging at visit 7 (2018-2019). Using Poisson regression with robust variance, we calculated the adjusted prevalence ratios (aPR) of the association of AVC with cardiovascular risk factors. RESULTS The overall AVC prevalence was 44.8%, with White males having the highest prevalence at 58.2%. The prevalence was similar for Black males (40.5%), White females (38.9%), and Black females (36.8%). AVC prevalence increased significantly with age among all race-sex groups. The probability of any AVC at age 80 years was 55.4%, 40.0%, 37.3%, and 36.2% for White males, Black males, White females, and Black females, respectively. Among persons with prevalent AVC, White males had the highest median AVC score (100.9 Agatston Units [AU]), followed by Black males (68.5AU), White females (52.3AU), and Black females (46.5AU). After adjusting for cardiovascular risk factors, Black males (aPR:0.53; 95%CI:0.33-0.83), White females (aPR:0.68; 95%CI:0.61-0.77), and Black females (aPR:0.49; 95%CI:0.31-0.77) had lower AVC prevalence compared to White males. In addition, systolic blood pressure, non-HDL-cholesterol, and lipoprotein (a) were independently associated with AVC, with no significant race/sex interactions. CONCLUSIONS AVC, although highly prevalent, was not universally present in this cohort of older adults. White males had ∼50-60% higher prevalence than other race-sex groups. Moreover, cardiovascular risk factors measured in older age showed significant association with AVC.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | | | - Albert D Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Frances M Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yasuyuki Honda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | - Ngozi Osuji
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
| | - John Jeffery Carr
- Department of Radiology, Vanderbilt University Medical Centre, Nashville, TN, USA
| | | | - Lynne Wagenknecht
- Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Suma Konety
- Division of Cardiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA.
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Diseases, Baltimore, MD, USA
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Boakye E, Osuji N, Erhabor J, Obisesan O, Osei AD, Mirbolouk M, Stokes AC, Dzaye O, El Shahawy O, Hirsch GA, Benjamin EJ, DeFilippis AP, Robertson RM, Bhatnagar A, Blaha MJ. Assessment of Patterns in e-Cigarette Use Among Adults in the US, 2017-2020. JAMA Netw Open 2022; 5:e2223266. [PMID: 35867060 PMCID: PMC9308055 DOI: 10.1001/jamanetworkopen.2022.23266] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023] Open
Abstract
Importance Updated data on the patterns of e-cigarette use among adults in the US are needed. Objective To examine recent patterns in current and daily e-cigarette use among US adults. Design, Setting, and Participants This repeated cross-sectional study used data from the 2017, 2018, and 2020 Behavioral Risk Factor Surveillance System, a nationally representative state-based survey of noninstitutionalized US adults. A total of 994 307 adults 18 years and older who were living in states and territories that provided data on e-cigarette use in 2017 (53 states and territories), 2018 (36 states and Guam), and 2020 (42 states and Guam) were included. Main Outcomes and Measures The weighted prevalence of current (past 30 days) and daily e-cigarette use was estimated for each year, and changes in prevalence from 2017 to 2020 were assessed, first overall and then stratified by participant characteristics, including state or territory of residence. Results Among 994 307 adults from states with data on e-cigarette use, 429 370 individuals (weighted 51.3% female) were participants in the 2017 survey, 280 184 (weighted 52.1% female) were participants in the 2018 survey, and 284 753 (weighted 52.1% female) were participants in the 2020 survey. The weighted proportions of young adults aged 18 to 24 years were 12.6% in 2017, 11.8% in 2018, and 11.9% in 2020. Across all 3 years, 17 035 participants (weighted, 1.0%) were American Indian or Alaska Native, 22 313 (weighted, 4.6%) were Asian, 75 780 (weighted, 12.2%) were Black, 72 190 (weighted, 15.1%) were Hispanic, 4817 (weighted, 0.2%) were Native Hawaiian, 757 140 (weighted, 65.1%) were White, 20 332 (weighted, 1.3%) were multiracial, and 6245 (weighted, 0.5%) were of other races and/or ethnicities. The prevalence of current e-cigarette use was 4.4% (95% CI, 4.3%-4.5%) in 2017, which increased to 5.5% (95% CI, 5.4%-5.7%) in 2018 and decreased slightly to 5.1% (95% CI, 4.9%-5.3%) in 2020. The recent decrease, though modest, was observed mainly among young adults aged 18 to 20 years (from 18.9% [95% CI, 17.2%-20.7%] to 15.6% [95% CI, 14.1%-17.1%]; P = .004). However, the prevalence of daily e-cigarette use increased consistently from 1.5% (95% CI, 1.4%-1.6%) in 2017 to 2.1% (95% CI, 2.0%-2.2%) in 2018 and 2.3% (95% CI, 2.2%-2.4%) in 2020. Among young adults aged 21 to 24 years, there was a slight, albeit insignificant, increase in the prevalence of current e-cigarette use (from 13.5% [95% CI, 12.3%-14.7%] to 14.5% [95% CI, 13.2%-15.9%]; P = .28) but a significant increase in the prevalence of daily e-cigarette use (from 4.4% [95% CI, 3.8%-5.1%] to 6.6% [95% CI, 5.6%-7.6%]; P < .001) between 2018 and 2020. State-level patterns in the prevalence of current e-cigarette use were heterogeneous, with states like Massachusetts (from 5.6% [95% CI, 4.8%-6.5%] to 4.1% [95% CI, 3.1%-5.3%]; P = .03) and New York (from 5.4% [95% CI, 4.9%-5.9%] to 4.1% [95% CI, 3.5%-4.7%]; P = .001) recording significant decreases between 2018 and 2020. In contrast, Guam (from 5.9% [95% CI, 4.5%-7.9%] to 11.4% [95% CI, 8.7%-14.8%]; P = .002) and Utah (from 6.1% [95% CI, 5.5%-6.7%] to 7.2% [95% CI, 6.5%-8.0%]; P = .02) recorded significant increases in current e-cigarette use over the same period. Conclusions and Relevance In this study, a slight decrease in the prevalence of current e-cigarette use was found between 2018 and 2020; this decrease was mainly observed among young adults aged 18 to 20 years. In contrast, daily e-cigarette use consistently increased, particularly among young adults aged 21 to 24 years. This increase in daily use suggests greater nicotine dependence among those who use e-cigarettes, warranting continued surveillance.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Ngozi Osuji
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | | | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | | | - Andrew C. Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Population Health, New York University School of Medicine, New York
| | - Glenn A. Hirsch
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
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23
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Kwapong YA, Boakye E, Wang G, Hong X, Lewey J, Mamas MA, Wu P, Blaha MJ, Nasir K, Hays AG, Blumenthal RS, Wang X, Sharma G. Maternal Glycemic Spectrum and Adverse Pregnancy and Perinatal Outcomes in a Multiracial US Cohort. J Cardiovasc Dev Dis 2022; 9:179. [PMID: 35735808 PMCID: PMC9224544 DOI: 10.3390/jcdd9060179] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307-PDM; 582-GDM; 3230-non-PDM/GDM) in the Boston Birth Cohort (1998-2016). Women in the non-PDM/GDM group were subdivided by tertiles of 1 h, 50 g oral glucose load test at 24-32 weeks: T1: 50-95 mg/dL (n = 1166), T2: 96-116 mg/dL (n = 1151), T3: 117-201 mg/dL (n = 913). Using multivariable logistic regression, we examined the association of maternal glycemia with APOs-preterm birth (PTB) and hypertensive disorders of pregnancy (HDP)-and adverse perinatal outcomes-high birth weight (HBW), cesarean section (CS), and sub-analyses by race-ethnicity. Compared to women in T1, women in T2 and T3 had a higher prevalence of pre-existing hypertension (T1: 2.8% vs. T2: 5.2% vs. T3: 6.3%) and obesity (T1: 13.3% vs. T2: 18.1% vs. T3: 22.9%). Women in T2 and T3 had higher odds of HBW (adjusted odds ratio aOR T2: 1.47 [1.01-2.19] T3: 1.68 [1.13-2.50]) compared to women in T1. Additionally, women in T2, compared to T1, had higher odds of HDP (aOR 1.44 [1.10-1.88]). Among non-Hispanic Black (NHB) women, those in T2 and T3 had higher odds of HDP compared to T1 (aOR T2 1.67 [1.13-2.51]; T3: 1.68 [1.07-2.62]). GDM and PDM were associated with higher odds of HBW, CS, PTB, and HDP, compared to women in T1. In this predominantly NHB and Hispanic cohort, moderate maternal glycemia without PDM/GDM was associated with higher odds of HBW and HDP, even more strongly among NHB women. If confirmed, a review of current guidelines of glucose screening and risk stratification in pregnancy may be warranted.
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Affiliation(s)
- Yaa Adoma Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Jennifer Lewey
- Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mamas Andreas Mamas
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Pensee Wu
- Division of Maternal and Fetal Medicine, Keele University, Keele ST5 5BG, UK
| | - Michael Joseph Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
- Center for Outcomes Research, Houston Methodist Hospital and DeBakey Heart & Vascular Center, Houston, TX 77030, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist Debakey Heart and Vascular Center, Houston, TX 77030, USA
| | - Allison Gamboa Hays
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Roger Scott Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
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24
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Obisesan OH, Kou M, Wang FM, Boakye E, Honda Y, Uddin SMI, Dzaye O, Osei AD, Orimoloye OA, Howard‐Claudio CM, Coresh J, Blumenthal RS, Hoogeveen RC, Budoff MJ, Matsushita K, Ballantyne CM, Blaha MJ. Lipoprotein(a) and Subclinical Vascular and Valvular Calcification on Cardiac Computed Tomography: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2022; 11:e024870. [PMID: 35656990 PMCID: PMC9238743 DOI: 10.1161/jaha.121.024870] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Lipoprotein(a) (Lp(a)) is a potent causal risk factor for cardiovascular events and mortality. However, its relationship with subclinical atherosclerosis, as defined by arterial calcification, remains unclear. This study uses the ARIC (Atherosclerosis Risk in Communities Study) to evaluate the relationship between Lp(a) in middle age and measures of vascular and valvular calcification in older age. Methods and Results Lp(a) was measured at ARIC visit 4 (1996-1998), and coronary artery calcium (CAC), together with extracoronary calcification (including aortic valve calcium, aortic valve ring calcium, mitral valve calcification, and thoracic aortic calcification), was measured at visit 7 (2018-2019). Lp(a) was defined as elevated if >50 mg/dL and CAC/extracoronary calcification were defined as elevated if >100. Logistic and linear regression models were used to evaluate the association between Lp(a) and CAC/extracoronary calcification, with further stratification by race. The mean age of participants at visit 4 was 59.2 (SD 4.3) years, with 62.2% women. In multivariable adjusted analyses, elevated Lp(a) was associated with higher odds of elevated aortic valve calcium (adjusted odds ratio [aOR], 1.82; 95% CI, 1.34-2.47), CAC (aOR, 1.40; 95% CI, 1.08-1.81), aortic valve ring calcium (aOR, 1.36; 95% CI, 1.07-1.73), mitral valve calcification (aOR, 1.37; 95% CI, 1.06-1.78), and thoracic aortic calcification (aOR, 1.36; 95% CI, 1.05-1.77). Similar results were obtained when Lp(a) and CAC/extracoronary calcification were examined on continuous logarithmic scales. There was no significant difference in the association between Lp(a) and each measure of calcification by race or sex. Conclusions Elevated Lp(a) at middle age is significantly associated with vascular and valvular calcification in older age, represented by elevated CAC, aortic valve calcium, aortic valve ring calcium, mitral valve calcification, thoracic aortic calcification. Our findings encourage assessing Lp(a) levels in individuals with increased cardiovascular disease risk, with subsequent comprehensive vascular and valvular assessment where elevated.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Medstar Union Memorial HospitalBaltimoreMD
| | - Minghao Kou
- Tulane University School of Public Health and Tropical MedicineNew OrleansLA
| | | | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | - Yasuyuki Honda
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | | | | | - Josef Coresh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute at Harbor‐UCLA Medical CenterLos AngelesCA
| | - Kunihiro Matsushita
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
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25
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Kwapong YA, Boakye E, Obisesan OH, Shah LM, Ogunwole SM, Hays AG, Blumenthal RS, Creanga AA, Blaha MJ, Cainzos-Achirica M, Nasir K, Douglas PS, Wang X, Sharma G. Nativity-Related Disparities in Preterm Birth and Cardiovascular Risk in a Multiracial U.S. Cohort. Am J Prev Med 2022; 62:885-894. [PMID: 35597568 DOI: 10.1016/j.amepre.2021.12.027] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Having a preterm birth is associated with future cardiovascular risk. Non-Hispanic Black women have higher rates of preterm birth than non-Hispanic White and Hispanic women, but nativity-related disparities in preterm birth are not well understood. METHODS Data from 6,096 women in the Boston Birth Cohort: non-Hispanic Black (2,699), non-Hispanic White (997), or Hispanic (2,400), were analyzed in June 2021. Differences in cardiovascular risk factors were assessed. The association of preterm birth with nativity and duration of U.S. residence were investigated using multivariable logistic regression. RESULTS U.S.-born women in all 3 racial-ethnic groups had a higher prevalence of obesity, smoking, and severe stress than foreign-born women. Foreign-born non-Hispanic Black and Hispanic women had lower odds of preterm birth than U.S.-born counterparts (non-Hispanic Black: AOR=0.79, 95% CI=0.65, 0.97; Hispanic: AOR=0.72, 95% CI=0.56, 0.93). In all the 3 groups, foreign-born women with shorter (<10 years) duration of U.S. residence had lower odds of preterm birth than the U.S.-born women (non-Hispanic Black: AOR=0.57, 95% CI=0.43, 0.75; Hispanic: AOR=0.72, 95% CI=0.55, 0.94; non-Hispanic White: AOR=0.46, 95% CI=0.25, 0.85), whereas the odds of preterm birth in foreign-born women with ≥10 years of residence were not significantly different. CONCLUSIONS Foreign-born women had better cardiovascular risk profiles in all groups and lower odds of preterm birth in non-Hispanic Black and Hispanic groups. In all the 3 groups, a shorter duration of U.S. residence was associated with lower odds of preterm birth. Further studies are needed to understand the biological and social determinants underlying these nativity-related disparities and the impact of acculturation.
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Affiliation(s)
- Yaa A Kwapong
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ellen Boakye
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Olufunmilayo H Obisesan
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lochan M Shah
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - S Michelle Ogunwole
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allison G Hays
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Roger S Blumenthal
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andreea A Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Miguel Cainzos-Achirica
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Khurram Nasir
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Pamela S Douglas
- Duke Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Garima Sharma
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland.
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26
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Boakye E, Obisesan OH, Uddin SMI, El-Shahawy O, Dzaye O, Osei AD, Benjamin EJ, Stokes AC, Robertson RM, Bhatnagar A, Blaha MJ. Corrigendum to "Cannabis vaping among adults in the United States: Prevalence, trends, and association with high-risk behaviors and adverse respiratory conditions" [Preventive Medicine 153 (2021) 106800]. Prev Med 2022; 159:107052. [PMID: 35450724 PMCID: PMC9847013 DOI: 10.1016/j.ypmed.2022.107052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Olufunmilayo H Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Omar El-Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Albert D Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Andrew C Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; University of Louisville School of Medicine, Louisville, KY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
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Berning P, Huang L, Razavi AC, Boakye E, Osuji N, Stokes AC, Martin SS, Ayers JW, Blaha MJ, Dzaye O. Association of Online Search Trends With Vaccination in the United States: June 2020 Through May 2021. Front Immunol 2022; 13:884211. [PMID: 35514956 PMCID: PMC9066639 DOI: 10.3389/fimmu.2022.884211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022] Open
Abstract
Stagnating COVID-19 vaccination rates and vaccine hesitancy remain a threat to public health. Improved strategies for real-time tracking and estimation of population-level behavior regarding vaccinations are needed. The aim of this study was to evaluate whether online search trends for COIVD-19 and influenza mirror vaccination rates. State-level weekly fraction of online searches for top vaccination-related search terms and CDC vaccination data were obtained from June 1, 2020, to May 31, 2021. Next, trends in online search and vaccination data for COVID-19 and influenza were analyzed for visual and quantitative correlation patterns using Spearman’s rank correlation analysis. Online searches in the US for COVID-19 vaccinations increased 2.71-fold (95% CI: 1.98-3.45) in the 4 weeks after the FDA emergency authorization compared to the precedent 4 weeks. In March-April 2021, US online searches reached a plateau that was followed by a decline of 83.3% (95% CI: 31.2%-135.3%) until May 31, 2021. The timing of peaks in online searches varied across US states. Online searches were strongly correlated with vaccination rates (r=0.71, 95% CI: 0.45 - 0.87), preceding actual reported vaccination rates in 44 of 51 states. Online search trends preceded vaccination trends by a median of 3.0 weeks (95% CI: 2.0-4.0 weeks) across all states. For influenza vaccination searches, seasonal peaks in September-October between 2016-2020 were noted. Influenza search trends highly correlated with the timing of actual vaccinations for the 2019-2020 (r=0.82, 95% CI: 0.64 – 0.93) and 2020-2021 season (r=0.91, 95% CI: 0.78 – 0.97). Search trends and real-world vaccination rates are highly correlated. Temporal alignment and correlation levels were higher for influenza vaccinations; however, only online searches for COVID-19 vaccination preceded vaccination trends. These findings indicate that US online search data can potentially guide public health efforts, including policy changes and identifying geographical areas to expand vaccination campaigns.
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Affiliation(s)
- Philipp Berning
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Leu Huang
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Alexander C Razavi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Emory Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, GA, United States
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ngozi Osuji
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John W Ayers
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Radiology and Neuroradiology, Charité, Berlin, Germany
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28
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Boakye E, Obisesan OH, Osei AD, Dardari Z, Dzaye O, Osuji N, Wang FM, Honda Y, Carr JJ, Howard-Claudio C, Wagenknecht L, Konety SH, Coresh J, Matsushita K, Blaha M, Whelton SP. SEX- AND RACE-SPECIFIC BURDEN OF AORTIC VALVE CALCIFICATION AMONG ADULTS ≥75 YEARS - THE ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dzaye O, Razavi AC, Dardari ZA, Berman DS, Budoff MJ, Miedema MD, Obisesan OH, Boakye E, Nasir K, Rozanski A, Rumberger JA, Shaw LJ, Mortensen MB, Whelton SP, Blaha MJ. Mean Versus Peak Coronary Calcium Density on Non-Contrast CT: Calcium Scoring and ASCVD Risk Prediction. JACC Cardiovasc Imaging 2022; 15:489-500. [PMID: 34801452 PMCID: PMC8917973 DOI: 10.1016/j.jcmg.2021.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 04/05/2021] [Revised: 08/19/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study sought to assess the relationship between mean vs peak calcified plaque density and their impact on calculating coronary artery calcium (CAC) scores and to compare the corresponding differential prediction of atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) mortality. BACKGROUND The Agatston CAC score is quantified per lesion as the product of plaque area and a 4-level categorical peak calcium density factor. However, mean calcium density may more accurately measure the heterogenous mixture of lipid-rich, fibrous, and calcified plaque reflective of ASCVD risk. METHODS We included 10,373 individuals from the CAC Consortium who had CAC >0 and per-vessel measurements of peak calcium density factor and mean calcium density. Area under the curve and continuous net reclassification improvement analyses were performed for CHD and ASCVD mortality to compare the predictive abilities of mean calcium density vs peak calcium density factor when calculating the Agatston CAC score. RESULTS Participants were on average 53.4 years of age, 24.4% were women, and the median CAC score was 68 Agatston units. The average values for mean calcium density and peak calcium density factor were 210 ± 50 HU and 3.1 ± 0.5, respectively. Individuals younger than 50 years of age and/or those with a total plaque area <100 mm2 had the largest differences between the peak and mean density measures. Among persons with CAC 1-99, the use of mean calcium density resulted in a larger improvement in ASCVD mortality net reclassification improvement (NRI) (NRI = 0.49; P < 0.001 vs. NRI = 0.18; P = 0.08) and CHD mortality discrimination (Δ area under the curve (AUC) = +0.169 vs +0.036; P < 0.001) compared with peak calcium density factor. Neither peak nor mean calcium density improved mortality prediction at CAC scores >100. CONCLUSION Mean and peak calcium density may differentially describe plaque composition early in the atherosclerotic process. Mean calcium density performs better than peak calcium density factor when combined with plaque area for ASCVD mortality prediction among persons with Agatston CAC 1-99.
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Affiliation(s)
- Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Alexander C Razavi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Olufunmilayo H Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St. Luke's Hospital, New York, New York, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, New Jersey, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Martin Bødtker Mortensen
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Osuji N, Uddin SI, Obisesan OH, Osei A, Erhabor J, Boakye E, DeFilippis AP, Blaha M. ASSOCIATION BETWEEN SOLE E-CIGARETTE USE AND ENDOTHELIAL FUNCTION: THE VAPORSENDOTHELIAL FUNCTION STUDY (VAPORS-E). J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kwapong Y, Boakye E, Wang G, Hong X, Blaha M, Nasir K, Hays AG, Blumenthal RS, Sharma G, Wang X. ASSOCIATION OF MATERNAL GLYCEMIA AND ADVERSE PREGNANCY OUTCOMES IN UNITED STATES URBAN, LOW-INCOME UNDERREPRESENTED WOMEN. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ogunwole SM, Turkson-Ocran RAN, Boakye E, Creanga AA, Wang X, Bennett WL, Sharma G, Cooper LA, Commodore-Mensah Y. Disparities in cardiometabolic risk profiles and gestational diabetes mellitus by nativity and acculturation: findings from 2016-2017 National Health Interview Survey. BMJ Open Diabetes Res Care 2022; 10:10/1/e002329. [PMID: 35168940 PMCID: PMC8852664 DOI: 10.1136/bmjdrc-2021-002329] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common complication of pregnancy with implications for cardiovascular health. Among reproductive-aged women, less is known about nativity-related disparities in cardiometabolic risk profiles and GDM history. We examined how cardiometabolic risk profiles and GDM history differed by nativity and explored associations between acculturation, cardiometabolic risk profiles and GDM history. RESEARCH DESIGN AND METHODS We analyzed cross-sectional data from the 2016-2017 National Health Interview Survey among reproductive-aged women (18-49 years) who both reported ever being pregnant and answered the question on GDM history. Using multivariable logistic regression, we examined the percentage with GDM history and compared cardiometabolic profiles by nativity status and acculturation (duration of US residence). RESULTS Of 9525 women, 22.5% were foreign-born. Also, 11.7% of foreign-born women had a GDM history vs 9.6% of US-born women. Foreign-born women with ≥10 years US residence had the highest age-standardized percentage with GDM history (11.0%) compared with US-born women (9.2%) and foreign-born women with <10 years US residence (6.7%). US-born women had a higher prevalence of hypertension, current smoking, and alcohol use than foreign-born women. Among foreign-born women, those with ≥10 years US residence had a higher prevalence of hypertension, current smoking, and alcohol use than those with <10 years US residence. In the fully adjusted model, foreign-born women with ≥10 years US residence had higher odds of GDM history than US-born women (OR 1.43; 95% CI 1.17 to 1.76) while foreign-born women with <10 years US residence and US-born women has similar odds of GDM history. CONCLUSIONS Greater duration of US residence may be associated with nativity-related disparities in GDM. Acculturation, including changing health-related behaviors may explain the disparities among foreign-born women and should be further investigated to appropriately target interventions to prevent GDM and future cardiometabolic diseases.
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Affiliation(s)
- S Michelle Ogunwole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Ellen Boakye
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yvonne Commodore-Mensah
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Shah LM, Kwapong YA, Boakye E, Ogunwole SM, Bennett WL, Blumenthal RS, Hays AG, Blaha MJ, Nasir K, Zakaria S, Wang G, Wang X, Sharma G. Racial Disparities in Gestational Diabetes by Maternal Nativity and Length of US Residence in an Urban Low-income Population in the United States. CJC Open 2022; 4:540-550. [PMID: 35734520 PMCID: PMC9207772 DOI: 10.1016/j.cjco.2022.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with increased risk of cardiovascular disease (CVD). Racial/ethnic differences in GDM prevalence have been described, but disparities by nativity and duration of US residence are not well studied. Methods We analyzed data from 6088 women (mean age: 27.5 years [standard deviation: 6.3 years]) from the Boston Birth Cohort who self-identified as non-Hispanic Black (NHB; n = 2697), Hispanic (n = 2395), or non-Hispanic White (NHW; n = 996). Using multivariable logistic regression, we examined the cross-sectional association of nativity and duration of US residence (< 10 vs ≥ 10 years) with GDM within each race/ethnicity group. Results Foreign-born NHB, NHW, and Hispanic women with a duration of US residence of < 10 years had a lower prevalence of CVD risk factors than those with US residence of ≥ 10 years, respectively, as follows: smoking (NHB: 1.7% vs 3.1%; NHW: 5.7% vs 8.1%; Hispanic: 0.4% vs 2.6%); obesity (NHB: 17.1% vs 23.4%; NHW: 3.8% vs 15.6%; Hispanic: 10.9% vs 22.7%); and severe stress (NHB: 8.7% vs 11.9%; NHW: 5.7% vs 28.1%; Hispanic: 3.8% vs 7.3%). In analyses adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women with a duration of US residence of < 10 years had higher odds of having GDM (adjusted odds ratio: 1.60, 95% confidence interval: 0.99-2.60), compared with their US-born counterparts, whereas foreign-born Hispanic women with a duration of US residence of < 10 years had lower odds of having GDM (adjusted odds ratio: 0.54, 95% confidence interval: 0.32-0.91). The odds of having GDM in Hispanic and NHB women with a duration of US residence of ≥ 10 years were not significantly different from those of their US-born counterparts. Conclusions The “healthy immigrant effect” and its waning with longer duration of US residence apply to the prevalence of GDM among Hispanic women but not NHB women. Further research on the intersectionality of race and nativity-based disparities is needed.
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Osei AD, Khan R, Grandhi GR, Boakye E, Obisesan OH, Dzaye O, Blaha MJ. Coronary Artery Calcium Measurement to Assist in Primary Prevention Decisions for Aspirin and Lipid-Lowering Therapies. Curr Cardiovasc Imaging Rep 2021. [DOI: 10.1007/s12410-021-09561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Boakye E, Uddin SI, Obisesan OH, Osei AD, Dzaye O, Sharma G, McEvoy JW, Blumenthal R, Blaha MJ. Aspirin for cardiovascular disease prevention among adults in the United States: Trends, prevalence, and participant characteristics associated with use. Am J Prev Cardiol 2021; 8:100256. [PMID: 34632437 PMCID: PMC8488247 DOI: 10.1016/j.ajpc.2021.100256] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE : Aspirin has been widely utilized over several decades for atherosclerotic cardiovascular disease (ASCVD) prevention among adults in the United States. We examined trends in aspirin use among adults aged ≥40 years from 1998 to 2019 and assessed factors associated with its use for primary and secondary ASCVD prevention. METHODS : Using 1998-2019 Behavioral Risk Factor Surveillance System data, we obtained weighted prevalence of aspirin use among adults aged ≥40 years for each year and examined trends in use over this period. Using multivariable logistic regression and utilizing data from 54,388 respondents aged ≥40 years in the 2019 data, we assessed factors associated with aspirin use for secondary prevention and for primary prevention stratified by the number of traditional ASCVD risk factors reported (hypertension, diabetes mellitus, high cholesterol, overweight/obesity, and cigarette smoking). RESULTS : Aspirin use prevalence increased from 29.0%(95%CI, 27.9%-30.2%) in 1998 to 37.5%(36.9%-38.0%) in 2009. However, use has slightly declined over the last decade: 35.6%(34.6%-36.6%) in 2011 to 33.5%(32.5%-34.6%) in 2019. In 2019, among respondents without cardiovascular disease (CVD), 27.5%(26.4%-28.6%) reported primary prevention aspirin use while 69.7%(67.0%-72.2%) of respondents with CVD reported secondary prevention aspirin use. Of concern, 45.6%(43.5%-47.7%) of adults aged ≥70 years without CVD reported primary prevention aspirin use. Additionally, among individuals without any self-reported traditional ASCVD risk factor, males (adjusted odds ratio(aOR):1.60, 95%CI:1.12-2.27), persons aged ≥70 years (aOR:3.22, 95%CI:2.27-4.55), and individuals with healthcare coverage (aOR:2.28, 95%CI:1.17-4.44) had higher odds of primary prevention aspirin use compared to females, persons aged 40-69 years, and individuals without healthcare coverage, respectively. Females were less likely than males to report secondary prevention aspirin use (aOR:0.64, 95%CI:0.50-0.82). CONCLUSION : Aspirin use has slightly declined over the last decade. A significant proportion of adults aged ≥70 years reported primary prevention aspirin use in 2019. Since current guidelines do not recommend primary prevention aspirin use among adults aged ≥70 years, such use should be discouraged.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX
| | - S.M. Iftekhar Uddin
- Department of Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY
| | | | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - John William McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - Roger Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Baltimore, MD
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX
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Boakye E, Obisesan OH, Uddin SMI, El-Shahawy O, Dzaye O, Osei AD, Benjamin EJ, Stokes AC, Robertson RM, Bhatnagar A, Blaha MJ. Cannabis vaping among adults in the United States: Prevalence, trends, and association with high-risk behaviors and adverse respiratory conditions. Prev Med 2021; 153:106800. [PMID: 34520787 PMCID: PMC9830549 DOI: 10.1016/j.ypmed.2021.106800] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/04/2021] [Accepted: 09/06/2021] [Indexed: 01/14/2023]
Abstract
The e-cigarette or vaping product-use-associated lung injury outbreak in the United States has raised concerns about the potential health effects of cannabis vaping, a method of cannabis use that is becoming increasingly popular. We used 2017-2019 Behavioral Risk Factor Surveillance System data to estimate yearly prevalence and trends of past-30-day cannabis use and vaping among US adults. We used multivariable logistic regression to evaluate the associations of cannabis vaping with high-risk behaviors, asthma, and other respiratory symptoms. Our sample size was 160,209 (53,945-2017; 55,475-2018; and 50,789-2019). Past-30-day cannabis use prevalence increased from 10.0% (95% CI, 9.4%-10.7%) in 2017 to 13.4% (12.8%-12.0%) in 2019. Similarly, past-30-day cannabis vaping prevalence increased from 1.0% (0.8%-1.2%) to 2.0% (1.7%-2.2%) over the same period, with the greatest increase, 1.2% to 3.9%, observed among young adults (18-24 years). Individuals who vaped cannabis were more likely to concurrently vape nicotine. Cannabis vaping was associated with increased odds of heavy alcohol use (aOR, 1.95; 95% CI, 1.45-2.63), binge drinking (aOR, 2.82; 95% CI, 2.25-3.54), and other high-risk behaviors (aOR, 2.47; 95% CI, 1.89-3.24). In analyses adjusting for sociodemographic characteristics and body mass index, cannabis vaping was not associated with asthma (aOR, 1.03; 95% CI, 0.64-1.64) or other respiratory symptoms (aOR, 1.08; 95% CI, 0.44-2.63). Adjusting for nicotine vaping did not substantively alter these associations. The prevalence of past-30-day cannabis vaping has increased, particularly among young adults, and was associated with high-risk behaviors. Although there was no association between cannabis vaping and asthma or other respiratory symptoms, the increasing trends of cannabis vaping, particularly among young adults, raise concern and underscore the need for continued surveillance.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
| | - Olufunmilayo H Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
| | - S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
| | - Omar El-Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
| | - Albert D Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Andrew C Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; University of Louisville School of Medicine, Louisville, KY, USA.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
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Boakye E, Kwapong YA, Obisesan O, Ogunwole SM, Hays AG, Nasir K, Blumenthal RS, Douglas PS, Blaha MJ, Hong X, Creanga AA, Wang X, Sharma G. Nativity-Related Disparities in Preeclampsia and Cardiovascular Disease Risk Among a Racially Diverse Cohort of US Women. JAMA Netw Open 2021; 4:e2139564. [PMID: 34928357 PMCID: PMC8689384 DOI: 10.1001/jamanetworkopen.2021.39564] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 11/14/2022] Open
Abstract
IMPORTANCE Preeclampsia is an independent risk factor for future cardiovascular disease and disproportionally affects non-Hispanic Black women. The association of maternal nativity and duration of US residence with preeclampsia and other cardiovascular risk factors is well described among non-Hispanic Black women but not among women of other racial and ethnic groups. OBJECTIVE To examine differences in cardiovascular risk factors and preeclampsia prevalence by race and ethnicity, nativity, and duration of US residence among Hispanic, non-Hispanic Black, and non-Hispanic White women. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of the Boston Birth Cohort included a racially diverse cohort of women who had singleton deliveries at the Boston Medical Center from October 1, 1998, to February 15, 2016. Participants self-identified as Hispanic, non-Hispanic Black, or non-Hispanic White. Data were analyzed from March 1 to March 31, 2021. EXPOSURES Maternal nativity and duration of US residence (<10 vs ≥10 years) were self-reported. MAIN OUTCOME AND MEASURES Diagnosis of preeclampsia, the outcome of interest, was retrieved from maternal medical records. RESULTS A total of 6096 women (2400 Hispanic, 2699 non-Hispanic Black, and 997 non-Hispanic White) with a mean (SD) age of 27.5 (6.3) years were included in the study sample. Compared with Hispanic and non-Hispanic White women, non-Hispanic Black women had the highest prevalence of chronic hypertension (204 of 2699 [7.5%] vs 65 of 2400 [2.7%] and 28 of 997 [2.8%], respectively), obesity (658 of 2699 [24.4%] vs 380 of 2400 [15.8%] and 152 of 997 [15.2%], respectively), and preeclampsia (297 of 2699 [11.0%] vs 212 of 2400 [8.8%] and 71 of 997 [7.1%], respectively). Compared with their counterparts born outside the US, US-born women in all 3 racial and ethnic groups had a significantly higher prevalence of obesity (Hispanic women, 132 of 556 [23.7%] vs 248 of 1844 [13.4%]; non-Hispanic Black women, 444 of 1607 [27.6%] vs 214 of 1092 [19.6%]; non-Hispanic White women, 132 of 776 [17.0%] vs 20 of 221 [9.0%]), smoking (Hispanic women, 98 of 556 [17.6%] vs 30 of 1844 [1.6%]; non-Hispanic Black women, 330 of 1607 [20.5%] vs 53 of 1092 [4.9%]; non-Hispanic White women, 382 of 776 [49.2%] vs 42 of 221 [19.0%]), and severe stress (Hispanic women, 76 of 556 [13.7%] vs 85 of 1844 [4.6%]; non-Hispanic Black women, 231 of 1607 [14.4%] vs 120 of 1092 [11.0%]; non-Hispanic White women, 164 of 776 [21.1%] vs 26 of 221 [11.8%]). After adjusting for sociodemographic and cardiovascular risk factors, birth status outside the US (adjusted odds ratio [aOR], 0.74 [95% CI, 0.55-1.00]) and shorter duration of US residence (aOR, 0.62 [95% CI, 0.41-0.93]) were associated with lower odds of preeclampsia among non-Hispanic Black women. However, among Hispanic and non-Hispanic White women, maternal nativity (aOR for Hispanic women, 1.07 [95% CI, 0.72-1.60]; aOR for non-Hispanic White women, 0.98 [95% CI, 0.49-1.96]) and duration of US residence (aOR for Hispanic women <10 years, 1.04 [95% CI, 0.67-1.59]; aOR for non-Hispanic White women <10 years, 1.20 [95% CI, 0.48-3.02]) were not associated with preeclampsia. CONCLUSIONS AND RELEVANCE Nativity-related disparities in preeclampsia persisted among non-Hispanic Black women but not among Hispanic and non-Hispanic White women after adjusting for sociodemographic and cardiovascular risk factors. Further research is needed to explore the interplay of factors contributing to nativity-related disparities in preeclampsia, particularly among non-Hispanic Black women.
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Affiliation(s)
- Ellen Boakye
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yaa Adoma Kwapong
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - S. Michelle Ogunwole
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allison G. Hays
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Khurram Nasir
- DeBakey Heart & Vascular Center and Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Roger S. Blumenthal
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Pamela S. Douglas
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michael J. Blaha
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andreea A. Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Minhas AS, Boakye E, Obisesan OH, Kwapong YA, Zakaria S, Creanga AA, Vaught AJ, Mehta LS, Davis MB, Bello NA, Cainzos-Achirica M, Nasir K, Blaha MJ, Blumenthal RS, Douglas PS, Wang X, Sharma G. The Association of Preterm Birth With Maternal Nativity and Length of Residence Among Non-Hispanic Black Women. CJC Open 2021; 4:289-298. [PMID: 35386126 PMCID: PMC8978076 DOI: 10.1016/j.cjco.2021.10.009] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Preterm birth (PTB) is associated with future cardiovascular disease (CVD) risk and disproportionally affects non-Hispanic Black (NHB) women. Limited data exist on the influence of length of US residence on nativity-related disparities in PTB. We examined PTB by maternal nativity (US born vs foreign born) and length of US residence among NHB women. Methods We analyzed data from 2699 NHB women (1607 US born; 1092 foreign born) in the Boston Birth Cohort, originally designed as a case-control study. Using multivariable logistic regression, we investigated the association of PTB with maternal nativity and length of US residence. Results In the total sample, 29.1% of women delivered preterm (31.4% and 25.6% among US born and foreign born, respectively). Compared with foreign born, US-born women were younger (25.8 vs 29.5 years), had higher prevalence of obesity (27.6% vs 19.6%), smoking (20.5% vs 4.9%), alcohol use (13.2% vs 7.4%), and moderate to severe stress (73.5% vs 59.4%) (all P < 0.001). Compared with US-born women, foreign-born women had lower odds of PTB after adjusting for sociodemographic characteristics, alcohol use, stress, parity, smoking, body mass index, chronic hypertension, and diabetes (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.65-0.97). Foreign-born NHB women with < 10 years of US residence had 43% lower odds of PTB compared with US-born (aOR, 0.57; 95% CI, 0.43-0.75), whereas those with ≥ 10 years of US residence did not differ significantly from US-born women in their odds of PTB (aOR, 0.76; 95% CI, 0.54-1.07). Conclusions The prevalence of CVD risk factors and proportion of women delivering preterm were lower in foreign-born than US-born NHB women. The "foreign-born advantage" was not observed with ≥ 10 years of US residence. Our study highlights the need to intensify public health efforts in exploring and addressing nativity-related disparities in PTB.
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Affiliation(s)
- Anum S. Minhas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Olufunmilayo H. Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yaa A. Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sammy Zakaria
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A. Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arthur J. Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Laxmi S. Mehta
- Division of Cardiology, the Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Melinda B. Davis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Natalie A. Bello
- Division of Cardiology, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Miguel Cainzos-Achirica
- Houston Methodist Hospital and DeBakey Heart & Vascular Center, Center for Outcomes Research, Houston, Texas, USA
| | - Khurram Nasir
- Houston Methodist Hospital and DeBakey Heart & Vascular Center, Center for Outcomes Research, Houston, Texas, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pamela S. Douglas
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Corresponding author: Dr Garima Sharma, Johns Hopkins University School of Medicine–Ciccarone Center of Prevention of Cardiovascular Disease, 565 C Carnegie Building, 600 N Wolfe Street, Baltimore, Maryland 21287, USA.
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Obisesan OH, Osei AD, Berman D, Dardari ZA, Uddin SMI, Dzaye O, Orimoloye OA, Budoff MJ, Miedema MD, Rumberger J, Mirbolouk M, Boakye E, Johansen MC, Rozanski A, Shaw LJ, Han D, Nasir K, Blaha MJ. Thoracic Aortic Calcium for the Prediction of Stroke Mortality (from the Coronary Artery Calcium Consortium). Am J Cardiol 2021; 148:16-21. [PMID: 33667445 DOI: 10.1016/j.amjcard.2021.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Thoracic aortic calcium(TAC) is an important marker of extracoronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium (CAC) score. The CAC Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no previous history of cardiovascular disease, baseline CAC scans for risk stratification, and follow-up for 12 ± 4 years. CAC scans capture the adjacent thoracic aorta, enabling assessment of TAC from the same images. TAC was available in 41,066 (62%), and was primarily analyzed as present or not present. To account for competing risks for nonstroke death, we utilized multivariable-adjusted Fine and Gray competing risk regression models adjusted for traditional cardiovascular risk factors and CAC score. The mean age of participants was 53.8 ± 10.3 years, with 34.4% female. There were 110 stroke deaths during follow-up. The unadjusted subdistribution hazard ratio (SHR) for stroke mortality in those who had TAC present compared with those who did not was 8.80 (95% confidence interval [CI]: 5.97, 12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21 (95% CI:1.39,3.49). In sex-stratified analyses, the fully adjusted SHR for females was 3.42 (95% CI: 1.74, 6.73) while for males it was 1.55 (95% CI: 0.83, 2.90). TAC was associated with stroke mortality independent of CAC and traditional risk factors, more so in women. The presence of TAC appears to be an independent risk marker for stroke mortality.
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Affiliation(s)
| | - Albert D Osei
- Medstar Union Memorial Hospital, Baltimore, Maryland
| | | | - Zeina A Dardari
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Omar Dzaye
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California
| | | | | | | | - Ellen Boakye
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, New York
| | | | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Michael J Blaha
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ogunwole M, Turkson-Ocran RAN, Boakye E, Bennett WL, Cooper LA, Creanga AA, Sharma G, Wang X, Commodore-mensah Y. Abstract 048: Disparities In Gestational Diabetes Mellitus Among US- Vs. Foreign-born Women: An Analysis Of 2016-2017 National Health Interview Survey. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.048] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Gestational diabetes mellitus (GDM) is a common complication of pregnancy. Although GDM is associated with increased risk of cardiovascular disease it is unclear whether the associations between GDM prevalence and cardiometabolic risk factors differ between US- and foreign-born women and whether length of US residence influences these associations.
Methods:
We analyzed cross-sectional data from the 2016-2017 National Health Interview Survey among women currently living in the US who both reported ever being pregnant and responded to the survey question about GDM. Using generalized linear models with binomial distribution and logit link, we examined the prevalence of GDM by nativity status and length of US residence adjusting for potential confounders (Table).
Results:
Of 24,466 women, 14.3% were foreign-born. The crude prevalence of GDM was higher among foreign-born (9.0%) compared to US-born women (7.1%). Foreign-born women with ≥10 years of residence in the US had the highest age-standardized GDM prevalence (8.3%) compared to US-born (7.5%) and foreign-born women with <10 years US residence (4.8%). Among women with a history of GDM, US-born women were more likely to be overweight/ obese, report a history of hypertension, be current smokers and alcohol drinkers than foreign-born women. Among foreign-born women, those with ≥10 years of US residence had higher prevalence of hypertension, smoking and alcohol use than those with <10 years in the US. In the fully adjusted regression model, only foreign-born women with ≥10 years of residence in the US had a significantly higher prevalence of GDM than US-born women (PR=1.43; 95% CI:1.22-1.67).
Conclusions:
In this sample of women with self-reported GDM, greater length of US residence contributes to nativity-related disparities in GDM. Acculturation, including changing health-related behaviors, may have a larger impact on maternal health outcomes of foreign-born women, and should be a target of interventions to reduce GDM and future cardiovascular diseases.
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Sharma G, Boakye E, Dzaye O, Kwapong YA, Zakaria S, Vaught A, Creanga A, Mehta L, Cainzos-Achirica M, Nasir K, Blaha M, Blumenthal R, Wang X. THE ASSOCIATION OF PRETERM BIRTH AND CARDIOVASCULAR RISK FACTORS WITH MATERNAL NATIVITY AND DURATION OF RESIDENCE IN THE UNITED STATES AMONG NON-HISPANIC BLACK WOMEN. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sharma G, Boakye E, Dzaye O, Kwapong YA, Zakaria S, Vaught A, Creanga A, Cainzos-Achirica M, Mehta L, Nasir K, Blaha M, Blumenthal R, Wang X. THE ASSOCIATION OF PREECLAMPSIA AND CARDIOVASCULAR RISK FACTORS WITH MATERNAL NATIVITY AND DURATION OF US RESIDENCE AMONG TWO DIVERSE RACIAL GROUPS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Akanyirige P, Ezema A, Boakye E, Bryant A, Jackson K, Mandieka E, Ohiomoba R, Princewill O, Youmans Q, Blaha M, Blumenthal R, Lewis A, Okwuosa I. CARDIOVASCULAR RISK PROFILES IN MARIJUANA SMOKERS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dzaye O, Adelhoefer S, Boakye E, Blaha MJ. Cardiovascular-related health behaviors and lifestyle during the COVID-19 pandemic: An infodemiology study. Am J Prev Cardiol 2021; 5:100148. [PMID: 33521755 PMCID: PMC7834537 DOI: 10.1016/j.ajpc.2021.100148] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/20/2022] Open
Abstract
Background Reports have suggested decreasing attention to CVD comorbidities during the COVID-19 pandemic, despite their association with worse virus-related outcomes. Using nowcasting tools, we sought to explore temporal trends in public interest by studying use of online search terms related to CVD comorbidities during the pandemic time period. Methods We queried Google Trends for recent (October 2019–October 2020) and seasonal (October 2016–October 2020) trends of search terms pertaining to cardiovascular-related behaviors or clinical care including clinical diagnostic and therapeutic-related terms. Additionally, we acquired data from Google Shopping Insights to explore consumer behavior. Data for search results in the US were compared using mean relative search volumes (RSV), tabulated by month. Results Online search interest in the terms “Exercise” and “Cigarettes” changed by +18.0% and −52.5%, respectively, comparing March–April with January–February 2020. Key terms related to CVD-related care, including diagnostic and therapeutic-related terms such as “Statin”, “Lipid profile”, “Low-density lipoprotein”, and “Hemoglobin A1C” declined to a four-year low in late March 2020 but regained pre-pandemic search query frequency by July 2020. Results were supported by Google Shopping analysis; for example, online consumer shopping-related searches for tobacco products reached at an all-year low after May 2020. Conclusion We report an increase in search interest for an overall healthier CVD-related lifestyle starting in March 2020, supported by online consumer shopping behavior. However, a months-long trough in public interest for CVD care-related search terms from March–May 2020 suggests a transient but substantial decrease in public focus on cardiovascular-related healthcare engagement. Future research is needed to understand if these mixed signals will persist into 2021 and how they potentially translate into real-world CVD-related event rates.
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Affiliation(s)
- Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Siegfried Adelhoefer
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Boakye E, Sharma G, Ogunwole SM, Zakaria S, Vaught AJ, Kwapong YA, Hong X, Ji Y, Mehta L, Creanga AA, Blaha MJ, Blumenthal RS, Nasir K, Wang X. Relationship of Preeclampsia With Maternal Place of Birth and Duration of Residence Among Non-Hispanic Black Women in the United States. Circ Cardiovasc Qual Outcomes 2021; 14:e007546. [PMID: 33563008 PMCID: PMC7887058 DOI: 10.1161/circoutcomes.120.007546] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preeclampsia is one of the leading causes of maternal mortality in the United States. It disproportionately affects non-Hispanic Black (NHB) women, but little is known about how preeclampsia and other cardiovascular disease risk factors vary among different subpopulations of NHB women in the United States. We investigated the prevalence of preeclampsia by nativity (US born versus foreign born) and duration of US residence among NHB women. METHODS We analyzed cross-sectional data from the Boston Birth Cohort (1998-2016), with a focus on NHB women. We performed multivariable logistic regression to investigate associations between preeclampsia, nativity, and duration of US residence after controlling for potential confounders. RESULTS Of 2697 NHB women, 40.5% were foreign born. Relative to them, US-born NHB women were younger, in higher percentage current smokers, had higher prevalence of obesity (body mass index ≥30 kg/m2) and maternal stress, but lower educational level. The age-adjusted prevalence of preeclampsia was 12.4% and 9.1% among US-born and foreign-born women, respectively. When further categorized by duration of US residence, the prevalence of all studied cardiovascular disease risk factors except for diabetes was lower among foreign-born NHB women with <10 versus ≥10 years of US residence. Additionally, the odds of preeclampsia in foreign-born NHB women with duration of US residence <10 years was 37% lower than in US-born NHB women. In contrast, the odds of preeclampsia in foreign-born NHB women with duration of US residence ≥10 years was not significantly different from that of US-born NHB women after adjusting for potential confounders. CONCLUSIONS The prevalence of preeclampsia and other cardiovascular disease risk factors is lower in foreign-born than in US-born NHB women. The healthy immigrant effect, which typically results in health advantages for foreign-born women, appears to wane with longer duration of US residence (≥10 years). Further research is needed to better understand these associations.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of
Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for Prevention of
Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - S. Michelle Ogunwole
- Division of General Internal Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur J. Vaught
- Department of Maternal Fetal Medicine, Division of
Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore,
MD, USA
| | - Yaa Adoma Kwapong
- Department of Population, Family and Reproductive Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laxmi Mehta
- Division of Cardiology, Ohio State University School of
Medicine, Columbus, OH, USA
| | - Andreea A. Creanga
- Department of Population, Family and Reproductive Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of
Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of
Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Khurram Nasir
- Houston Methodist Hospital and DeBakey Heart & Vascular
Center, Center for Outcomes Research, Houston, TX, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Boakye E, Nyieku IE. The state of fire safety in industrial buildings in Ghana: a case study of Tema metropolis. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Freudenthaler S, Meineke I, Schreeb KH, Boakye E, Gundert-Remy U, Gleiter CH. Influence of urine pH and urinary flow on the renal excretion of memantine. Br J Clin Pharmacol 1998; 46:541-6. [PMID: 9862242 PMCID: PMC1873797 DOI: 10.1046/j.1365-2125.1998.00819.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS The present study assessed the influence of urinary flow rate and urine pH on the renal excretion of the NMDA-receptor antagonist memantine. METHODS In a randomized, open, four-period cross-over trial, 12 healthy male volunteers received 10 mg memantine daily for 43 days. After reaching steady state conditions the volunteers were allocated to four different regimens to alter urine pH and urinary flow, which were each separated by a 1 week period while the study medication continued (A: acidification of urine pH, low urinary flow; B: acidification of urine pH, high urinary flow; C: alkalinization of urine pH, low urinary flow; D: alkalinization of urine pH, high urinary flow). RESULTS The renal clearance of memantine (CL(R)) in regimen A and B was 7-10 fold higher in comparison with regimen C and D (P<0.05). There were small but statistically significant differences of CL(R) between the two regimens with acidic urine pH (A: median: 210.2 ml min(-1) vs B: median: 218.7 ml min(-1)) and between the two regimens with alkaline urine pH (C: median: 19.4 ml min(-1) vs D: median: 30.5 ml min(-1)). The amount of memantine excreted into the urine within one regimen (Ae0-24h) was 5.7-7.4 fold higher in regimens A and B than C and D (P< 0.05). Differences of the AUC(0,24 h) and Cmax/AUC(0,24 h) were significant (P<0.05) between each of the regimens with acidic urine pH (A, B) and regimens (C, D) with alkaline urine pH (A vs C, A vs D, B vs C, B vs D) but not between regimens A vs B or C vs D. CONCLUSIONS The present study demonstrated a considerable effect of urine pH, whereas no clinically relevant change of the renal excretion of memantine with urinary flow could be detected. As the renal excretion of memantine may have an impact on therapeutic efficacy changes of dietary habits that may alter urine pH should be avoided during treatment with memantine.
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Affiliation(s)
- S Freudenthaler
- Department of Clinical Pharmacology, Georg-August-Universität Göttingen, Germany
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