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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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Persky V, Abasilim C, Tsintsifas K, Day T, Sargis RM, Daviglus M, Cai J, Freels S, Kaplan R, Isasi CR, Pirzada A, Meyer ML, Talavera GA, Thyagarajan B, Agarwal S, Chavez N, Grieco A, Turyk ME. Thyroid Hormones and Diabetes in Euthyroid Hispanic/Latino Adults of Diverse Backgrounds: HCHS/SOL. J Endocr Soc 2024; 8:bvae039. [PMID: 38623380 PMCID: PMC11017329 DOI: 10.1210/jendso/bvae039] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 04/17/2024] Open
Abstract
Context Previous studies have demonstrated associations of endogenous thyroid hormones with diabetes; less is known about stages of diabetes development at which they are operative, mechanisms of associations, and the role of the hypothalamic-pituitary-thyroid axis. Objective This study examined associations of thyroid hormones with incident prediabetes and diabetes and with changes in glycemic traits in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest cohort of Hispanic/Latino adults with diverse backgrounds in the United States. Methods The study includes 592 postmenopausal euthyroid women and 868 euthyroid men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Baseline hormones included thyrotropin (TSH), free thyroxine (FT4), total triiodothyronine (T3), and indices calculated from thyroid hormones evaluating pituitary sensitivity to thyroid hormone. Transitions to diabetes and prediabetes, and changes in glycemic traits determined at the 6-year follow-up visit, were examined using multivariable Poisson and linear regressions. Results Among women, T3 (incident rate ratio [IRR] = 1.65; 95% CI, 1.22-2.24; P = .001) and TSH (IRR = 2.09; 95% CI, 1.01-4.33; P = .047) were positively, while FT4 (IRR = 0.59; 95% CI, 0.39-0.88; P = .011) was inversely, associated with transition from prediabetes to diabetes. Among men, the T3/FT4 ratio was positively associated with transition from normoglycemia to prediabetes but not from prediabetes to diabetes. Indices measuring sensitivity of the pituitary to thyroid hormone suggested increased sensitivity in men who transitioned from prediabetes to diabetes. Conclusion Positive associations in women of T3 and TSH and inverse associations of FT4, as well as inverse associations of thyroid indices in men with transition from prediabetes to diabetes, but not from normoglycemia to diabetes, suggest decreased pituitary sensitivity to thyroid hormones in women and increased sensitivity in men later in the development of diabetes.
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Affiliation(s)
- Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Chibuzor Abasilim
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Konstantina Tsintsifas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Tessa Day
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55415, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Noel Chavez
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Arielle Grieco
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
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Ejiri K, Ding N, Kim E, Honda Y, Cainzos‐Achirica M, Tanaka H, Howard‐Claudio CM, Butler KR, Hughes TM, Van't Hof JR, Meyer ML, Blaha MJ, Matsushita K. Association of Segment-Specific Pulse Wave Velocity With Vascular Calcification: The ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc 2024; 13:e031778. [PMID: 38214278 PMCID: PMC10926832 DOI: 10.1161/jaha.123.031778] [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: 08/14/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Pulse wave velocity (PWV) is a noninvasive measure of arterial stiffness and predictor of cardiovascular disease. However, the association between PWV and vascular calcification across different vascular beds has not been fully investigated. This study aimed to quantify the association between PWV and multiterritory calcification and to explore whether PWV can identify individuals with vascular calcification beyond traditional risk factors. METHODS AND RESULTS Among 1351 older adults (mean age, 79.2 years [SD, 4.1]) from the ARIC (Atherosclerosis Risk in Communities) study, we measured segment-specific PWVs: heart-carotid, heart-femoral, carotid-femoral, heart-ankle, brachial-ankle, and femoral-ankle. Dependent variables were high calcium score (≥75th percentile of Agatston score) across different vascular beds: coronary arteries, aortic valve ring, aortic valve, mitral valve, ascending aorta, and descending aorta. Quartiles of carotid-femoral, heart-femoral, heart-ankle, and brachial-ankle PWV were significantly associated with coronary artery calcium (eg, adjusted odds ratio [OR] for the highest versus lowest quartile of carotid-femoral PWV, 1.84 [95% CI, 1.24-2.74]). Overall, PWVs were most strongly associated with descending aorta calcification, with significant results for carotid-femoral, heart-femoral, heart-ankle, and brachial-ankle PWV (eg, adjusted OR for the highest versus lowest quartile of carotid-femoral PWV, 3.99 [95% CI, 2.61-6.17]). In contrast, femoral-ankle PWV was inversely associated with descending aorta calcification. Some PWVs improved the discrimination of coronary artery calcium and descending aorta calcification beyond traditional risk factors. CONCLUSIONS The associations of PWV with vascular calcification varied substantially across segments, with descending aorta calcification most closely linked to PWVs. Our study suggests that some PWVs, especially carotid-femoral PWV, are helpful to identify individuals with coronary artery calcium and descending aorta calcification.
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Affiliation(s)
- Kentaro Ejiri
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Ning Ding
- Yale New Haven Health Bridgeport HospitalNew HavenCT
| | | | - Yasuyuki Honda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Hirofumi Tanaka
- University of Texas at Austin, Kinesiology and Health EducationAustinTX
| | | | - Kenneth R. Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Timothy M. Hughes
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNC
| | | | | | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | - Kunihiro Matsushita
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Kucirka LM, Angarita AM, Manuck TA, Boggess KA, Derebail VK, Wood ME, Meyer ML, Segev DL, Reynolds ML. Characteristics and Outcomes of Patients With Pregnancy-Related End-Stage Kidney Disease. JAMA Netw Open 2023; 6:e2346314. [PMID: 38064217 PMCID: PMC10709776 DOI: 10.1001/jamanetworkopen.2023.46314] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Importance The incidence of pregnancy-related acute kidney injury is increasing and is associated with significant maternal morbidity including progression to end-stage kidney disease (ESKD). Little is known about characteristics and long-term outcomes of patients who develop pregnancy-related ESKD. Objectives To examine the characteristics and clinical outcomes of patients with pregnancy-related ESKD and to investigate associations between pre-ESKD nephrology care and outcomes. Design, Setting, and Participants This was a cohort study of 183 640 reproductive-aged women with incident ESKD between January 1, 2000, and November 20, 2020, from the US Renal Data System and maternal data from births captured in the US Centers for Disease Control and Prevention publicly available natality data. Data were analyzed from December 2022 to June 2023. Exposure Pregnancy-related primary cause of ESKD, per International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes reported at ESKD onset by the primary nephrologist on Centers for Medicare and Medicaid Services form 2728. Main Outcomes Measures Multivariable Cox proportional hazards and competing risk models were constructed to examine time to (1) mortality, (2) access to kidney transplant (joining the waiting list or receiving a live donor transplant), and (3) receipt of transplant after joining the waitlist. Results A total of 341 patients with a pregnancy-related primary cause of ESKD were identified (mean [SD] age 30.2 [7.3]). Compared with the general US birthing population, Black patients were overrepresented among those with pregnancy-related ESKD (109 patients [31.9%] vs 585 268 patients [16.2%]). In adjusted analyses, patients with pregnancy-related ESKD had similar or lower hazards of mortality compared with those with glomerulonephritis or cystic kidney disease (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.76-1.19), diabetes or hypertension (aHR, 0.49; 95% CI, 0.39-0.61), or other or unknown primary causes of ESKD (aHR, 0.60; 95% CI, 0.48-0.75). Despite this, patients with pregnancy-related ESKD had significantly lower access to kidney transplant compared with those with other causes of ESKD, including (1) glomerulonephritis or cystic kidney disease (adjusted subhazard ratio [aSHR], 0.51; 95% CI, 0.43-0.66), (2) diabetes or hypertension (aSHR, 0.81; 95% CI, 0.67-0.98), and (3) other or unkown cause (aSHR, 0.82; 95% CI, 0.67-0.99). Those with pregnancy-related ESKD were less likely to have nephrology care or have a graft or arteriovenous fistula placed before ESKD onset (nephrology care: adjusted relative risk [aRR], 0.47; 95% CI, 0.40-0.56; graft or arteriovenous fistula placed: aRR, 0.31; 95% CI, 0.17-0.57). Conclusion and Relevance In this study, those with pregnancy-related ESKD had reduced access to transplant and nephrology care, which could exacerbate existing disparities in a disproportionately Black population. Increased access to care could improve quality of life and health outcomes among these young adults with high potential for long-term survival.
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Affiliation(s)
- Lauren M. Kucirka
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Ana M. Angarita
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tracy A. Manuck
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kim A. Boggess
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Vimal K. Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill
| | - Mollie E. Wood
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill
- Center for Pharmacoepidemiology, University of North Carolina at Chapel Hill
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill
| | - Dorry L. Segev
- Division of Transplant, Department of Surgery, New York University Langone Medical Center, New York
| | - Monica L. Reynolds
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill
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Nazzal EM, Waller AE, Meyer ML, Ising AI, Jones-Vessey K, Urrutia E, Urrutia RP. Pregnancy and Emergency Department Utilization in North Carolina, 2016-2021: A Population-Based Surveillance Study. AJPM Focus 2023; 2:100142. [PMID: 37790954 PMCID: PMC10546499 DOI: 10.1016/j.focus.2023.100142] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency department surveillance data between 2016 and 2021 to describe the sociodemographic factors associated with the use of emergency department for pregnancy-associated problems and subsequent hospital admission. Methods North Carolina Disease Event Tracking and Epidemiologic Collection Tool is a syndromic surveillance system that includes all emergency department encounters at civilian acute-care facilities in North Carolina. We analyzed all emergency department visits between January 1, 2016 and December 31, 2021 for female patients aged 15-44 years residing in North Carolina with at least 1 ICD-10-CM code (analysis occurred in July 2021-October 2022). Each emergency department visit was categorized as pregnancy-associated if assigned ICD-10-CM code(s) indicated pregnancy. We stratified visits by age, race, ethnicity, county of residence, and insurance and compared them with estimated pregnant population proportions using 1-sample t-tests. We used multivariable logistic regression to determine whether pregnancy-associated visits were more likely to be associated with hospital admission and then to determine sociodemographic predictors of admission among pregnancy-associated emergency department visits. Results More than 6.4 million emergency department visits were included (N=6,471,197); 10.1% (n=655,476) were pregnancy-associated, significantly higher than the proportion of women estimated to be pregnant at any given time in North Carolina (4.6%, p<0.0001) and increased over time (8.6% in 2016 vs 11.1% in 2021, p<0.0001). Pregnancy-associated visits were lower than expected for ages 25-44 years and higher than expected for those aged 15-24 years, for those of Black race, and for patients residing in rural or suburban areas. The proportion admitted was higher for pregnancy-associated emergency department visits than for nonpregnancy associated (15.6% vs 7.0%, AOR=3.06 [95% CI=3.03, 3.09]). Pregnancy-associated emergency department visits for patients of Black race had 0.58 times (95% CI=0.57, 0.59) the odds of admission compared with White patients. Conclusions Emergency department utilization during pregnancy is common. The proportion of pregnancy-associated emergency department visits among reproductive-age women is increasing, as are inpatient admissions from the emergency department for pregnancy-associated diagnoses. Use of public health surveillance databases such as the North Carolina Disease Event Tracking and Epidemiologic Collection Tool may help identify opportunities for improving disparities in maternal health care, especially related to access to care.
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Affiliation(s)
- Elizabeth M. Nazzal
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anna E. Waller
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Amy I. Ising
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kathleen Jones-Vessey
- Women's and Children's Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Eugene Urrutia
- UNC Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Rachel P. Urrutia
- UNC Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Casey MF, Niznik J, Anton G, Selman K, Meyer ML, Kelley CJ, Busby-Whitehead J, Goldberg E, Davenport K, Roberts E. Prevalence of fall risk-increasing drugs in older adults presenting with falls to the emergency department. Acad Emerg Med 2023; 30:1170-1173. [PMID: 37086203 PMCID: PMC10619391 DOI: 10.1111/acem.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Martin F Casey
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Joshua Niznik
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Greta Anton
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Katherine Selman
- Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Casey J Kelley
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Goldberg
- Department of Emergency Medicine, University of Colorado, Denver, Colorado, USA
| | - Kathleen Davenport
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ellen Roberts
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
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7
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Stone K, Veerasingam D, Meyer ML, Heffernan KS, Higgins S, Maria Bruno R, Bueno CA, Döerr M, Schmidt-Trucksäss A, Terentes-Printzios D, Voicehovska J, Climie RE, Park C, Pucci G, Bahls M, Stoner L. Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk-A Call to Action on Behalf of VascAgeNet. Hypertension 2023; 80:1980-1992. [PMID: 37470189 PMCID: PMC10510846 DOI: 10.1161/hypertensionaha.123.21314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
This review critiques the literature supporting clinical assessment and management of cardiovascular disease and cardiovascular disease risk stratification with brachial-ankle pulse wave velocity (baPWV). First, we outline what baPWV actually measures-arterial stiffness of both large central elastic arteries and medium-sized muscular peripheral arteries of the lower limb. Second, we argue that baPWV is not a surrogate for carotid-femoral pulse wave velocity. While both measures are dependent on the properties of the aorta, baPWV is also strongly dependent on the muscular arteries of the lower extremities. Increased lower-extremity arterial stiffness amplifies and hastens wave reflections at the level of the aorta, widens pulse pressure, increases afterload, and reduces coronary perfusion. Third, we used an established evaluation framework to identify the value of baPWV as an independent vascular biomarker. There is sufficient evidence to support (1) proof of concept; (2) prospective validation; (3) incremental value; and (4) clinical utility. However, there is limited or no evidence to support (5) clinical outcomes; (6) cost-effectiveness; (8) methodological consensus; or (9) reference values. Fourth, we address future research requirements. The majority of the evaluation criteria, (1) proof of concept, (2) prospective validation, (3) incremental value, (4) clinical utility and (9) reference values, can be supported using existing cohort datasets, whereas the (5) clinical outcomes and (6) cost-effectiveness criteria require prospective investigation. The (8) methodological consensus criteria will require an expert consensus statement. Finally, we finish this review by providing an example of a future clinical practice model.
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Affiliation(s)
- Keeron Stone
- Centre for Cardiovascular Health and Ageing, Cardiff Metropolitan University, Cardiff, Wales, United Kingdom (K.S.)
- National Cardiovascular Research Network, Wales (K.S.)
| | - Dave Veerasingam
- Cardiothoracic Surgery, Galway University Hospital, Ireland (D.V.)
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill (M.L.M.)
| | | | - Simon Higgins
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill (S.H., L.S.)
| | - Rosa Maria Bruno
- Université Paris Cité, Inserm, PARCC, France (R.M.B.)
- Clinical Pharmacology Unit, AP-HP, Hôpital européen Georges Pompidou, Paris, France (R.M.B.)
| | - Celia Alvarez Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain (C.A.B.)
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay (C.A.B.)
| | - Marcus Döerr
- Department of Internal Medicine B, University Medicine Greifswald, Germany (M.D., M.B.)
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany (M.D., M.B.)
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise, and Health (A.S.-T.), University of Basel, Switzerland
- Department of Clinical Research, University Hospital Basel (A.S.-T.), University of Basel, Switzerland
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Athens Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (D.T.-P.)
| | - Jūlija Voicehovska
- Internal Diseases Department, Riga Stradins University, Latvia (J.V.)
- Nephrology and Renal Replacement Clinics, Riga East University Hospital, Latvia (J.V.)
| | - Rachel E Climie
- Menzies Institute for Medical Research, University of Tasmania (R.E.C.)
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, London, United Kingdom (C.P.)
| | - Giacomo Pucci
- Department of Medicine, University of Perugia, Unit of Internal Medicine, "Santa Maria" Terni Hospital, Italy (G.P.)
| | - Martin Bahls
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany (M.D., M.B.)
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill (S.H., L.S.)
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill (L.S.)
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (L.S.)
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8
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Pomeroy A, Pagan Lassalle P, Kline CE, Heffernan KS, Meyer ML, Stoner L. The relationship between sleep duration and arterial stiffness: A meta-analysis. Sleep Med Rev 2023; 70:101794. [PMID: 37301055 PMCID: PMC10851278 DOI: 10.1016/j.smrv.2023.101794] [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: 12/22/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023]
Abstract
Chronically short (<7 h) and long (>9 h) sleep duration may increase cardiovascular disease (CVD) risk relative to the recommended sleep duration (7-9 h). The objective of this study was to evaluate the effects of short and long sleep duration on arterial stiffness, a marker of CVD risk, in adults. Eleven cross-sectional studies were reviewed with a total sample size of 100,050 participants (64.5% male). Weighted mean differences (WMD) and 95% confidence intervals (95% CI) were calculated and pooled using random effects models, and standardized mean differences (SMD) were calculated to determine effect size magnitude. Compared to the recommended sleep duration, both short (WMD = 20.6 cm/s, 95% confidence intervals (CI): 13.8-27.4 cm/s, SMD = 0.02) and long sleep duration (WMD = 33.6 cm/s, 95% CI: 20.0-47.2 cm/s, SMD = 0.79) were associated with higher (detrimental) pulse wave velocity (PWV). The associations between short sleep and higher PWV in adults with cardiometabolic disease, and long sleep and higher PWV in older adults, were also significant in sub-group analysis. These findings indicate short and long sleep duration may contribute to subclinical CVD.
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Affiliation(s)
- Alexander Pomeroy
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Patricia Pagan Lassalle
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher E Kline
- Department of Health and Human Development, University of Pittsburgh, PA, USA
| | - Kevin S Heffernan
- David B. Falk College of Sport and Human Dynamics, Syracuse, NY, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Persky V, Abasilim C, Tsintsifas K, Day T, Sargis RM, Daviglus ML, Cai J, Freels S, Unterman T, Chavez N, Kaplan R, Isasi CR, Pirzada A, Meyer ML, Talavera GA, Thyagarajan B, Peters BA, Madrigal JM, Grieco A, Turyk ME. Sex Hormones and Diabetes in 45- to 74-year-old Men and Postmenopausal Women: The Hispanic Community Health Study. J Clin Endocrinol Metab 2023; 108:1709-1726. [PMID: 36633580 PMCID: PMC10271226 DOI: 10.1210/clinem/dgad018] [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: 08/19/2022] [Revised: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Previous studies demonstrated associations of endogenous sex hormones with diabetes. Less is known about their dynamic relationship with diabetes progression through different stages of the disease, independence of associations, and role of the hypothalamic-pituitary gonadal axis. The purpose of this analysis was to examine relationships of endogenous sex hormones with incident diabetes, prediabetes, and diabetes traits in 693 postmenopausal women and 1015 men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos and followed for 6 years. Baseline hormones included estradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), and, in men, testosterone and bioavailable testosterone. Associations were analyzed using multivariable Poisson and linear regressions. In men, testosterone was inversely associated with conversion from prediabetes to diabetes (incidence rate ratio [IRR] for 1 SD increase in testosterone: 0.821; 95% CI, 0.676, 0.997; P = 0.046), but not conversion from normoglycemia to prediabetes. Estradiol was positively associated with increase in fasting insulin and homeostatic model assessment of insulin resistance. In women, SHBG was inversely associated with change in glycosylated hemoglobin, postload glucose, and conversion from prediabetes to diabetes (IRR = 0.62; 95% CI, 0.44, 0.86, P = 0.005) but not from normoglycemia to prediabetes. Relationships with other hormones varied across glycemic measures. Stronger associations of testosterone and SHBG with transition from prediabetes to diabetes than from normoglycemic to prediabetes suggest they are operative at later stages of diabetes development. Biologic pathways by which sex hormones affect glucose homeostasis await future studies.
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Affiliation(s)
- Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Chibuzor Abasilim
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Konstantina Tsintsifas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Tessa Day
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL,USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL,USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Terry Unterman
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL,USA
| | - Noel Chavez
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL,USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | | | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica M Madrigal
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Arielle Grieco
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
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10
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Alhalimi TA, Wang T, Meyer ML, Tanaka H. Effects of body positions on arterial stiffness as assessed by pulse wave velocity. J Hypertens 2023; 41:971-978. [PMID: 37016919 DOI: 10.1097/hjh.0000000000003418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Assessing arterial stiffness through pulse wave velocity (PWV) usually requires participants to be in a supine position. If this position is not feasible, adjustments such as tilting the bed or bending the knees may be made. The Vicorder device also recommends tilting the upper body to prevent jugular vein interference in the recorded carotid pulse. OBJECTIVE To examine the impact of varying body positions on PWV. METHODS Seventy adults were studied in the fully supine (0°) to 40° upper body tilted-up positions with and without knee bend. Carotid-femoral PWV (cfPWV) was measured using two different testing devices (Omron VP-1000plus and Vicorder) and brachial-ankle PWV (baPWV) was measured using Omron. RESULTS cfPWV measured at 10° tilt-up was not different from 0° position while baPWV increased significantly from 10°. Elevations in cfPWV were 7% at 20° and 15% at 40° compared with 0° position. Knee bend did not affect cfPWV but decreased baPWV at each angle ( P < 0.05). Jugular vein interference on the Vicorder was observed in 78% of participants in supine position, decreasing as body angle increased (7% at 30°). However, cfPWV values measured by Vicorder were consistent with those obtained by Omron even with jugular vein interference. CONCLUSION Arterial stiffness assessed by PWV increased gradually and significantly in semi-Fowler's position ≥20°. Knee bend decreased baPWV but did not seem to affect cfPWV. PWV should be measured in supine position if possible. If the supine posture is not tolerated, knee bend followed by a slight incline position may be recommended.
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Affiliation(s)
- Taha A Alhalimi
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas
| | - Tianyu Wang
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hirofumi Tanaka
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas
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11
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Bonner AN, Jayawickreme S, Malek AM, Vladutiu CJ, Oliver-Williams C, Cortés YI, Tanaka H, Meyer ML. Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study. Front Cardiovasc Med 2023; 10:1172828. [PMID: 37288258 PMCID: PMC10242178 DOI: 10.3389/fcvm.2023.1172828] [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: 02/23/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Although studies have demonstrated a J-shaped association between parity and cardiovascular disease (CVD), the association with arterial stiffness is not fully understood. Methods We examined the association between parity and carotid-femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness. We conducted a longitudinal analysis of 1220 women (mean age 73.7 years) who attended the Atherosclerosis Risk in Communities Study visit 5 (2011-2013). At visit 2 (1990-1992), women self-reported parity (number of prior live births), which we categorized as: 0 (never pregnant or pregnant with no live births); 1-2 (referent); 3-4; and 5+ live births. Technicians measured cfPWV at visit 5 (2011-2013) and visit 6 or 7 (2016-2019). Multivariable linear regression modeled the associations of parity with visit 5 cfPWV and cfPWV change between visit 5 and 6/7 adjusted for demographics and potential confounding factors. Results Participants reported 0 (7.7%), 1-2 (38.7%), 3-4 (40.0%), or 5+ (13.6%) prior live births. In adjusted analyses, women with 5+ live births had a higher visit 5 cfPWV (β=50.6 cm/s, 95% confidence interval: 3.6, 97.7 cm/s) than those with 1-2 live births. No statistically significant associations were observed for other parity groups with visit 5 cfPWV or with cfPWV change. Discussion In later life, women with 5+ live births had higher arterial stiffness than those with 1-2 live births, but cfPWV change did not differ by parity, suggesting women with 5+ live births should be targeted for early primary prevention of CVD given their higher arterial stiffness at later-life.
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Affiliation(s)
- Alison N. Bonner
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Shantal Jayawickreme
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Clare Oliver-Williams
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Central Bedfordshire Council, Chicksands, Bedfordshire, United Kingdom
| | - Yamnia I. Cortés
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, United States
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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12
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Loop MS, Lotspeich SC, Garcia TP, Meyer ML. Abstract P599: Should Regression Calibration or Multiple Imputation Be Used When Calibrating Different Devices in a Longitudinal Study? Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Objective:
In longitudinal studies, devices used to measure exposures, like pulse wave velocity (PWV), can change from visit to visit. Calibration studies, where a subset of participants receive measurements from both devices at follow-up, are often used to assess differences in the device measurements. Regression calibration and multiple imputation are common statistical methods to correct for those differences, but no study yet exists to compare the two when the quantity of interest is change in the exposure over time. We compared both methods in a hypothetical study of change in PWV and its association with total brain volume.
Methods:
We simulated true values of PWV at baseline and follow up, as well as imperfect measurements of PWV using an “old” device and “new” device. Two statistical methods were compared:
regression calibration
, which calibrates the new device measurements at follow up to the old device using linear regression in a calibration study; and
multiple imputation
, which imputes the (mostly) missing old device measurements at follow up.We varied the bias and measurement error of each device and for each scenario simulated 1,000 datasets of size n=2,500. Two percent of participants in each iteration were chosen to participate in the calibration study, and thus had measurements on the old and new devices at follow up. We used 200 bootstrap replicates to calculate the standard errors for the regression calibration method and 50 imputed datasets for the multiple imputation method. To compare the methods we used bias of the estimated association and how well the standard errors approximated the empirical standard errors.
Results:
Regression calibration was virtually unbiased for the association between change in PWV and total brain volume when the old device had larger measurement error than the new device. The maximum bias for regression calibration across all scenarios was still small (6%). When the old device had more measurement error or the two devices had equal measurement error, multiple imputation underestimated the association by more than 10%. This underestimation was reduced to approximately 2% when the new device had a larger measurement error than the old device. In all scenarios, regression calibration underestimated the empirical standard error by approximately 35%, while multiple imputation underestimated it by only 2-5%.
Conclusions:
In analyses of change in PWV and total brain volume, when unbiased estimation is the main objective, regression calibration is favorable to multiple imputation. When null hypothesis significance testing is the main objective, multiple imputation may be favorable in order to not underestimate the standard errors. We expect these conclusions to apply to other change in exposure and outcome relationships with similar ratios between the association’s magnitude and the amount of measurement error.
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13
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Pagan Lassalle P, Patterson C, Meyer ML, Stoner L. Abstract P657: Association Between Perceived Discrimination and Arterial Stiffness: A Scoping Review. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
The association of perceived discrimination (PD) and subclinical cardiovascular disease (CVD) risk has not been established, limiting our understanding of the importance of PD to CVD pathology.
Purpose:
With respect to PD and pulse wave velocity (PWV), a measure of arterial stiffness and subclinical CVD risk, this scoping review aimed to: (i) identify and synthesize the available research, and (ii) identify research gaps and make recommendations for future research.
Hypothesis:
We hypothesized that greater PD would be associated with greater (worse) PWV.
Methods:
All original research was eligible if it included adults (≥18 years) and co-measurement of PD and PWV. Electronic databases (PubMed, Embase, SPORTDiscuss, and CINALH+) were searched up to June 28
th
, 2022.
Results:
We identified 419 articles, of which 58 were duplicates, and 355 were irrelevant. We reviewed the full text of six articles. Three articles evaluated the same cohort, so two were excluded to minimize confounding, and another for lacking a measure of PD. As summarized in Table 1, a total of three observational (one longitudinal) studies were identified from Brazil, the UK, and the US. In the UK and Brazil studies, PD was associated with greater (worse) PWV. The Brazil study also reported that Black and Brown adults had greater odds of high PWV (>10 m/s) compared to the reference group and to those in the same racial/ethnic group without PD. For the US study, PD was significantly associated with PWV in non-Hispanic Black (NHB) females only.
Conclusion:
There was a trend of a positive association between PD and greater (worse) PWV. In the US, the positive association was evident only for NHB females, suggesting sex may impact the effect of PD on PWV. Future studies should focus on characterizing the effect of PD by sex and consider additional factors like intersectionality or coping mechanisms that may influence the association and predispose certain populations to added CVD risk.
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Affiliation(s)
| | | | | | - Lee Stoner
- The Univ of North Carolina at Chapel Hill, Chapel Hill, NC
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14
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Zieff G, Stone K, Paterson C, Fryer S, Diana J, Blackwell J, Meyer ML, Stoner L. Pulse-wave velocity assessments derived from a simple photoplethysmography device: Agreement with a referent device. Front Cardiovasc Med 2023; 10:1108219. [PMID: 36824455 PMCID: PMC9941627 DOI: 10.3389/fcvm.2023.1108219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Objective Pulse-wave velocity (PWV), a common measure of arterial stiffness, can be measured continuously and across multiple body sites using photoplethysmography (PPG). The objective was to determine whether a simple photoplethysmography PPG PWV method agrees with a referent device. Approach Photoplethysmography heart-finger PWV (hfPWV) and heart-toe PWV (htPWV) were compared to oscillometric carotid-wrist PWV (cwPWV) and carotid-ankle PWV (caPWV) referent measurements, respectively. In 30 adults (24.6 ± 4.8 years, body mass index 25.2 ± 5.9 kg/m2, 18 female), three measurements were made: two supine baseline measurements (Base 1, Base 2) and one measurement (Tilt) 5 min after a modified head-up tilt test (mHUTT). Overall agreement and repeated measures agreement (change in PPG PWV from Base to Tilt vs. change in referent PWV from Base to Tilt) were calculated using linear mixed models. Agreement estimates were expressed as intra-class correlation coefficients (ICC). Main results For hfPWV there was strong overall agreement (ICC: 0.77, 95%CI: 0.67-0.85), but negligible and non-significant repeated measures agreement (ICC: 0.10, 95%CI: -0.18 to 0.36). For htPWV, there was moderate overall agreement (ICC:0.50, 95%CI: 0.31-0.65) and strong repeated measures agreement (ICC: 0.81, 95%CI: 0.69-0.89). Significance Photoplethysmography can continuously measure PWV at multiple arterial segments with moderate-strong overall agreement. While further work with upper-limb PPG PWV is needed, PPG can adequately capture acute changes in lower-limb PWV.
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Affiliation(s)
- Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,*Correspondence: Gabriel Zieff,
| | - Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Craig Paterson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Jake Diana
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jade Blackwell
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Physiology, The University of Arizona, Tucson, AZ, United States
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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15
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Higgins S, Cowley ES, Paterson C, Hanson ED, Dave GJ, Meyer ML, Lin FC, Gibbs BB, Vu M, Stoner L. Protocol for a study on Sitting with Interruption and Whole-Body Cardiovascular Health (SWITCH) in middle-aged adults. Contemp Clin Trials 2023; 125:107048. [PMID: 36509249 PMCID: PMC9918673 DOI: 10.1016/j.cct.2022.107048] [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: 10/13/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sedentary behavior (SB) is a biologically distinct yet understudied cardiovascular disease risk (CVD) factor. However, specific public health policy regarding the optimal strategy for SB interruption is unavailable. This paper outlines the protocol for part I of the Sitting with Interruption and Whole-Body Cardiovascular Health (SWITCH) study, including the rationale, objectives, methodology, and next steps. We additionally detail practical considerations that went into the development of the NIH R01 grant supporting this research. METHODS Healthy men and women (n = 56, aged 36-55) who are inactive (<90 min/wk. of moderate-to-vigorous intensity physical activities for past 3 months) and sedentary (sitting for >8 h/day), will be recruited for this randomized crossover trial. Specifically, participants will complete the following 4-h conditions: (i) SB with once/h 5 min walk break; (ii) SB with once/h 15 min stand break; (iii) SB with twice/h breaks (alternating 5 min walk and 15 min stand); and (iv) SB with no breaks (i.e., control). Focus group discussions will refine our socioecological SB reduction model. RESULTS The primary outcome will be change in aortic arterial stiffness (i.e., pulse wave velocity; PWV, m/s) for each substitution strategy relative to the control (SB with no breaks) condition. CONCLUSIONS The outcomes from this study will facilitate the design of a subsequent randomized controlled trial to test a mechanism-informed, feasible SB-reduction intervention and support the development of SB policy.
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Affiliation(s)
- Simon Higgins
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Emma S Cowley
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig Paterson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gaurav J Dave
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Depart of Epidemiology, Gillings School of Global Public Health; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Maihan Vu
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Depart of Epidemiology, Gillings School of Global Public Health; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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King BL, Meyer ML, Chari SV, Hurka-Richardson K, Bohrmann T, Chang PP, Rodgers JE, Busby-Whitehead J, Casey MF. Accuracy of the electronic health record's problem list in describing multimorbidity in patients with heart failure in the emergency department. PLoS One 2022; 17:e0279033. [PMID: 36512600 PMCID: PMC9747000 DOI: 10.1371/journal.pone.0279033] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with heart failure (HF) often suffer from multimorbidity. Rapid assessment of multimorbidity is important for minimizing the risk of harmful drug-disease and drug-drug interactions. We assessed the accuracy of using the electronic health record (EHR) problem list to identify comorbid conditions among patients with chronic HF in the emergency department (ED). A retrospective chart review study was performed on a random sample of 200 patients age ≥65 years with a diagnosis of HF presenting to an academic ED in 2019. We assessed participant chronic conditions using: (1) structured chart review (gold standard) and (2) an EHR-based algorithm using the problem list. Chronic conditions were classified into 37 disease domains using the Agency for Healthcare Research Quality's Elixhauser Comorbidity Software. For each disease domain, we report the sensitivity, specificity, positive predictive value, and negative predictive of using an EHR-based algorithm. We calculated the intra-class correlation coefficient (ICC) to assess overall agreement on Elixhauser domain count between chart review and problem list. Patients with HF had a mean of 5.4 chronic conditions (SD 2.1) in the chart review and a mean of 4.1 chronic conditions (SD 2.1) in the EHR-based problem list. The five most prevalent domains were uncomplicated hypertension (90%), obesity (42%), chronic pulmonary disease (38%), deficiency anemias (33%), and diabetes with chronic complications (30.5%). The positive predictive value and negative predictive value of using the EHR-based problem list was greater than 90% for 24/37 and 32/37 disease domains, respectively. The EHR-based problem list correctly identified 3.7 domains per patient and misclassified 2.0 domains per patient. Overall, the ICC in comparing Elixhauser domain count was 0.77 (95% CI: 0.71-0.82). The EHR-based problem list captures multimorbidity with moderate-to-good accuracy in patient with HF in the ED.
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Affiliation(s)
- Brandon L. King
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Srihari V. Chari
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Thomas Bohrmann
- Analytical Partners Consulting LLC, Raleigh, North Carolina, United States of America
| | - Patricia P. Chang
- Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Jo Ellen Rodgers
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States of America
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center of Aging and Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Martin F. Casey
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
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Mok Y, Ishigami J, Lutsey PL, Tanaka H, Meyer ML, Heiss G, Matsushita K. Peripheral Artery Disease and Subsequent Risk of Infectious Disease in Older Individuals: The ARIC Study. Mayo Clin Proc 2022; 97:2065-2075. [PMID: 36210200 DOI: 10.1016/j.mayocp.2022.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/02/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To quantify the association of peripheral artery disease (PAD) with infection risk because PAD has been understudied despite recognition of atherosclerotic cardiovascular disease as a risk factor for infection. METHODS Among 5082 participants of the Atherosclerosis Risk in Communities study (aged 71 to 90 years during 2011-2013), we assessed the association of PAD status, based on clinical history and ankle-brachial index (ABI), with infection-related hospitalization (through December 2019) using multivariable Cox regression. We also cross-classified participants by PAD and coronary heart disease (CHD)/stroke status at baseline, with implications for polyvascular disease. RESULTS During the median follow-up of 6.5 years, there were 1677 infection-related hospitalizations. Peripheral artery disease (clinical history or ABI ≤0.90) was independently associated with the risk of overall infection (adjusted hazard ratio [HR], 1.66 [95% CI, 1.42 to 1.94] vs ABI of 1.11 to 1.20), as was borderline low ABI of 0.91 to 1.00 (adjusted HR, 1.75 [95% CI, 1.47 to 2.07]). Results were consistent across major types of infection (ie, cellulitis, bloodstream infection, pneumonia, and urinary tract infection). For overall infection, PAD plus CHD/stroke had the highest HR of hospitalized infection (1.9), and PAD alone and CHD/stroke alone showed similar HRs of 1.6. For subtypes of infection, PAD alone had the highest HR of approximately 2 for bloodstream infection; PAD alone and PAD plus CHD/stroke had a similar risk of urinary tract infection with HR of approximately 1.7. CONCLUSION Peripheral artery disease and borderline low ABI were robustly associated with infection-related hospitalization of older adults. The contribution of PAD to infection risk was comparable to that of CHD/stroke, warranting clinical attention to PAD for the prevention of infectious diseases.
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Affiliation(s)
- Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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18
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Peter KM, Pike JR, Preisser JS, Kucharska-Newton AM, Meyer ML, Mirabelli MC, Palta P, Hughes T, Matsushita K, Lu Y, Heiss G. Decline in Lung Function From Mid-to Late-Life With Central Arterial Stiffness: The Atherosclerosis Risk in Communities Study. Angiology 2022; 73:967-975. [PMID: 35624428 PMCID: PMC9490435 DOI: 10.1177/00033197221105747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We investigated the association of lung function at mid-life, later in life, and its 20-year decline, with arterial stiffness later in life. We examined 5720 Atherosclerosis Risk in Communities Study participants who attended Visits 1 (1987-1989) and 5 (2011-2013). Lung function measures were forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), obtained at Visits 1, 2 (1990-1992), and 5. Central artery stiffness (carotid-femoral pulse wave velocity [cfPWV]) was measured at Visit 5. We evaluated associations of lung function with later-life central artery stiffness and cfPWV >75th percentile by multivariable linear and logistic regressions. Lung function at Visit 1 (FEV1 β: -26, 95% Confidence Interval [CI]: -48, -5; FVC β: -14, 95% CI: -32, 5) and Visit 5 (FEV1 β: -22, 95% CI: -46, 2; FVC β: -18, 95% CI: -38, 2) were inversely associated with cfPWV at Visit 5, and with odds of high cfPWV in fully adjusted models. Twenty-year decline in lung function was not associated with continuous or dichotomous measures of arterial stiffness (FEV1 β: 11, 95% CI: -46, 68; FVC β: -4, 95% CI: -52, 43). Lung function at mid-life and late-life was inversely associated with arterial stiffness in later life.
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Affiliation(s)
- Kennedy M. Peter
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James R. Pike
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S. Preisser
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M. Kucharska-Newton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of Kentucky – Lexington, Lexington, KY, USA
| | | | | | | | | | | | - Yifei Lu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Poles J, Adams N, Carey G, Heffernan KS, Meyer ML, Schwarz A, Mayer C, Hametner B, Stoner L. Agreement Between Single- And Double-point Estimations Of Pulse Wave Velocity. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000875416.28516.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Cilhoroz BT, DeBlois JP, Lefferts WK, Keller AP, Pagan Lassalle P, Meyer ML, Stoner L, Heffernan KS. Exploration of cerebral hemodynamic pathways through which large artery function affects neurovascular coupling in young women. Front Cardiovasc Med 2022; 9:914439. [PMID: 36035945 PMCID: PMC9411931 DOI: 10.3389/fcvm.2022.914439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe interactions between large artery function and neurovascular coupling (NVC) are emerging as important contributors to cognitive health. Women are disproportionally affected by Alzheimer's disease and related dementia later in life. Understanding large artery correlates of NVC in young women may help with preservation of cognitive health with advancing age.PurposeTo explore the association between large artery function, NVC and cognitive performance in young women.MethodsVascular measurements were made in 61 women (21 ± 4 yrs) at rest and during a cognitive challenge (Stroop task). Transcranial Doppler was used to measure left middle cerebral artery (MCA) maximum velocity (Vmax), mean velocity (Vmean), and pulsatility index (PI). NVC was determined as MCA blood velocity reactivity to the Stroop task. Large artery function was determined using carotid-femoral pulse wave velocity (cfPWV) as a proxy measure of aortic stiffness and carotid ultrasound-derived measures of compliance and reactivity (diameter change to the Stroop task). Cognitive function was assessed separately using a computerized neurocognitive battery that included appraisal of response speed, executive function, information processing efficiency, memory, attention/concentration, and impulsivity.ResultsMCA Vmax reactivity was positively associated with executive function (β = 0.26, 95% CI 0.01–0.10); MCA Vmean reactivity was negatively associated with response speed (β = −0.33, 95% CI −0.19 to −0.02) and positively with memory score (β = 0.28, 95% CI 0.01–0.19). MCA PI reactivity was negatively associated with attention performance (β = −0.29, 95% CI −14.9 to −1.0). Path analyses identified significant paths (p < 0.05) between carotid compliance and carotid diameter reactivity to select domains of cognitive function through MCA reactivity.ConclusionsNVC was associated with cognitive function in young women. Carotid artery function assessed as carotid compliance and carotid reactivity may contribute to optimal NVC in young women through increased blood flow delivery and reduced blood flow pulsatility.
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Affiliation(s)
- Burak T. Cilhoroz
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
| | - Jacob P. DeBlois
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
| | - Wesley K. Lefferts
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Allison P. Keller
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
| | - Patricia Pagan Lassalle
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, United States
| | - Michelle L. Meyer
- Department of Epidemiology, Gilling's School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, United States
- Department of Epidemiology, Gilling's School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kevin S. Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
- *Correspondence: Kevin S. Heffernan
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21
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Bates LC, Damare MI, Hanson ED, Moore JB, Bae-Jump V, Meyer ML, Stoner L. Sedentary Behavior Reduction: A Stepwise Approach to Increasing Physical Activity and Reducing Cardiovascular Disease Risk in Endometrial Cancer Survivors. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2307250] [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: 11/06/2022] Open
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22
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Heffernan KS, Stoner L, Meyer ML, Loprinzi PD. Association Between Estimated Pulse Wave Velocity and Cognitive Performance in Older Black and White Adults in NHANES. J Alzheimers Dis 2022; 88:985-993. [PMID: 35754267 DOI: 10.3233/jad-220042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Aging-associated cognitive decline is greater in non-Hispanic Black (NHB) adults than non-Hispanic White (NHW) adults. An important risk factor for cognitive decline with aging is arterial stiffening, though the importance to racial variation remains poorly understood. OBJECTIVE We examined the association of an estimate of arterial stiffness with cognitive function in a bi-racial sample of 60-85-year-old adults (N = 3,616, 26.5% NHB) enrolled in the National Health and Nutrition Examination Survey (NHANES) between 1999-2002 and 2011-2014. METHODS As a measure of vascular aging, pulse wave velocity was estimated (ePWV) using an equation incorporating age and mean arterial pressure and expressed as m/s. Using the digit symbol substitution test (DSST), cognitive function was expressed as the number of correctly matched symbols (out of 133) within 120 s. Linear regression models examined associations between ePWV and DSST. RESULTS In models that adjusted for sex, education, smoking, body mass index, history of cardiovascular disease, and hypertension, ePWV was inversely associated with DSST score in NHB adults (β= -3.47, 95% CI = -3.9 to -3.0; p < 0.001) and NHW adults (β= -3.51, 95% CI = -4.4 to -2.6; p < 0.001). CONCLUSION ePWV is inversely associated with a measure of cognitive function in older Black and White adults. ePWV may be a useful measure of vascular aging that can offer insight into cognitive aging.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse NY, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul D Loprinzi
- Department of Health, Exercise Science and Recreation Management, University of Mississippi, Oxford MS, USA
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23
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Charry D, Gouskova N, Meyer ML, Ring K, Nambi V, Heiss G, Tanaka H. Arterial stiffness and contralateral differences in blood pressure: The Atherosclerosis Risk in Communities (ARIC) study. J Clin Hypertens (Greenwich) 2022; 24:878-884. [PMID: 35698928 PMCID: PMC9278590 DOI: 10.1111/jch.14493] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
Abstract
A large interarm difference in brachial systolic blood pressure (SBP) (≥10 or ≥15 mmHg) is strongly associated with elevated cardiovascular events and mortality. Evidence demonstrating whether such contralateral differences in SBP occur in ankle blood pressure and its association with arterial stiffness is scarce. The aims of this study were to characterize arm and ankle contralateral SBP differences in a sample of community‐dwelling older adults (5077), and to determine whether this difference is associated with arterial stiffness assessed by pulse wave velocity (PWV) between the heart and ankle (haPWV), femoral artery and ankle (faPWV), and brachial artery and ankle (baPWV) in the right and left sides. Prevalence of interarm SBP differences ≥10 and ≥15 mmHg was 5.1% and .7%, respectively; the corresponding prevalence for interankle SBP was 24.9% and 12.0%. Higher BMI and lower ankle‐brachial index (ABI) were significantly correlated with greater interarm SBP differences. Increased age, higher BMI, lower ABI, and greater contralateral differences in haPWV, faPWV, and baPWV were significantly correlated to greater interankle SBP differences. Interankle SBP difference ≥15 mmHg was significantly associated with contralateral differences of >80 cm/s in haPWV (OR = 1.94 [95% CI = 1.52–2.49]), >165 cm/s in faPWV (OR = 1.64 [95% CI = 1.27–2.12]), and >240 cm/s in baPWV (OR = 2.43 [95% CI = 1.94–3.05]). The associations remained significant after adjustment for age, sex, race, BMI, smoking status, and ABI. Compared with interarm differences, interankle differences in SBP are common in older adults. The magnitude of interankle, but not interarm, differences in SBP is associated with various measures of arterial stiffness.
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Affiliation(s)
- Daniela Charry
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Natalia Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle L Meyer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kimberley Ring
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Vijay Nambi
- Department of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Gerardo Heiss
- Department of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
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24
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Hurka-Richardson K, Platts-Mills TF, McLean SA, Weinberger M, Stearns SC, Bush M, Quackenbush E, Chari S, Aylward A, Kroenke K, Kerns RD, Weaver MA, Keefe FJ, Berkoff D, Meyer ML. Brief Educational Video plus Telecare to Enhance Recovery for Older Emergency Department Patients with Acute Musculoskeletal Pain: an update to the study protocol for a randomized controlled trial. Trials 2022; 23:400. [PMID: 35550175 PMCID: PMC9096747 DOI: 10.1186/s13063-022-06310-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background This update describes changes to the Brief Educational Tool to Enhance Recovery (BETTER) trial in response to the COVID-19 pandemic. Methods/design The original protocol was published in Trials. Due to the COVID-19 pandemic, the BETTER trial converted to remote recruitment in April 2020. All recruitment, consent, enrollment, and randomization now occur by phone within 24 h of the acute care visit. Other changes to the original protocol include an expansion of inclusion criteria and addition of new recruitment sites. To increase recruitment numbers, eligibility criteria were expanded to include individuals with chronic pain, non-daily opioid use within 2 weeks of enrollment, presenting musculoskeletal pain (MSP) symptoms for more than 1 week, hospitalization in past 30 days, and not the first time seeking medical treatment for presenting MSP pain. In addition, recruitment sites were expanded to other emergency departments and an orthopedic urgent care clinic. Conclusions Recruiting from an orthopedic urgent care clinic and transitioning to remote operations not only allowed for continued participant enrollment during the pandemic but also resulted in some favorable outcomes, including operational efficiencies, increased enrollment, and broader generalizability. Trial registration ClinicalTrials.gov NCT04118595. Registered on October 8, 2019.
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Affiliation(s)
- Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | | | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA.,Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sally C Stearns
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Eugenia Quackenbush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Srihari Chari
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Aileen Aylward
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Kurt Kroenke
- Regenstrief Institute and Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Robert D Kerns
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, USA
| | - Mark A Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC, USA
| | - Francis J Keefe
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - David Berkoff
- Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA.
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25
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Wang W, Norby FL, Alonso A, Gottesman RF, Jack CR, Meyer ML, Knopman DS, Sullivan KJ, Hughes TM, Lakshminarayan K, Lutsey PL. Association of Carotid Intima-Media Thickness with Brain MRI Markers in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). J Stroke Cerebrovasc Dis 2022; 31:106388. [PMID: 35193028 PMCID: PMC9018472 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Elevated carotid intima-media thickness (cIMT) and carotid plaque are markers of arterial injury and may be linked to structural brain injury. We hypothesized cIMT or presence of carotid plaque at midlife are associated with presence of infarcts and cerebral microbleeds, greater white matter hyperintensity (WMH) volume, and smaller regional brain volumes in late-life. METHODS We included 1,795 Atherosclerosis Risk in Communities (ARIC) Study participants (aged 57±6 years, 57% female, 23% Black) with carotid ultrasounds in 1990-1992 and brain MRI scans in 2011-2013. Weighted linear regression was used for brain volume outcomes, while logistic regression was used for infarcts and cerebral microbleeds. RESULTS After multivariable adjustments, the highest cIMT quintile was associated with smaller deep gray matter (β [95% CI]: -0.11 [-0.22, -0.01]) and cortical volume in a temporal-parietal meta region of interest (ROI) (β [95% CI]: -0.10 [-0.20, -0.01]) in late-life. Similarly, those with carotid plaque had smaller regional brain volumes than those without (βs [95% CIs]: -0.05 [-0.12, 0.03] and -0.06 [-0.13, 0.01] for deep gray matter and temporal-parietal meta ROI). No significant relations were observed with WMH volume, infarcts, or cerebral microbleeds. CONCLUSION Over a median follow-up of 21 years, greater midlife cIMT and presence of carotid plaque were associated with smaller deep gray matter volume and cortical volume in a meta ROI involving temporal and parietal lobe regions typically involved in neurodegeneration, including Alzheimer's disease, in later life. Contrary to our hypothesis, associations between measures of arterial injury and markers of vascular brain injury were null.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, United States.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States.
| | | | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States.
| | - Kevin J Sullivan
- Department of Medicine: The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, United States.
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States.
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
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26
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Stone K, Fryer S, Faulkner J, Meyer ML, Heffernan K, Kucharska-Newton A, Zieff G, Paterson C, Matsushita K, Hughes TM, Tanaka H, Stoner L. Associations of lower-limb atherosclerosis and arteriosclerosis with cardiovascular risk factors and disease in older adults: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2022; 340:53-60. [PMID: 34799100 PMCID: PMC10167791 DOI: 10.1016/j.atherosclerosis.2021.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 06/29/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Atherosclerosis and arteriosclerosis contribute to vascular aging and cardiovascular disease (CVD) risk. Both processes can be assessed simply in the lower-limbs and reflect systemic pathology. However, only atherosclerosis is routinely assessed, typically via ankle-brachial index (ABI). Arteriosclerosis can be assessed using femoral-ankle pulse wave velocity (faPWV), but no studies have identified whether ABI and faPWV similarly associate with overt CVD and risk factors, nor whether faPWV confers additional information. The aims of this study were to (i) compare associations of ABI and faPWV with traditional CVD risk factors, including age, sex, systolic blood pressure (SBP), high-density lipoprotein (HDL), total cholesterol (TC), smoking, and diabetes; and (ii) determine the independent and additive associations of ABI and faPWV with a composite measure of prevalent CVD. METHODS We evaluated ABI and faPWV in 4330 older-aged (75.3 ± 5.0 years) adults using an oscillometric screening device. Associations between ABI and faPWV with CVD risk factors and CVD were determined using mixed-model linear- and logistic-regression. RESULTS ABI and faPWV were associated with age, HDL, and smoking. ABI was associated with sex, TC, diabetes. faPWV was associated with SBP. Both ABI and faPWV were inversely associated with CVD. Low ABI (≤0.9 vs. >0.9) and low faPWV (≤9.94 vs. >9.94) increased the odds of CVD by 2.41-fold (95% CI:1.85,3.17) and 1.46-fold (95% CI:1.23,1.74), respectively. The inverse association between faPWV and CVD was independent of ABI and CVD risk factors. CONCLUSIONS ABI and faPWV, measures of lower-limb atherosclerosis and arteriosclerosis, are independently associated with CVD risk factors and prevalent CVD. Assessment of faPWV may confer additional risk information beyond ABI.
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Affiliation(s)
- Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK.
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - James Faulkner
- Department of Sport, Exercise & Health, University of Winchester, Winchester, UK
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, USA
| | - Anna Kucharska-Newton
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig Paterson
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy M Hughes
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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27
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Heffernan K, Stoner L, Meyer ML, Keifer A, Bates L, Lassalle PP, Hanson ED, Horiuchi M, Michos ED, Kucharska-Newton A, Matsushita K, Hughes TM, Tanaka H. Associations between estimated and measured carotid-femoral pulse wave velocity in older Black and White adults: the atherosclerosis risk in communities (ARIC) study. J Cardiovasc Aging 2022; 2:7. [PMID: 36816983 PMCID: PMC9934460 DOI: 10.20517/jca.2021.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction Aortic stiffness offers important insight into vascular aging and cardiovascular disease (CVD) risk. The referent measure of aortic stiffness is carotid-femoral pulse wave velocity (cfPWV). cfPWV can be estimated (ePWV) from age and mean arterial pressure. Few studies have directly compared the association of ePWV to measured cfPWV, particularly in non-White adults. Moreover, whether ePWV and cfPWV correlate similarly with CVD risk remains unexplored. Aim (1) To estimate the strength of the agreement between ePWV and cfPWV in both Black and White older adults; and (2) to compare the associations of ePWV and cfPWV with CVD risk factors and determine whether these associations were consistent across races. Methods and Results We evaluated 4478 [75.2 (SD 5.0) years] Black and White older adults in the Atherosclerosis Risk in Communities (ARIC) Study. cfPWV was measured using an automated pulse waveform analyzer. ePWV was derived from an equation based on age and mean arterial pressure. Association and agreement between the two measurements were determined using Pearson's correlation coefficient (r), standard error of estimate (SEE), and Bland-Altman analysis. Associations between traditional risk factors with ePWV and cfPWV were evaluated using linear mixed regression models. We observed weak correlations between ePWV and cfPWV within White adults (r = 0.36) and Black adults (r = 0.31). The mean bias for Bland-Altman analysis was low at -0.17 m/s (95%CI: -0.25 to -0.09). However, the inspection of the Bland-Altman plots indicated systematic bias (P < 0.001), which was consistent across race strata. The SEE, or typical absolute error, was 2.8 m/s suggesting high variability across measures. In models adjusted for sex, prevalent diabetes, the number of prevalent cardiovascular diseases, and medication count, both cfPWV and ePWV were positively associated with heart rate, triglycerides, and fasting glucose, and negatively associated with body mass index (BMI) and smoking status in White adults (P < 0.05). cfPWV and ePWV were not associated with heart rate, triglycerides, and fasting glucose in Black adults, while both measures were negatively associated with BMI in Black adults. Conclusions Findings suggest a weak association between ePWV and cfPWV in older White and Black adults from ARIC. There were similar weak associations between CVD risk factors with ePWV and cfPWV in White adults with subtle differences in associations in Black adults.
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Affiliation(s)
- Kevin Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY 13244, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Michelle L. Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adam Keifer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lauren Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Patricia Pagan Lassalle
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Erik D. Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Masahiro Horiuchi
- Department of Human Environmental Science, Mount Fuji Research Institute, Yamanashi 403-0005, Japan
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Anna Kucharska-Newton
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.,Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Timothy M. Hughes
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC 27157, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA
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Wang W, Gottesman RF, Meyer ML, Hughes TM, Sullivan KJ, Wong DF, Lakshminarayan K, Lutsey PL. Carotid Intima-Media Thickness and Amyloid-β Deposition: The ARIC-PET Study. J Alzheimers Dis 2022; 88:17-22. [PMID: 35527548 PMCID: PMC10167843 DOI: 10.3233/jad-215671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed whether carotid intima-media thickness (cIMT) is prospectively associated with amyloid-β (Aβ). 332 nondemented Atherosclerosis Risk in Communities Study participants with carotid ultrasounds (1990-1992) and PET scans (2012-2014) were studied. Participants in the highest (versus lowest) cIMT tertile had 2.17 times the odds of elevated Aβ (95% CI: 1.15-4.11), after demographic and APOE ɛ4 adjustments. An interaction with APOE ɛ4 was observed (p = 0.02). Greater cIMT was associated with elevated Aβ independent of vascular risk factors among those with ≥1 APOE ɛ4 allele, but not in noncarriers. In this cohort, higher cIMT was associated with Aβ deposition 22 years later, particularly among APOE ɛ4 carriers.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kevin J. Sullivan
- Department of Medicine: The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Dean F. Wong
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
- Department of Neuroscience, Washington University in St. Louis, St. Louis, Missouri
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Wang FM, Yang C, Ballew SH, Kalbaugh CA, Meyer ML, Tanaka H, Heiss G, Allison M, Salameh M, Coresh J, Matsushita K. Ankle-brachial index and subsequent risk of incident and recurrent cardiovascular events in older adults: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2021; 336:39-47. [PMID: 34688158 PMCID: PMC8604439 DOI: 10.1016/j.atherosclerosis.2021.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS The ankle-brachial index (ABI) is a diagnostic test for screening and detecting peripheral artery disease (PAD), as well as a risk enhancer in the AHA/ACC guidelines on the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, our understanding of the association between ABI and cardiovascular risk in contemporary older populations is limited. Additionally, the prognostic value of ABI among individuals with prior ASCVD is not well understood. METHODS Among 5,003 older adults at ARIC visit 5 (2011-2013) (4,160 without prior ASCVD [median age 74 years, 38% male], and 843 with ASCVD [median age 76 years, 65% male]), we quantified the association between ABI and the risk of heart failure (HF), and composite coronary heart disease and stroke (CHD/stroke) using multivariable Cox regression models. RESULTS Over a median follow-up of 5.5 years, we observed 400 CHD/stroke events and 338 HF cases (242 and 199 cases in those without prior ASCVD, respectively). In participants without a history of ASCVD, a low ABI ≤0.9 (relative to ABI 1.11-1.20) was associated with both CHD/stroke and HF (adjusted hazard ratios 2.40 [95% CI: 1.55-3.71] and 2.23 [1.40-3.56], respectively). In those with prior ASCVD, low ABI was not significantly associated with CHD/stroke, but was with HF (7.12 [2.47-20.50]). The ABI categories of 0.9-1.2 and > 1.3 were also independently associated with increased HF risk. Beyond traditional risk factors, ABI significantly improved the risk discrimination of CHD/stroke in those without ASCVD and HF, regardless of baseline ASCVD. CONCLUSIONS Low ABI was associated with CHD/stroke in those without prior ASCVD and higher risk of HF regardless of baseline ASCVD status. These results support ABI as a risk enhancer for guiding primary cardiovascular prevention and suggest its potential value in HF risk assessment for older adults.
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Affiliation(s)
- Frances M Wang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chao Yang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shoshana H Ballew
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michelle L Meyer
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gerardo Heiss
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Maya Salameh
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Josef Coresh
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
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30
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Stoner L, Barone Gibbs B, Meyer ML, Fryer S, Credeur D, Paterson C, Stone K, Hanson ED, Kowalsky RJ, Horiuchi M, Mack CP, Dave G. A Primer on Repeated Sitting Exposure and the Cardiovascular System: Considerations for Study Design, Analysis, Interpretation, and Translation. Front Cardiovasc Med 2021; 8:716938. [PMID: 34485414 PMCID: PMC8415972 DOI: 10.3389/fcvm.2021.716938] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/29/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
Sedentary behavior, particularly sitting, is ubiquitous in many contemporary societies. This is a major societal concern considering the evidence for a strong association between sitting behavior and cardiovascular disease morbidity and mortality. Unsurprisingly, leading public health agencies have begun to advocate “reduction” in sitting behavior. Though, the guidelines are typically vague and non-specific. The lack of specific guidelines for prolonged sitting is attributable to the absence of available evidence to facilitate guideline development. To inform policy, well-designed randomized controlled trials are required to test the efficacy of specific and translatable sitting reduction strategies. To guide the design of randomized controlled trials, this review postulates that several gaps in the literature first need to be filled. Following a general discussion of the importance of sitting behavior to contemporary societies, each of the following are discussed: (i) acute sitting exposure and systems physiology; (ii) recommendations for a systems physiology toolbox; (iii) study design considerations for acute sitting exposure; and (iv) translation of sitting-focused research.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bethany Barone Gibbs
- Department of Health and Human Development and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Daniel Credeur
- Department of Biology, Ave Maria University, Ave Maria, FL, United States
| | - Craig Paterson
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Robert J Kowalsky
- Department of Health and Kinesiology, Texas A&M University-Kingsville, Kingsville, TX, United States
| | - Masahiro Horiuchi
- Division of Human Environmental Science, Mount Fuji Research Institute, Yamanashi, Japan
| | - Christopher P Mack
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gaurav Dave
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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31
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Poles J, Adams N, Kelsch E, Heffernan K, Meyer ML, Burnet K, Kowalsky RJ, Gibbs BB, Stoner L. AGREEMENT BETWEEN ACUTE CHANGES IN CAROTID-FEMORAL AND BRACHIAL-FEMORAL PULSE WAVE VELOCITY. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000759992.48368.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Adams NT, Poles J, Kelsch E, Heffernan K, Meyer ML, Burnet K, Kowalsky RJ, Gibbs BB, Stoner L. Agreement Of Seated And Supine Pulse Wave Velocity Measurements With Prolonged Sitting. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760004.56812.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Caughey MC, Qiao Y, Meyer ML, Palta P, Matsushita K, Tanaka H, Wasserman BA, Heiss G. Relationship Between Central Artery Stiffness, Brain Arterial Dilation, and White Matter Hyperintensities in Older Adults: The ARIC Study-Brief Report. Arterioscler Thromb Vasc Biol 2021; 41:2109-2116. [PMID: 33882687 PMCID: PMC8478115 DOI: 10.1161/atvbaha.120.315692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Melissa C. Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University; Chapel Hill, NC
| | - Ye Qiao
- Department of Radiology, Johns Hopkins School of Medicine; Baltimore, MD
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine; Chapel Hill, NC
| | - Priya Palta
- Department of Medicine, Columbia University School of Medicine; New York, NY
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | | | - Bruce A. Wasserman
- Department of Radiology, Johns Hopkins School of Medicine; Baltimore, MD
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health; Chapel Hill, NC
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34
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Wang W, Norby FL, George KM, Alonso A, Mosley TH, Gottesman RF, Meyer ML, Lutsey PL. Association of Carotid Intima-Media Thickness and Other Carotid Ultrasound Features With Incident Dementia in the ARIC-NCS. J Am Heart Assoc 2021; 10:e020489. [PMID: 33870735 PMCID: PMC8200760 DOI: 10.1161/jaha.120.020489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Increased carotid intima‐media thickness, interadventitial diameter, presence of carotid plaque, and lower distensibility are predictors for cardiovascular disease. These indices likely relate to cerebrovascular disease, and thus may constitute a form of vascular contributions to dementia and Alzheimer disease–related dementia. Therefore, we assessed the relationship of carotid measurements and arterial stiffness with incident dementia in the ARIC (Atherosclerosis Risk in Communities) study. Methods and Results A total of 12 459 ARIC participants with carotid arterial ultrasounds in 1990 to 1992 were followed through 2017 for dementia. Dementia cases were identified using in‐person and phone cognitive status assessments, hospitalization discharge codes, and death certificate codes. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident dementia. Participants were aged 57±6 at baseline, 57% were women, and 23% were Black individuals. Over a median follow‐up time of 24 years, 2224 dementia events were ascertained. After multivariable adjustments, the highest quintile of carotid intima‐media thickness and interadventitial diameter in midlife was associated with increased risk of dementia (HR [95% CIs], 1.25 [1.08–1.45]; and 1.22 [1.04–1.43], respectively) compared with its respective lowest quintile. Presence of carotid plaque did not have a significant association with dementia (HR [95% CI], 1.06 [0.97–1.15]). Higher distensibility was associated with lower risk of dementia (HR [95% CI] highest versus lowest quintile, 0.76 [0.63–0.91]). Conclusions Greater carotid intima‐media thickness, interadventitial diameter, and lower carotid distensibility are associated with an increased risk of incident dementia. These findings suggest that both atherosclerosis and carotid stiffness may be implicated in dementia risk.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Faye L Norby
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN.,Department of Cardiology Center for Cardiac Arrest Prevention Cedars-Sinai Smidt Heart Institute Los Angeles CA
| | - Kristen M George
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN.,Division of Public Health Sciences University of California Davis Davis CA
| | - Alvaro Alonso
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Thomas H Mosley
- The MIND Center University of Mississippi Medical Center Jackson MS
| | | | - Michelle L Meyer
- Department of Emergency Medicine University of North Carolina at Chapel Hill NC
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
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35
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Giersch GEW, Charkoudian N, Pereira T, Edgell H, Freeberg KA, Craighead DH, Neill M, Allison EY, Zapcic AK, Smith KJ, Bock JM, Casey DP, Shenouda N, Ranadive SM, Tremblay JC, Williams AM, Simpson LL, Meah VL, Ruediger SL, Bailey TG, Pereira HM, Lei TH, Perry B, Mündel T, Freemas JA, Worley ML, Baranauskas MN, Carter SJ, Johnson BD, Schlader ZJ, Bates LC, Stoner L, Zieff G, Poles J, Adams N, Meyer ML, Hanson ED, Greenlund IM, Bigalke JA, Carter JR, Kerr ZY, Stanford K, Pomeroy A, Boggess K, de Souza HLR, Meireles A, Arriel RA, Leite LHR, Marocolo M, Chapman CL, Atencio JK, Kaiser BW, Comrada LN, Halliwill JR, Minson CT, Williams JS, Dunford EC, MacDonald MJ, Santisteban KJ, Larson EA, Reed E, Needham KW, Gibson BM, Gillen J, Barbosa TC, Cardoso LLY, Gliemann L, Tamariz-Ellemann A, Hellsten Y, DuBos LE, Babcock MC, Moreau KL, Wickham KA, Vagula M, Moir ME, Klassen SA, Rodrigues A. Commentaries on Point:Counterpoint: Investigators should/should not control for menstrual cycle phase when performing studies of vascular control. J Appl Physiol (1985) 2021; 129:1122-1135. [PMID: 33197376 DOI: 10.1152/japplphysiol.00809.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gabrielle E W Giersch
- Thermal and Mountain Medicine Division, United States Army Research Institute for Environmental Medicine, Natick, Massachusetts,Oak Ridge Institute for Science and Education, Oak Ridge, Tennnessee
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute for Environmental Medicine, Natick, Massachusetts
| | - T Pereira
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - H Edgell
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Kaitlin A Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Matthew Neill
- Department of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Elric Y Allison
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Andrea K Zapcic
- Department of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kurt J Smith
- Integrative Physiology Lab, Department of Kinesiology and Nutrition, University of Chicago, Chicago, Illinois
| | - Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa,Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa,Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ninette Shenouda
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Sushant M Ranadive
- Department of Kinesiology, University of Maryland, College Park, Maryland
| | - Joshua C Tremblay
- Centre for Heart, Lung and Vascular Health, University of British Columbia–Okanagan, Kelowna, British Columbia, Canada
| | - Alexandra M Williams
- Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Lydia L Simpson
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Stefanie L Ruediger
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre of Research on Exercise, Physical Activity and Health, The University of Queensland, Australia
| | - Tom G Bailey
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre of Research on Exercise, Physical Activity and Health, The University of Queensland, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Hugo M Pereira
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - Tze-Huan Lei
- College of Physical Education, Hubei Normal University, Huangshi, China,Laboratory for Applied Human Physiology, Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Blake Perry
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Toby Mündel
- School of Sport Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Jessica A Freemas
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Morgan L Worley
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Marissa N Baranauskas
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Stephen J Carter
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Blair D Johnson
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Zachary J Schlader
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Lauren C Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jillian Poles
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nathan Adams
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ian M Greenlund
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Jeremy A Bigalke
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Stanford
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alex Pomeroy
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kim Boggess
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hiago L R de Souza
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson Meireles
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Rhai A Arriel
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Laura H R Leite
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Moacir Marocolo
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | - Jessica K Atencio
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Brendan W Kaiser
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Lindan N Comrada
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - John R Halliwill
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | | | - Jennifer S Williams
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Emily C Dunford
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Maureen J MacDonald
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Emily A Larson
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Emma Reed
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Karen W Needham
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Brandon M Gibson
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Jenna Gillen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Thales C Barbosa
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Licy L Yanes Cardoso
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lasse Gliemann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Lyndsey E DuBos
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew C Babcock
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kerrie L Moreau
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Veterans Affairs Eastern Colorado Geriatric Research, Educational and Clinical Center, Denver, Colorado
| | - Kate A Wickham
- Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | | | - M Erin Moir
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | | | - Alex Rodrigues
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Drager D, Soliman EZ, Meyer ML, Zhang ZM, Alonso A, Heiss G, Whitsel EA. Short-term repeatability of the peguero-lo presti electrocardiographic left ventricular hypertrophy criteria. Ann Noninvasive Electrocardiol 2021; 26:e12829. [PMID: 33591619 PMCID: PMC8164147 DOI: 10.1111/anec.12829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 01/03/2023] Open
Abstract
Background Electrocardiographic left ventricular hypertrophy (ECG‐LVH) represents preclinical cardiovascular disease and predicts cardiovascular disease morbidity and mortality. While the newly developed Peguero‐Lo Presti ECG‐LVH criteria have greater sensitivity for LVH than the Cornell voltage and Sokolow–Lyon criteria, its short‐term repeatability is unknown. Therefore, we characterized the short‐term repeatability of Peguero‐Lo Presti ECG‐LVH criteria and evaluate its agreement with Cornell voltage and Sokolow–Lyon ECG‐LVH criteria. Methods Participants underwent two resting, standard, 12‐lead ECGs at each of two visits one week apart (n = 63). We defined a Peguero‐Lo Presti index as a sum of the deepest S wave amplitude in any single lead and lead V4 (i.e., SD + SV4) and defined Peguero‐Lo Presti LVH index as ≥ 2,300 µV among women and ≥ 2,800 µV among men. We estimated repeatability as an intraclass correlation coefficient (ICC), agreement as a prevalence‐adjusted bias‐adjusted kappa coefficient (κ), and precision using 95% confidence intervals (CIs). Results The Peguero‐Lo Presti index was repeatable: ICC (95% CI) = 0.94 (0.91–0.97). Within‐visit agreement of Peguero‐Lo Presti LVH was high at the first and second visits: κ (95% CI) = 0.97 (0.91–1.00) and 1.00 (1.00–1.00). Between‐visit agreement of the first and second measurements at each visit was comparable: κ (95% CI) = 0.90 (0.80–1.00) and 0.93 (0.85–1.00). Agreement of Peguero‐Lo Presti and Cornell or Sokolow–Lyon LVH on any one of the four ECGs was slightly lower: κ (95% CI) = 0.71 (0.54–0.89). Conclusion The Peguero‐Lo Presti index and LVH have excellent repeatability and agreement, which support their use in clinical and epidemiological studies.
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Affiliation(s)
- Dominique Drager
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zhu-Ming Zhang
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Alvaro Alonso
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Stone K, Fryer S, Faulkner J, Meyer ML, Zieff G, Paterson C, Burnet K, Kelsch E, Credeur D, Lambrick D, Stoner L. Acute Changes in Carotid-Femoral Pulse-Wave Velocity Are Tracked by Heart-Femoral Pulse-Wave Velocity. Front Cardiovasc Med 2021; 7:592834. [PMID: 33553252 PMCID: PMC7854542 DOI: 10.3389/fcvm.2020.592834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Carotid-femoral pulse-wave velocity (cfPWV) is the reference standard measure of central arterial stiffness. However, it requires assessment of the carotid artery, which is technically challenging, and subject-level factors, including carotid artery plaque, may confound measurements. A promising alternative that overcomes these limitations is heart-femoral PWV (hfPWV), but it is not known to what extent changes in cfPWV and hfPWV are associated. Objectives: To determine, (1) the strength of the association between hfPWV and cfPWV; and (2) whether change in hfPWV is associated with change in cfPWV when central arterial stiffness is perturbed. Methods: Twenty young, healthy adults [24.0 (SD: 3.1) years, 45% female] were recruited. hfPWV and cfPWV were determined using Doppler ultrasound at baseline and following a mechanical perturbation in arterial stiffness (120 mmHg thigh occlusion). Agreement between the two measurements was determined using mixed-effects regression models and Bland-Altman analysis. Results: There was, (1) strong (ICC > 0.7) agreement between hfPWV and cfPWV (ICC = 0.82, 95%CI: 0.69, 0.90), and, (2) very strong (ICC > 0.9) agreement between change in hfPWV and cfPWV (ICC = 0.92, 95%CI: 0.86, 0.96). cfPWV was significantly greater than hfPWV at baseline and during thigh occlusion (both P < 0.001). Inspection of the Bland-Altman plot, comparing cfPWV and corrected hfPWV, revealed no measurement magnitude bias. Discussion: The current findings indicate that hfPWV and cfPWV are strongly associated, and that change in cfPWV is very strongly associated with change in hfPWV. hfPWV may be a simple alternative to cfPWV in the identification of cardiovascular risk in clinical and epidemiological settings.
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Affiliation(s)
- Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - James Faulkner
- Department of Sport, Exercise and Health, University of Winchester, Winchester, United Kingdom
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Craig Paterson
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Kathryn Burnet
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Elizabeth Kelsch
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Credeur
- Department of Biology, Ave Maria University, Ave Maria, FL, United States
| | - Danielle Lambrick
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Lassalle PP, Meyer ML, Boggess KA, Stoner L. Central pulse wave velocity in neonates: feasibility and comparison to normative data. Hypertens Res 2020; 43:1322-1324. [DOI: 10.1038/s41440-020-0489-y] [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] [Received: 03/16/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
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Peter RS, Meyer ML, Mons U, Schöttker B, Keller F, Schmucker R, Koenig W, Brenner H, Rothenbacher D. Long-term trajectories of anxiety and depression in patients with stable coronary heart disease and risk of subsequent cardiovascular events. Depress Anxiety 2020; 37:784-792. [PMID: 32237189 DOI: 10.1002/da.23011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anxiety and depression seem to be under-recognized in their importance and are often not incorporated in subsequent prevention strategies in routine clinical care of coronary heart disease. METHODS The KAROLA cohort included coronary heart disease patients participating in an in-patient rehabilitation program (years 1999/2000) and followed after 1, 3, 6, 8, 10, 13, and 15 years. We identified anxiety and depression trajectories based on the hospital anxiety and depression scale subdomains using joint latent class mixture time-to-event models. We included cardiovascular (CV) events and non-CV mortality as competing endpoints. RESULTS We included 1,109 patients (15.4% female; mean age, 59.4 (standard deviation [SD] = 8.0) years) with baseline covariate data. Over a median follow-up of 14.8 years, participants experienced 324 subsequent CV events. We identified four anxiety and depression trajectory classes, a low-stable class (52.2% and 69.6% of patients for anxiety and depression, respectively), moderate-stable class (37.6% and 23.8%), increasing class (2.3% and 3.3%), and high-stable/high-decreasing class (7.9% and 3.3%). The hazard ratio (HR) for subsequent CV events for the increasing anxiety class was 2.13 (95% confidence interval [CI], 0.61; 7.45) compared with the low-stable class after covariate adjustment. Patients following the high-decreasing anxiety trajectory showed an HR of 1.72 (95% CI, 1.11; 2.68) and patients following the high-stable depression trajectory an HR of 2.47 (95% CI, 1.35; 4.54). CONCLUSIONS Chronic high anxiety and depression trajectory classes were associated with increased risk of subsequent CV events. Assessments of both symptoms of anxiety and depression during long-term routine medical care are recommended to identify patients who would benefit from appropriate interventions.
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Affiliation(s)
- Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ute Mons
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Ageing Research, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | | | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance (partner site), Munich, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Gellert KS, Alonso A, Chen LY, Meyer ML, Soliman EZ, Suzuki T, Loehr LR. Association of Sleep Apnea, Diagnosed by Self-Reported Physician Diagnosis or Hospital Discharge Codes, With Atrial Fibrillation and Ectopy Using Ambulatory Electrocardiogram in the ARIC Study. Circ Arrhythm Electrophysiol 2020; 13:e007574. [PMID: 32195600 DOI: 10.1161/circep.119.007574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kapuaola S Gellert
- Department of Epidemiology (K.S.G.), University of North Carolina at Chapel Hill
| | - Alvaro Alonso
- Department of Epidemiology (A.A.), Emory University, Atlanta, GA
| | - Lin Y Chen
- Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis
| | - Michelle L Meyer
- Department of Emergency Medicine (M.L.M.), University of North Carolina at Chapel Hill
| | - Elsayed Z Soliman
- Department of Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Takeki Suzuki
- School of Medicine (T.S.), Indiana University, Indianapolis
| | - Laura R Loehr
- Department of Medicine (L.R.L.), University of North Carolina at Chapel Hill
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Wei J, Palta P, Meyer ML, Kucharska-Newton A, Pence BW, Aiello AE, Power MC, Walker KA, Sharrett AR, Tanaka H, Jack CR, Mosley TH, Reid RI, Reyes DA, Heiss G. Aortic Stiffness and White Matter Microstructural Integrity Assessed by Diffusion Tensor Imaging: The ARIC-NCS. J Am Heart Assoc 2020; 9:e014868. [PMID: 32157957 PMCID: PMC7335527 DOI: 10.1161/jaha.119.014868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Changes in white matter microstructural integrity are detectable before appearance of white matter lesions on magnetic resonance imaging as a manifestation of cerebral small‐vessel disease. The information relating poor white matter microstructural integrity to aortic stiffness, a hallmark of aging, is limited. We aimed to examine the association between aortic stiffness and white matter microstructural integrity among older adults. Methods and Results We conducted a cross‐sectional study to examine the association between aortic stiffness and white matter microstructural integrity among 1484 men and women (mean age, 76 years) at the 2011 to 2013 examination of the ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study). Aortic stiffness was measured as carotid‐femoral pulse wave velocity. Cerebral white matter microstructural integrity was measured as fractional anisotropy and mean diffusivity using diffusion tensor imaging. Multivariable linear regression was used to examine the associations of carotid‐femoral pulse wave velocity with fractional anisotropy and mean diffusivity of the overall cerebrum and at regions of interest. Each 1‐m/s higher carotid‐femoral pulse wave velocity was associated with lower overall fractional anisotropy (β=−0.03; 95% CI, −0.05 to −0.02) and higher overall mean diffusivity (β=0.03; 95% CI, 0.02–0.04). High carotid‐femoral pulse wave velocity (upper 25th percentile) was associated with lower fractional anisotropy (β=−0.40; 95% CI, −0.61 to −0.20) and higher overall mean diffusivity (β=0.27; 95% CI, 0.10–0.43). Similar associations were observed at individual regions of interest. Conclusions High aortic stiffness is associated with low cerebral white matter microstructural integrity among older adults. Aortic stiffness may serve as a target for the prevention of poor cerebral white matter microstructural integrity.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Priya Palta
- School of Medicine Columbia University New York NY.,Department of Epidemiology Mailman School of Public Health Columbia University New York NY
| | - Michelle L Meyer
- Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC
| | - Anna Kucharska-Newton
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC.,Department of Epidemiology College of Public Health University of Kentucky Lexington KY
| | - Brian W Pence
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Allison E Aiello
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Melinda C Power
- Department of Epidemiology and Biostatistics Milken Institute School of Public Health Washington DC
| | - Keenan A Walker
- Department of Neurology Johns Hopkins University Baltimore MD
| | - A Richey Sharrett
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education University of Texas at Austin TX
| | | | | | - Robert I Reid
- Department of Information Technology Mayo Clinic Rochester MN
| | | | - Gerardo Heiss
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
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Stoner L, Kucharska-Newton A, Meyer ML. Cardiometabolic Health and Carotid-Femoral Pulse Wave Velocity in Children: A Systematic Review and Meta-Regression. J Pediatr 2020; 218:98-105.e3. [PMID: 31810627 PMCID: PMC7260444 DOI: 10.1016/j.jpeds.2019.10.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 06/04/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify, in children the normal rate of carotid-femoral pulse wave velocity (cfPWV) progression, and whether presence of cardiometabolic risk factors is associated with cfPWV. STUDY DESIGN Electronic databases (PubMed, Google Scholar) were searched from inception to May 2018, for all studies which reported cfPWV in children (<19 years of age). Random effects meta-regression quantified the association between time (years) and cfPWV, and a systematic review was performed to determine whether cardiometabolic risk factors are associated with cfPWV. RESULTS Data from 28 articles were eligible for inclusion, including 9 reference value (n = 13 100), 5 cardiovascular risk (n = 5257), 10 metabolic risk (n = 2999), and 8 obesity-focused (n = 8760) studies. Meta-regression findings (9 studies) showed that the increase in cfPWV per year (age) was 0.12 m/second (95% CI, 0.07-0.16 m/second) per year, and when stratified by sex the CIs overlapped. Systematic review findings showed that cardiometabolic risk factors were positively associated with cfPWV, including positive associations with blood pressure, impaired glucose metabolism, and metabolic syndrome. However, obesity was not consistently associated with cfPWV. CONCLUSIONS Arterial stiffness in children progresses with age and is associated with cardiometabolic risk factors. Although further longitudinal studies are warranted, the presented reference data will be valuable to epidemiologists tracking children, and to scientists and clinicians prescribing therapies to mitigate risk in a population that is increasingly more vulnerable to cardiovascular disease.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, NC.
| | - Anna Kucharska-Newton
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
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Meyer ML, Sotres‐Alvarez D, Steiner AZ, Cousins L, Talavera GA, Cai J, Daviglus ML, Loehr LR. Polycystic Ovary Syndrome Signs and Metabolic Syndrome in Premenopausal Hispanic/Latina Women: the HCHS/SOL Study. J Clin Endocrinol Metab 2020; 105:5698885. [PMID: 31917455 PMCID: PMC7007876 DOI: 10.1210/clinem/dgaa012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS), a condition of androgen excess in women, is associated with cardiometabolic risk factors; however, this association is not fully characterized in a population-based sample of premenopausal women and high-risk groups such as Hispanics/Latinas. OBJECTIVE We examined the association of PCOS signs and metabolic syndrome (MetS) in premenopausal Hispanic/Latina women. METHODS This cross-sectional analysis includes 1427 women age 24 to 44 years from the Hispanic Community Health Study/Study of Latinos. PCOS signs included menstrual cycle greater than 35 days or irregular, self-reported PCOS, and oral contraceptive use to regulate periods or acne, and a composite of 1 or more PCOS signs. We calculated odds ratios (OR) and 95% CI for MetS, accounting for sociodemographic factors and the complex survey design; an additional model included body mass index (BMI). RESULTS The mean age was 34 years and 30% reported any PCOS sign. The odds of MetS were higher in women reporting cycles greater than 35 days or irregular (OR 1.63; CI: 1.07-2.49) vs cycles 24 to 35 days, self-reported PCOS (OR 2.49; CI: 1.38-4.50) vs no PCOS, and any PCOS sign (OR 1.58; CI: 1.10-2.26) vs none. We found no association between OC use to regulate periods or acne and MetS (OR 1.1; CI: 0.6-1.8). When adjusting for BMI, only the association of self-reported PCOS and MetS was attenuated (OR 1.78; CI: 0.92-3.44). CONCLUSIONS In Hispanic/Latina women, irregular menstrual cycles, self-reported PCOS, and any PCOS sign were associated with MetS and could indicate women at metabolic disease risk.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Correspondence: Michelle L. Meyer, PhD, MPH, University of North Carolina Chapel Hill, Department of Emergency Medicine, 170 Manning Drive, Campus Box 7594, Chapel Hill, North Carolina 27599-7594. E-mail:
| | | | - Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Duke, North Carolina
| | - Larry Cousins
- Children’s Specialists of San Diego, San Diego, California
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, California
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina-Chapel Hill, North Carolina
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Meyer ML, Klein BE, Klein R, Palta P, Sharrett AR, Heiss G, Nambi V, Wong TY, Tanaka H. Central arterial stiffness and retinal vessel calibers: the Atherosclerosis Risk in Communities Study-Neurocognitive Study. J Hypertens 2020; 38:266-273. [PMID: 31584520 PMCID: PMC6949400 DOI: 10.1097/hjh.0000000000002252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The retinal microvasculature provides a window to the cerebral vasculature and enables examination of changes in retinal caliber that may mimic those occurring in cerebrovascular disease. The association of central arterial stiffness and retinal vessel caliber in a population sample is not fully understood. METHODS In 1706 older adults (mean age 76.3, 58.1% women) from the population-based Atherosclerosis Risk in Communities Study, we examined the cross-sectional association of central arterial stiffness [carotid-femoral pulse wave velocity (cfPWV)] with retinal vessel calibers [central retinal arteriolar equivalent (CRAE) and central retinal vein equivalent (CRVE)]. We estimated the association of cfPWV with CRAE narrowing (<25th percentile) and CRVE widening (>75th percentile) after adjustment for age, sex, race-field center, BMI, smoking, and type 2 diabetes. We tested for effect modification by sex, hypertension, and type 2 diabetes. RESULTS Carotid-femoral PWV (m/s) was not associated with the odds of CRAE narrowing [odds ratio (OR): 0.99; 95% CI: 0.95-1.03]. The association of cfPWV with CRVE widening was stronger in those without hypertension (OR: 1.10; 95% CI: 1.01-1.20) versus those with hypertension (OR: 1.01 95% CI: 0.96-1.05) and slightly stronger in those with type 2 diabetes (OR: 1.07; 95% CI: 1.00-1.14) versus without type 2 diabetes (OR: 1.01; 95% CI: 0.96-1.06). CONCLUSIONS In older adults, cfPWV was associated with wider retinal venular caliber, particularly in individuals without hypertension. Central arterial stiffening may be associated with cerebral microvascular changes, as exhibited in its retinal vasculature component.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Barbara E Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Ronald Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Priya Palta
- Department of Medicine, Columbia University, New York City, NY
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, TX
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
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Poon AK, Meyer ML, Tanaka H, Selvin E, Pankow J, Zeng D, Loehr L, Knowles JW, Rosamond W, Heiss G. Association of insulin resistance, from mid-life to late-life, with aortic stiffness in late-life: the Atherosclerosis Risk in Communities Study. Cardiovasc Diabetol 2020; 19:11. [PMID: 31992297 PMCID: PMC6986071 DOI: 10.1186/s12933-020-0986-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background Insulin resistance may contribute to aortic stiffening that leads to end-organ damage. We examined the cross-sectional association and prospective association of insulin resistance and aortic stiffness in older adults without diabetes. Methods We analyzed 2571 men and women at Visit 5 (in 2011–2013), and 2350 men and women at repeat examinations from baseline at Visit 1 (in 1987–1989) to Visit 5 (in 2011–2013). Linear regression was used to estimate the difference in aortic stiffness per standard unit of HOMA-IR, TG/HDL-C, and TyG at Visit 5. Linear mixed effects were used to assess if high, as opposed to non-high, aortic stiffness (> 75th percentile) was preceded by a faster annual rate of change in log-HOMA-IR, log-TG/HDL-C, and log-TyG from Visit 1 to Visit 5. Results The mean age of participants was 75 years, 37% (n = 957) were men, and 17% (n = 433) were African American. At Visit 5, higher HOMA-IR, higher TG/HDL-C, and higher TyG were associated with higher aortic stiffness (16 cm/s per SD (95% CI 6, 27), 29 cm/s per SD (95% CI 18, 40), and 32 cm/s per SD (95% CI 22, 42), respectively). From Visit 1 to Visit 5, high aortic stiffness, compared to non-high aortic stiffness, was not preceded by a faster annual rate of change in log-HOMA-IR from baseline to 9 years (0.030 (95% CI 0.024, 0.035) vs. 0.025 (95% CI 0.021, 0.028); p = 0.15) or 9 years onward (0.011 (95% CI 0.007, 0.015) vs. 0.011 (95% CI 0.009, 0.013); p = 0.31); in log-TG/HDL-C from baseline to 9 years (0.019 (95% CI 0.015, 0.024) vs. 0.024 (95% CI 0.022, 0.026); p = 0.06) or 9 years onward (− 0.007 (95% CI − 0.010, − 0.005) vs. − 0.009 (95% CI − 0.010, − 0.007); p = 0.08); or in log-TyG from baseline to 9 years (0.002 (95% CI 0.002, 0.003) vs. 0.003 (95% CI 0.003, 0.003); p = 0.03) or 9 years onward (0 (95% CI 0, 0) vs. 0 (95% CI 0, 0); p = 0.08). Conclusions Among older adults without diabetes, insulin resistance was associated with aortic stiffness, but the putative role of insulin resistance in aortic stiffness over the life course requires further study.
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Affiliation(s)
- Anna K Poon
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA. .,, 1620 Tremont Street, OBC 3-34, Boston, MA, 02120, USA.
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - James Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Laura Loehr
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Joshua W Knowles
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, USA
| | - Wayne Rosamond
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
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Meyer ML, Soliman EZ, Drager D, Heiss G. Short-term repeatability of electrocardiographic criteria of left ventricular hypertrophy. Ann Noninvasive Electrocardiol 2019; 25:e12688. [PMID: 31498512 DOI: 10.1111/anec.12688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/08/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a marker of cardiac end-organ damage and a risk factor for cardiovascular morbidity and mortality. Although clinical trials and cohort studies commonly use the electrocardiogram (ECG) for LVH assessment, the repeatability of ECG-LVH criteria has not been sufficiently examined. Therefore, we evaluated the repeatability of ECG-LVH criteria. METHODS Participants (n = 63) underwent two standard ECGs at each of two visits, two weeks apart. The ECGs were processed centrally to calculate Cornell voltage (CV) LVH, Cornell voltage product (CVP) LVH, Sokolow-Lyon (SL) LVH, and Sokolow-Lyon product (SLP) LVH. We also used the waveforms measurements contributing to these LVH criteria as continuous variables, referred to here as CV-index, CVP-index, and SL-index. We calculated the intraclass correlation coefficient (ICC), minimal detectable change (95% confidence), and the prevalence-adjusted bias-adjusted kappa (PABAK). RESULTS ICCs (95% confidence intervals (CI)) were 0.97 (0.96, 0.98) for CV-index, 0.97 (0.95, 0.98) for CVP-index, and 0.93 (0.90, 0.96) for log of SL-index. Minimal detectable change between repeat measures of CV-index, CVP-index, and log of SL-index were ≥236.7 mV, ≥26.7 mV, and ≥0.09 mV, respectively. The within-visit PABAK was 1 for all ECG-LVH criteria, except for the first visit SLP-LVH (PABAK = 0.93). Between-visit PABAK ranged from 0.83 to 0.97 across LVH criteria. CONCLUSIONS CV, CVP, and SL ECG-LVH as continuous variables have excellent repeatability, and as binary variables have excellent within-visit agreement and good between-visit agreement. These results alleviate concerns about the repeatability the ECG-LVH use in clinical trials and epidemiologic studies.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Dominique Drager
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Oyenuga AO, Folsom AR, Cheng S, Tanaka H, Meyer ML. Greater Adherence to Life's Simple 7 Is Associated With Less Arterial Stiffness: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Hypertens 2019; 32:769-776. [PMID: 31090885 PMCID: PMC6636696 DOI: 10.1093/ajh/hpz057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Greater arterial stiffness is associated independently with increased cardiovascular disease risk. The American Heart Association (AHA) has recommended following "Life's Simple 7 (LS7)" to optimize cardiovascular health; we tested whether better LS7 in middle age is associated with less arterial stiffness in later life. METHODS We studied 4,232 black and white participants aged 45-64 years at the baseline (1987-89) visit of the Atherosclerosis Risk in Communities Study cohort who also had arterial stiffness measured in 2011-13 (mean ± SD interval: 23.6 ± 1.0 years). We calculated a 14-point summary score for baseline LS7 and classified participants as having "poor" (0-4), "average" (5-9), or "ideal" (10-14) cardiovascular health. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CI) for arterial stiffening: a high carotid-femoral pulse wave velocity (cfPWV, ≥13.23 m/s) or a high central pulse pressure (central PP, ≥ 82.35 mm Hg). RESULTS The age, race, sex, and heart rate-adjusted ORs (95% CI) for high cfPWV in the "ideal," "average," and "poor" LS7 summary categories were 1 (Reference), 1.30 (1.11, 1.53), and 1.68 (1.10,2.56), respectively (P-trend = 0.0003). Similarly, the adjusted ORs (95% CI) for high central PP across LS7 summary categories were 1 (Reference), 1.48 (1.27, 1.74), and 1.63 (1.04, 2.56), respectively (P-trend <0.0001). CONCLUSION Greater LS7 score in middle age is associated with less arterial stiffness 2-3 decades later. These findings further support the AHA recommendation to follow LS7 for cardiovascular disease prevention.
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Affiliation(s)
- Abayomi O Oyenuga
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Hirofumi Tanaka
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Malek AM, Vladutiu CJ, Meyer ML, Cushman M, Newman R, Lisabeth LD, Kleindorfer D, Lakkur S, Howard VJ. The association of age at menopause and all-cause and cause-specific mortality by race, postmenopausal hormone use, and smoking status. Prev Med Rep 2019; 15:100955. [PMID: 31367516 PMCID: PMC6651856 DOI: 10.1016/j.pmedr.2019.100955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022] Open
Abstract
While a mean age at menopause of 51 years has been reported in the United States (U.S.), some U.S. women experience menopause before age 45, possibly increasing risk of cardiovascular mortality; however, the role in all-cause and cerebrovascular-related mortality is unclear. The purpose of this study was to investigate the association between age at menopause and all-cause and cause-specific mortality by race, hormone replacement therapy (HRT) use, and smoking status. REasons for Geographic and Racial Differences in Stroke (REGARDS) is a population-based study of 30,239 participants aged ≥45 years enrolled between 2003 and 2007 of whom 14,361 were postmenopausal women. Age at menopause was defined as <45 (early) or ≥45. All-cause and cause-specific mortality were ascertained through 2013. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between age at menopause and mortality, adjusting for baseline measures. Of 11,287 eligible women (6403 white; 4884 black), mean menopause age was 45.2 (SD 7.9) with 1524 deaths over 7.1 years. Significant interactions were detected between early age at menopause (39%) and HRT use in association with all-cause mortality (p < 0.01), mortality from coronary heart disease (p = 0.06), and mortality from all other causes (p = 0.04). An association between early age at menopause and all-cause mortality was observed among ever-HRT users (HR = 1.31, 95% CI: 1.10–1.56), but not never-HRT users (HR = 1.01, 95% CI: 0.85–1.20). There were no differences in associations examined by race or smoking status. Increased all-cause mortality risk was observed for ever-HRT users with menopause before age 45. Increased all-cause mortality risk in ever-HRT users with menopause before age 45 HRT use modified the association of menopause before age 45 and CHD mortality. There were no differences in associations examined by race or smoking status.
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Key Words
- Age
- BMI, body mass index
- BWHS, Black Women's Health Study
- CHD, coronary heart disease
- CI, confidence interval
- CVD, cardiovascular disease
- Coronary heart disease
- ECG, electrocardiogram
- FDA, Food and Drug Administration
- HR, hazard ratio
- HRT, hormone replacement therapy
- MI, myocardial infarction
- MRR, mortality rate ratio
- Menopause
- Mortality
- NAMS, North American Menopause Society
- NDI, National Death Index
- REGARDS
- REGARDS, REasons for Geographic and Racial Differences in Stroke
- RR, relative risk
- Race
- SD, standard deviation
- Smoking
- U.S., United States
- Women
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Affiliation(s)
- Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine J Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Cushman
- Department of Med-Hematology Oncology, University of Vermont, Burlington, VT, USA.,Department of Pathology & Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Sindhu Lakkur
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Meyer ML, Lin FC, Jaensch A, Mons U, Hahmann H, Koenig W, Brenner H, Rothenbacher D. Multi-state models of transitions in depression and anxiety symptom severity and cardiovascular events in patients with coronary heart disease. PLoS One 2019; 14:e0213334. [PMID: 30845176 PMCID: PMC6405099 DOI: 10.1371/journal.pone.0213334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/20/2019] [Indexed: 12/29/2022] Open
Abstract
Objective Patients with coronary heart disease (CHD) commonly suffer from depression and anxiety, yet transitions of symptom severity and cardiovascular events (CVE) over time are not well characterized. Methods We included 997 patients with stable CHD from a prospective cohort study. We estimated 5- and 10-year transition probabilities of depression and anxiety symptom severity levels and fatal- and non-fatal adverse CVE. Depression and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale 5 times over 13 years and categorized as no, mild, or moderate/severe symptoms. Using multi-state modeling, we calculated 5- and 10-year transition probabilities for depression and anxiety symptom severity and CVE and calculated transition intensity ratios for factors associated with symptom severity progression and regression. Results At 5 years, only approximately half of participants with moderate or severe symptom severity at baseline transitioned to no symptom severity. Patients with low physical activity (<1x/week or never) had a higher probability of worse symptom severity after 5 and 10 years and a higher probability of a CVE after 5 and 10 years regardless of their depression status at baseline compared to higher physical activity groups. Higher body mass index, <10 years of education, and lower physical activity were associated with depression symptom progression; female and lower physical activity were associated with anxiety symptom progression. Conclusions Patients with CHD had a consistent burden of depression and anxiety symptoms. Secondary prevention strategies should target depression and anxiety and include a physical activity component.
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Affiliation(s)
- Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Palta P, Sharrett AR, Wei J, Meyer ML, Kucharska‐Newton A, Power MC, Deal JA, Jack CR, Knopman D, Wright J, Griswold M, Tanaka H, Mosley TH, Heiss G. Central Arterial Stiffness Is Associated With Structural Brain Damage and Poorer Cognitive Performance: The ARIC Study. J Am Heart Assoc 2019; 8:e011045. [PMID: 30646799 PMCID: PMC6497348 DOI: 10.1161/jaha.118.011045] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022]
Abstract
Background Central arterial stiffening and increased pulsatility, with consequent cerebral hypoperfusion, may result in structural brain damage and cognitive impairment. Methods and Results We analyzed a cross-sectional sample of ARIC - NCS (Atherosclerosis Risk in Communities-Neurocognitive Study) participants (aged 67-90 years, 60% women) with measures of cognition (n=3703) and brain magnetic resonance imaging (n=1255). Central arterial hemodynamics were assessed as carotid-femoral pulse wave velocity and pressure pulsatility (central pulse pressure). We derived factor scores for cognitive domains. Brain magnetic resonance imaging using 3-Tesla scanners quantified lacunar infarcts; cerebral microbleeds; and volumes of white matter hyperintensities, total brain, and the Alzheimer disease signature region. We used logistic regression, adjusted for demographics, apolipoprotein E ɛ4, heart rate, mean arterial pressure, and select cardiovascular risk factors, to estimate the odds of lacunar infarcts or cerebral microbleeds. Linear regression, additionally adjusted for intracranial volume, estimated the difference in log-transformed volumes of white matter hyperintensities , total brain, and the Alzheimer disease signature region. We estimated the mean difference in cognitive factor scores across quartiles of carotid-femoral pulse wave velocity or central pulse pressure using linear regression. Compared with participants in the lowest carotid-femoral pulse wave velocity quartile, participants in the highest quartile of carotid-femoral pulse wave velocity had a greater burden of white matter hyperintensities ( P=0.007 for trend), smaller total brain volumes (-18.30 cm3; 95% CI , -27.54 to -9.07 cm3), and smaller Alzheimer disease signature region volumes (-1.48 cm3; 95% CI , -2.27 to -0.68 cm3). These participants also had lower scores in executive function/processing speed (β=-0.04 z score; 95% CI , -0.07 to -0.01 z score) and general cognition (β=-0.09 z score; 95% CI , -0.15 to -0.03 z score). Similar results were observed for central pulse pressure . Conclusions Central arterial hemodynamics were associated with structural brain damage and poorer cognitive performance among older adults.
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Affiliation(s)
- Priya Palta
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | | | - Jingkai Wei
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Michelle L. Meyer
- Department of Emergency MedicineUniversity of North Carolina at Chapel HillChapel HillNC
| | - Anna Kucharska‐Newton
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Melinda C. Power
- Department of Epidemiology and BiostatisticsMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDC
| | | | | | | | | | - Michael Griswold
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Hirofumi Tanaka
- Department of Kinesiology and Health EducationUniversity of Texas at AustinTX
| | - Thomas H. Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Gerardo Heiss
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
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