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Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality among women. Despite improvements in cardiovascular disease prevention efforts, there remain gaps in cardiovascular disease awareness among women, as well as age and racial disparities in ASCVD outcomes for women. Disparity also exists in the impact the traditional risk factors confer on ASCVD risk between women and men, with smoking and diabetes both resulting in stronger relative risks in women compared to men. Additionally there are risk factors that are unique to women (such as pregnancy-related factors) or that disproportionally affect women (such as auto-immune disease) where preventive efforts should be targeted. Risk assessment and management must also be sex-specific to effectively reduce cardiovascular disease and improve outcomes among women. Evidence supports the use of statin therapy for primary prevention in women at higher ASCVD risk. However, some pause should be given to prescribing aspirin therapy in women without known ASCVD, with most evidence supporting the use of aspirin for women≥65 years not at increased risk for bleeding. This review article will summarize (1) traditional and non-traditional assessments of ASCVD risk and (2) lifestyle and pharmacologic therapies for the primary prevention of ASCVD in women.
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Affiliation(s)
- Rebeccah A McKibben
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Mahmoud Al Rifai
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Lena M Mathews
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
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552
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Michos ED, Lutsey PL. 25-hydroxyvitamin D Levels and Coronary Heart Disease Risk Reclassification in Hypertension--Is it worth the "hype"? Atherosclerosis 2015; 245:237-9. [PMID: 26725039 DOI: 10.1016/j.atherosclerosis.2015.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Erin D Michos
- Ciccarone Center for The Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA.
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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553
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Hueper K, Vogel-Claussen J, Parikh MA, Austin JHM, Bluemke DA, Carr J, Choi J, Goldstein TA, Gomes AS, Hoffman EA, Kawut SM, Lima J, Michos ED, Post WS, Po MJ, Prince MR, Liu K, Rabinowitz D, Skrok J, Smith BM, Watson K, Yin Y, Zambeli-Ljepovic AM, Barr RG. Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study. Am J Respir Crit Care Med 2015; 192:570-80. [PMID: 26067761 DOI: 10.1164/rccm.201411-2120oc] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, and brain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease. OBJECTIVES To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema. METHODS PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below -950 Hounsfield units (-950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output. MEASUREMENTS AND MAIN RESULTS Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52% in severe COPD (all P < 0.01 vs. control subjects). PMBF was reduced with greater percentage emphysema-950HU and radiologist-defined emphysema, particularly panlobular and centrilobular emphysema (all P ≤ 0.01). Registration of MRI and CT images revealed that PMBF was reduced in mild COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers. CONCLUSIONS PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature.
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Affiliation(s)
- Katja Hueper
- 1 Department of Radiology and.,2 Department of Radiology and Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- 1 Department of Radiology and.,2 Department of Radiology and Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | | | | | - David A Bluemke
- 5 Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | | | - Jiwoong Choi
- 7 Department of Radiology.,8 IIHR-Hydroscience & Engineering
| | - Thomas A Goldstein
- 9 Department of Biomedical Engineering, Stanford University, Stanford, California
| | | | - Eric A Hoffman
- 7 Department of Radiology.,11 Department of Medicine, and.,12 Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Steven M Kawut
- 13 Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joao Lima
- 1 Department of Radiology and.,14 Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Erin D Michos
- 14 Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Wendy S Post
- 14 Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Kiang Liu
- 16 Department of Biostatistics, Northwestern University, Chicago, Illinois
| | - Dan Rabinowitz
- 17 Department of Statistics, Columbia University, New York, New York; and
| | | | | | - Karol Watson
- 18 Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | | | | | - R Graham Barr
- 3 Department of Medicine.,20 Department of Epidemiology, Columbia University Medical Center, New York, New York
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554
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Martin SS, Feldman DI, Blumenthal RS, Jones SR, Post WS, McKibben RA, Michos ED, Ndumele CE, Ratchford EV, Coresh J, Blaha MJ. mActive: A Randomized Clinical Trial of an Automated mHealth Intervention for Physical Activity Promotion. J Am Heart Assoc 2015; 4:JAHA.115.002239. [PMID: 26553211 PMCID: PMC4845232 DOI: 10.1161/jaha.115.002239] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [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: 01/14/2023]
Abstract
Background We hypothesized that a fully automated mobile health (mHealth) intervention with tracking and texting components would increase physical activity. Methods and Results mActive enrolled smartphone users aged 18 to 69 years at an ambulatory cardiology center in Baltimore, Maryland. We used sequential randomization to evaluate the intervention's 2 core components. After establishing baseline activity during a blinded run‐in (week 1), in phase I (weeks 2 to 3), we randomized 2:1 to unblinded versus blinded tracking. Unblinding allowed continuous access to activity data through a smartphone interface. In phase II (weeks 4 to 5), we randomized unblinded participants 1:1 to smart texts versus no texts. Smart texts provided smartphone‐delivered coaching 3 times/day aimed at individual encouragement and fostering feedback loops by a fully automated, physician‐written, theory‐based algorithm using real‐time activity data and 16 personal factors with a 10 000 steps/day goal. Forty‐eight outpatients (46% women, 21% nonwhite) enrolled with a mean±SD age of 58±8 years, body mass index of 31±6 kg/m2, and baseline activity of 9670±4350 steps/day. Daily activity data capture was 97.4%. The phase I change in activity was nonsignificantly higher in unblinded participants versus blinded controls by 1024 daily steps (95% confidence interval [CI], −580 to 2628; P=0.21). In phase II, participants receiving texts increased their daily steps over those not receiving texts by 2534 (95% CI, 1318 to 3750; P<0.001) and over blinded controls by 3376 (95% CI, 1951 to 4801; P<0.001). Conclusions An automated tracking‐texting intervention increased physical activity with, but not without, the texting component. These results support new mHealth tracking technologies as facilitators in need of behavior change drivers. Clinical Trial Registration URL: http://ClinicalTrials.gov/. Unique identifier: NCT01917812.
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Affiliation(s)
- Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.) Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M., W.S.P., R.A.M.K., E.D.M., C.E.N., J.C.)
| | - David I Feldman
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.)
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.)
| | - Steven R Jones
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.)
| | - Wendy S Post
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.) Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M., W.S.P., R.A.M.K., E.D.M., C.E.N., J.C.)
| | - Rebeccah A McKibben
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.) Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M., W.S.P., R.A.M.K., E.D.M., C.E.N., J.C.)
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.) Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M., W.S.P., R.A.M.K., E.D.M., C.E.N., J.C.)
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.) Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M., W.S.P., R.A.M.K., E.D.M., C.E.N., J.C.)
| | - Elizabeth V Ratchford
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.)
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M., W.S.P., R.A.M.K., E.D.M., C.E.N., J.C.)
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.)
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555
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Michos ED, Martin SS, Blumenthal RS. Bringing back targets to "IMPROVE" atherosclerotic cardiovascular disease outcomes: the duel for dual goals; are two targets better than one? Circulation 2015; 132:1218-20. [PMID: 26330413 DOI: 10.1161/circulationaha.115.018511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erin D Michos
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Seth S Martin
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
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556
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Lupton JR, Faridi KF, Martin SS, Sharma S, Kulkarni K, Jones SR, Michos ED. Deficient serum 25-hydroxyvitamin D is associated with an atherogenic lipid profile: The Very Large Database of Lipids (VLDL-3) study. J Clin Lipidol 2015; 10:72-81.e1. [PMID: 26892123 DOI: 10.1016/j.jacl.2015.09.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/15/2015] [Accepted: 09/14/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cross-sectional studies have found an association between deficiencies in serum vitamin D, as measured by 25-hydroxyvitamin D (25[OH]D), and an atherogenic lipid profile. These studies have focused on a limited panel of lipid values including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). OBJECTIVE Our study examines the relationship between serum 25(OH)D and an extended lipid panel (Vertical Auto Profile) while controlling for age, gender, glycemic status, and kidney function. METHODS We used the Very Large Database of Lipids, which includes US adults clinically referred for analysis of their lipid profile from 2009 to 2011. Our study focused on 20,360 subjects who had data for lipids, 25(OH)D, age, gender, hemoglobin A1c, insulin, creatinine, and blood urea nitrogen. Subjects were split into groups based on serum 25(OH)D: deficient (<20 ng/mL), intermediate (≥ 20-30 ng/mL), and optimal (≥ 30 ng/mL). The deficient group was compared to the optimal group using multivariable linear regression. RESULTS In multivariable-adjusted linear regression, deficient serum 25(OH)D was associated with significantly lower serum HDL-C (-5.1%) and higher total cholesterol (+9.4%), non-HDL-C (+15.4%), directly measured LDL-C (+13.5%), intermediate-density lipoprotein cholesterol (+23.7%), very low-density lipoprotein cholesterol (+19.0%), remnant lipoprotein cholesterol (+18.4%), and TG (+26.4%) when compared with the optimal group. CONCLUSION Deficient serum 25(OH)D is associated with significantly lower HDL-C and higher directly measured LDL-C, intermediate-density lipoprotein cholesterol, very low-density lipoproteins cholesterol, remnant lipoprotein cholesterol, and TG. Future trials examining vitamin D supplementation and cardiovascular disease risk should consider using changes in an extended lipid panel as an additional outcome measurement.
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Affiliation(s)
- Joshua R Lupton
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Kamil F Faridi
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Sristi Sharma
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Krishnaji Kulkarni
- Department of Research and Development, Atherotech Diagnostics Laboratory, Birmingham, AL, USA
| | - Steven R Jones
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA.
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557
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Liu K, Colangelo LA, Daviglus ML, Goff DC, Pletcher M, Schreiner PJ, Sibley CT, Burke GL, Post WS, Michos ED, Lloyd-Jones DM. Can Antihypertensive Treatment Restore the Risk of Cardiovascular Disease to Ideal Levels?: The Coronary Artery Risk Development in Young Adults (CARDIA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Heart Assoc 2015; 4:e002275. [PMID: 26391135 PMCID: PMC4599509 DOI: 10.1161/jaha.115.002275] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background It is unclear whether antihypertensive treatment can restore cardiovascular disease risk to the risk level of persons with ideal blood pressure (BP) levels. Methods and Results Data from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Coronary Artery Risk Development in Young Adults (CARDIA) study were analyzed. Outcomes were compared among participants without or with antihypertensive treatment at 3 BP levels: <120/<80 mm Hg, systolic BP 120 to 139 mm Hg or diastolic BP 80 to 89 mm Hg (120 to 129/≤80 mm Hg for participants with diabetes), and systolic BP ≥140 or diastolic BP ≥90 mm Hg (systolic BP ≥130 or diastolic BP ≥80 mm Hg for participants with diabetes). Among MESA participants aged ≥50 years at baseline, those with BP <120/<80 mm Hg on treatment had higher left ventricular mass index, prevalence of estimated glomerular filtration rate <60 mL/min per 1.73 m2, prevalence of coronary calcium score >100, and twice the incident cardiovascular disease rate over 9.5 years of follow-up than those with BP <120/<80 mm Hg without treatment. In CARDIA at year 25, persons with BP <120/<80 mm Hg with treatment had much longer exposure to higher BP and higher risk of end-organ damage and subclinical atherosclerosis than those with BP <120/<80 mm Hg without treatment. An exploratory analysis suggested that when cumulative systolic BP was high (eg, >3000 mm Hg–years in 25 years), the increase in left ventricular mass index accelerated. Conclusions The data suggest that based on the current approach, antihypertensive treatment cannot restore cardiovascular disease risk to ideal levels. Emphasis should be placed on primordial prevention of BP increases to further reduce cardiovascular disease morbidity and mortality.
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Affiliation(s)
- Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C., D.M.L.J.)
| | - Laura A Colangelo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C., D.M.L.J.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, IL (M.L.D.)
| | - David C Goff
- Colorado School of Public Health, Aurora, CO (D.C.G.)
| | - Mark Pletcher
- Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (M.P.)
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (P.J.S.)
| | - Christopher T Sibley
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (C.T.S.)
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (G.L.B.)
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (W.S.P., E.D.M.)
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (W.S.P., E.D.M.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C., D.M.L.J.)
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558
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Takiar R, Lutsey PL, Zhao D, Guallar E, Schneider ALC, Grams ME, Appel LJ, Selvin E, Michos ED. The associations of 25-hydroxyvitamin D levels, vitamin D binding protein gene polymorphisms, and race with risk of incident fracture-related hospitalization: Twenty-year follow-up in a bi-ethnic cohort (the ARIC Study). Bone 2015; 78:94-101. [PMID: 25920689 PMCID: PMC4466148 DOI: 10.1016/j.bone.2015.04.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/22/2015] [Accepted: 04/20/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Deficient levels of 25-hydroxyvitamin D [25(OH)D] have been associated with increased fracture risk. Racial differences in fracture risk may be related to differences in bioavailable vitamin D due to single nucleotide polymorphism (SNP) variations in the vitamin D binding protein (DBP). METHODS We measured 25(OH)D levels in 12,781 middle-aged White and Black participants [mean age 57 years (SD 5.7), 25% Black] in the ARIC Study who attended the second examination from 1990-1992. Participants were genotyped for two DBP SNPs (rs4588 and rs7041). Incident hospitalized fractures were measured by abstracting hospital records for ICD-9 codes. We used Cox proportional hazards models to evaluate the association between 25(OH)D levels and risk of fracture with adjustment for possible confounders. Interactions were tested by race and DBP genotype. RESULTS There were 1122 incident fracture-related hospitalizations including 267 hip fractures over a median of 19.6 years of follow-up. Participants with deficient 25(OH)D (<20 ng/mL) had a higher risk of any fracture hospitalization [HR=1.21 (95% CI 1.05-1.39)] and hospitalization for hip fracture [HR=1.35 (1.02-1.79)]. No significant racial interaction was noted (p-interaction=0.20 for any fracture; 0.74 for hip fracture). There was no independent association of rs4588 and rs7041 with fracture. However, there was a marginal interaction for 25(OH)D deficiency with rs7041 among Whites (p-interaction=0.065). Whites with both 25(OH)D deficiency and the GG genotype [i.e., with predicted higher levels of DBP and lower bioavailable vitamin D] were at the greatest risk for any fracture [HR=1.48 (1.10-2.00)] compared to Whites with the TT genotype and replete 25(OH)D (reference group). CONCLUSIONS Deficient 25(OH)D levels are associated with higher incidence of hospitalized fractures. Marginal effects were seen in Whites for the DBP genotype associated with lower bioavailable vitamin D, but result inconclusive. Further investigation is needed to more directly evaluate the association between bioavailable vitamin D and fracture risk.
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Affiliation(s)
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MD, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L C Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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559
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Elshazly MB, Quispe R, Michos ED, Sniderman AD, Toth PP, Banach M, Kulkarni KR, Coresh J, Blumenthal RS, Jones SR, Martin SS. Patient-Level Discordance in Population Percentiles of the Total Cholesterol to High-Density Lipoprotein Cholesterol Ratio in Comparison With Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol: The Very Large Database of Lipids Study (VLDL-2B). Circulation 2015; 132:667-76. [PMID: 26137953 DOI: 10.1161/circulationaha.115.016163] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/18/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, estimated low-density lipoprotein cholesterol (LDL-C), and non-HDL-C are routinely available from the standard lipid profile. We aimed to assess the extent of patient-level discordance of TC/HDL-C with LDL-C and non-HDL-C, because discordance suggests the possibility of additional information. METHODS AND RESULTS We compared population percentiles of TC/HDL-C, Friedewald-estimated LDL-C, and non-HDL-C in 1 310 432 US adults from the Very Large Database of Lipids. Lipid testing was performed by ultracentrifugation (Vertical Auto Profile, Atherotech, AL). One in 3 patients had ≥25 percentile units discordance between TC/HDL-C and LDL-C, whereas 1 in 4 had ≥25 percentile units discordance between TC/HDL-C and non-HDL-C. The proportion of patients with TC/HDL-C > LDL-C by ≥25 percentile units increased from 3% at triglycerides <100 mg/dL to 51% at triglycerides 200 to 399 mg/dL. On a smaller scale, TC/HDL-C > non-HDL-C discordance by ≥25 percentile units increased from 6% to 21%. In those with <15th percentile levels of LDL-C (<70 mg/dL) or non-HDL-C (<93 mg/dL), a respective 58% and 46% were above the percentile-equivalent TC/HDL-C of 2.6. Age, sex, and directly measured components of the standard lipid profile explained >86% of the variance in percentile discordance between TC/HDL-C versus LDL-C and non-HDL-C. CONCLUSIONS In this contemporary, cross-sectional, big data analysis of US adults who underwent advanced lipid testing, the extent of patient-level discordance suggests that TC/HDL-C may offer potential additional information to LDL-C and non-HDL-C. Future studies are required to determine the clinical implications of this observation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01698489.
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Affiliation(s)
- Mohamed B Elshazly
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
| | - Renato Quispe
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Erin D Michos
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Allan D Sniderman
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Peter P Toth
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Maciej Banach
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Krishnaji R Kulkarni
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Josef Coresh
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Roger S Blumenthal
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Steven R Jones
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Seth S Martin
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
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560
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Reis JP, Michos ED, Selvin E, Pankow JS, Lutsey PL. Race, vitamin D-binding protein gene polymorphisms, 25-hydroxyvitamin D, and incident diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2015; 101:1232-40. [PMID: 25926504 PMCID: PMC4441813 DOI: 10.3945/ajcn.115.107334] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/24/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Low 25-hydroxyvitamin D [25(OH)D] is associated with diabetes, but few studies have examined racially diverse populations while also accounting for key vitamin D-binding protein (DBP) gene polymorphisms. OBJECTIVE We sought to evaluate whether the association between 25(OH)D and incident diabetes varied by race and important DBP single nucleotide polymorphisms (SNPs). DESIGN We studied 10,222 adults (8120 whites, 2102 blacks) aged 46-70 y at baseline (1990-1992) from the ARIC (Atherosclerosis Risk in Communities) Study with follow-up for incident diabetes ascertained during study visits conducted in 1993-1995 and 1996-1998. Adjusted HRs and their 95% CIs for diabetes were estimated according to 25(OH)D status. RESULTS During follow-up there were 750 incident cases of diabetes. The association of 25(OH)D with diabetes varied by race (P-interaction = 0.004). Among whites, the adjusted HR for diabetes corresponding to each additional SD higher 25(OH)D concentration (21.3 nmol/L) was 0.95 (95% CI: 0.91, 0.99). No significant association was observed among blacks (HR: 1.06; 95% CI: 0.99, 1.14). There was evidence that the A allele at rs4588 and the T allele at rs7041, which are reported to be associated with high and low DBP concentrations, respectively, modified the association between 25(OH)D and diabetes among whites (P-interaction < 0.05 for both) but not blacks (P-interaction > 0.50 for both). CONCLUSIONS In this large, community-based study, low 25(OH)D concentrations were associated with diabetes among whites but not blacks. Interactions by key DBP SNPs varied between genotypes associated with either high or low DBP concentrations among whites but not blacks. Nevertheless, the findings from this prospective study suggest that there are important differences in the association of 25(OH)D with incident diabetes between white and black adults.
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Affiliation(s)
- Jared P Reis
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (JPR); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (EDM); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (ES); and the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (JSP and PLL).
| | - Erin D Michos
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (JPR); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (EDM); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (ES); and the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (JSP and PLL)
| | - Elizabeth Selvin
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (JPR); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (EDM); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (ES); and the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (JSP and PLL)
| | - James S Pankow
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (JPR); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (EDM); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (ES); and the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (JSP and PLL)
| | - Pamela L Lutsey
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (JPR); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (EDM); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (ES); and the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (JSP and PLL)
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561
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Schneider ALC, Lutsey PL, Selvin E, Mosley TH, Sharrett AR, Carson KA, Post WS, Pankow JS, Folsom AR, Gottesman RF, Michos ED. Vitamin D, vitamin D binding protein gene polymorphisms, race and risk of incident stroke: the Atherosclerosis Risk in Communities (ARIC) study. Eur J Neurol 2015; 22:1220-7. [PMID: 25962507 DOI: 10.1111/ene.12731] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/09/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Low vitamin D levels, measured by serum 25-hydroxyvitamin D [25(OH)D], are associated with increased stroke risk. Less is known about whether this association differs by race or D binding protein (DBP) single nucleotide polymorphism (SNP) status. Our objective was to characterize the associations of and interactions between 25(OH)D levels and DBP SNPs with incident stroke. It was hypothesized that associations of low 25(OH)D with stroke risk would be stronger amongst persons with genotypes associated with higher DBP levels. METHODS 25(OH)D was measured by mass spectroscopy in 12 158 participants in the Atherosclerosis Risk in Communities (ARIC) study (baseline 1990-1992, mean age 57 years, 57% female, 23% black) and they were followed through 2011 for adjudicated stroke events. Two DBP SNPs (rs7041, rs4588) were genotyped. Cox models were adjusted for demographic/behavioral/socioeconomic factors. RESULTS During a median of 20 years follow-up, 804 incident strokes occurred. The lowest quintile of 25(OH)D (<17.2 ng/ml) was associated with higher stroke risk [hazard ratio (HR) 1.34 (1.06-1.71) versus highest quintile]; this association was similar by race (P interaction 0.60). There was weak evidence of increased risk of stroke amongst those with 25(OH)D < 17.2 ng/ml and either rs7041 TG/GG [HR = 1.29 (1.00-1.67)] versus TT genotype [HR = 1.19 (0.94-1.52)] (P interaction 0.28) or rs4588 CA/AA [HR = 1.37 (1.07-1.74)] versus CC genotype [HR = 1.14 (0.91-1.41)] (P interaction 0.11). CONCLUSIONS Low 25(OH)D is a risk factor for stroke. Persons with low 25(OH)D who are genetically predisposed to high DBP (rs7041 G, rs4588 A alleles), who therefore have lower predicted bioavailable 25(OH)D, may be at greater risk for stroke, although our results were not conclusive and should be interpreted as hypothesis generating.
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Affiliation(s)
- A L C Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - E Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - A R Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - A R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - R F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E D Michos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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562
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Michos ED, Misialek JR, Selvin E, Folsom AR, Pankow JS, Post WS, Lutsey PL. 25-hydroxyvitamin D levels, vitamin D binding protein gene polymorphisms and incident coronary heart disease among whites and blacks: The ARIC study. Atherosclerosis 2015; 241:12-7. [PMID: 25941991 DOI: 10.1016/j.atherosclerosis.2015.04.803] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/13/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In observational studies, low 25-hydroxyvitamin D (25(OH)D) has been associated with increased risk of coronary heart disease (CHD), and this association may vary by race. Racial differences in the frequency of vitamin D binding protein (DBP) single nucleotide polymorphisms (SNPs) might account for similar bioavailable vitamin D in blacks despite lower mean 25(OH)D. We hypothesized that the associations of low 25(OH)D with CHD risk would be stronger among whites and among persons with genotypes associated with higher DBP levels. METHODS We measured 25(OH)D by mass spectroscopy in 11,945 participants in the ARIC Study (baseline 1990-1992, mean age 57 years, 59% women, 24% black). Two DBP SNPs (rs7041; rs4588) were genotyped. We used adjusted Cox proportional hazards models to examine the association of 25(OH)D with adjudicated CHD events through December 2011. RESULTS Over a median of 20 years, there were 1230 incident CHD events. Whites in the lowest quintile of 25(OH)D (<17 ng/ml) compared to the upper 4 quintiles had an increased risk of incident CHD (HR 1.28, 95% CI 1.05-1.56), but blacks did not (1.03, 0.82-1.28), after adjustment for demographics and behavioral/socioeconomic factors (p-interaction with race = 0.22). Results among whites were no longer significant after further adjustment for potential mediators of this association (i.e. diabetes, hypertension). There was no statistically significant interaction of 25(OH)D with the DBP SNPs rs4588 (p = 0.92) or rs7041 (p = 0.87) in relation to CHD risk. CONCLUSIONS Low 25(OH)D was associated with incident CHD in whites, but no interactions of 25(OH)D with key DBP genotypes was found.
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Affiliation(s)
- Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins University School of Medicine, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States
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563
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Lutsey PL, Michos ED, Misialek JR, Pankow JS, Loehr L, Selvin E, Reis JP, Gross M, Eckfeldt JH, Folsom AR. Race and Vitamin D Binding Protein Gene Polymorphisms Modify the Association of 25-Hydroxyvitamin D and Incident Heart Failure: The ARIC (Atherosclerosis Risk in Communities) Study. JACC Heart Fail 2015; 3:347-356. [PMID: 25863973 DOI: 10.1016/j.jchf.2014.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to determine if low serum 25-hydroxyvitamin D (25[OH]D) is associated with incident heart failure (HF) and if the association is: 1) partly mediated by traditional cardiovascular risk factors; 2) stronger among whites than blacks; and 3) stronger among those genetically predisposed to having high levels of vitamin D binding protein (DBP). BACKGROUND Suboptimal 25(OH)D is a potential cardiovascular risk factor. METHODS A total of 12,215 ARIC (Atherosclerosis Risk in Communities) study participants free of HF at baseline (1990 to 1992; median age, 56; 24% black) were followed through 2010. Total serum 25(OH)D was measured at baseline using liquid chromatography-mass spectrometry. Incident HF events were identified by a hospital discharge code of ICD9-428 and parallel International Classification of Diseases codes for HF deaths. RESULTS During 21 years of follow-up, 1,799 incident HF events accrued. The association between 25(OH)D and HF varied by race (p-interaction = 0.02). Among whites, risk was 2-fold higher for those in the lowest (≤17 ng/ml) versus highest (≥31 ng/ml) quintile of 25(OH)D. The association was attenuated but remained significant with covariate adjustment. In blacks there was no overall association. In both races, those with low 25(OH)D and the rs7041 G allele, which predisposes to high DBP, were at greater risk (p-interaction = 0.01). CONCLUSIONS Low serum 25(OH)D was independently associated with incident HF among whites, but not among blacks. However, in both races, low 25(OH)D was associated with HF risk among those genetically predisposed to high DBP. These findings provide novel insight into metabolic differences that may underlie racial variation in the association between 25(OH)D and cardiovascular risk.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Laura Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth Selvin
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Myron Gross
- Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - John H Eckfeldt
- Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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564
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Yeboah J, Sillau S, Delaney JC, Blaha MJ, Michos ED, Young R, Qureshi WT, McClelland R, Burke GL, Psaty BM, Herrington DM. Implications of the new American College of Cardiology/American Heart Association cholesterol guidelines for primary atherosclerotic cardiovascular disease event prevention in a multi ethnic cohort: Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 2015; 169:387-395.e3. [PMID: 25728729 DOI: 10.1016/j.ahj.2014.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 09/02/2014] [Accepted: 12/04/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of replacing the National Cholesterol Education Program (NCEP)/Adult Treatment Program (ATP) III cholesterol guidelines with the new 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for primary prevention of cardiovascular disease is unclear. METHODS We used risk factor and 10-year clinical event rate data from MESA, combined with estimates of efficacy of moderate and high-intensity statin therapy from meta-analyses of statin primary prevention trials to estimate (a) the change in number of subjects eligible for drug therapy and (2) the anticipated reduction in atherosclerotic cardiovascular disease (ASCVD) events and increment in type 2 diabetes mellitus (T2DM) associated with the change in cholesterol guidelines. RESULTS Of the 6,814 MESA participants, 5,437 were not on statins at baseline and had complete data for analysis (mean age 61.4±10.3). Using the NCEP/ATP III guidelines, 1,334 (24.5%) would have been eligible for statin therapy compared with 3,015 (55.5%) under the new ACC/AHA guidelines. Among the subset of newly eligible, 127/1,742 (7.3%) had an ASCVD event during 10years of follow-up. Assuming 10years of moderate-intensity statin therapy, the estimated absolute reduction in ASCVD events for the newly eligible group was 2.06% (number needed to treat [NNT] 48.6) and the estimated absolute increase in T2DM was 0.90% (number needed to harm [NNH] 110.7). Assuming 10years of high-intensity statin therapy, the corresponding estimates for reductions in ASCVD and increases in T2DM were as follows: ASCVD 2.70% (NNT 37.5) and T2DM 2.60% (NNH 38.6). The estimated effects of moderate-intensity statins on 10-year risk for ASCVD and T2DM in participants eligible for statins under the NCEP/ATP III were as follows: 3.20% (NNT 31.5) and 1.06% (NNH 94.2), respectively. CONCLUSION Substituting the NCEP/ATP III cholesterol guidelines with the 2013 ACC/AHA cholesterol guidelines in MESA more than doubled the number of participants eligible for statin therapy. If the new ACC/AHA cholesterol guidelines are adopted and extend the primary prevention population eligible for treatment, the risk-benefit profile is much better for moderate-intensity than high-intensity statin treatment.
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Affiliation(s)
- Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Stefan Sillau
- Department of Biostatistics, University Washington School of Medicine, Seattle, WA
| | - Joseph C Delaney
- Department of Biostatistics, University Washington School of Medicine, Seattle, WA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore MD
| | - Rebekah Young
- Department of Biostatistics, University Washington School of Medicine, Seattle, WA
| | - Waqas T Qureshi
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC
| | - Robyn McClelland
- Department of Biostatistics, University Washington School of Medicine, Seattle, WA
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA; Group Health Research Unit, Group Health Cooperative, Seattle, WA
| | - David M Herrington
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC
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565
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Affiliation(s)
- Seth S Martin
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Erin D Michos
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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566
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Lutsey PL, Eckfeldt JH, Ogagarue ER, Folsom AR, Michos ED, Gross M. The 25-hydroxyvitamin D3 C-3 epimer: distribution, correlates, and reclassification of 25-hydroxyvitamin D status in the population-based Atherosclerosis Risk in Communities Study (ARIC). Clin Chim Acta 2015; 442:75-81. [PMID: 25578393 DOI: 10.1016/j.cca.2014.12.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Little is known about the vitamin D3 epimer [3-epi-25(OH)D3], particularly in adults. We describe characteristics of the D3 epimer within the community-based ARIC cohort. METHODS The vitamin D3 epimer, 25(OH)D3, and 25(OH)D2 were measured using LC-MS/MS in stored serum collected in 1990-1992 from 9,887 white and 3,221 black ARIC study participants, aged 46-70years. Cross-sectional characteristics were explored. RESULTS Concentrations of the epimer were quantifiable (≥1.41ng/ml) in 33.4% of whites and 15.0% of blacks and made up on average 3.23% and 2.25% of total D3 [epimer+25(OH)D3] concentrations, respectively. Epimer levels were positively correlated with 25(OH)D3 in both whites (r=0.54) and blacks (r=0.36) and were unrelated to 25(OH)D2 concentrations. Overall, epimer levels were associated with participant characteristics in a manner similar to that typically observed for 25(OH)D3. Including the epimer in the calculation of total 25(OH)D resulted in approximately 2% of participants being reclassified from being clinically 25(OH)D deficient to having suboptimal levels. CONCLUSIONS Low concentrations of the D3 epimer were present in adult serum and overall the epimer concentration is moderately correlated with the 25(OH)D3 concentration. The reclassification of participant's clinical 25(OH)D status upon inclusion of the epimer was minimal.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, 1300 So 2nd Street, Suite 300, Minneapolis, MN, United States.
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
| | - Ejovwoke R Ogagarue
- Department of Urology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, 1300 So 2nd Street, Suite 300, Minneapolis, MN, United States
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Myron Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
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567
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Steffen BT, Guan W, Remaley AT, Paramsothy P, Heckbert SR, McClelland RL, Greenland P, Michos ED, Tsai MY. Use of lipoprotein particle measures for assessing coronary heart disease risk post-American Heart Association/American College of Cardiology guidelines: the Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol 2014; 35:448-54. [PMID: 25477346 DOI: 10.1161/atvbaha.114.304349] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/16/2022]
Abstract
OBJECTIVE The American College of Cardiology and American Heart Association have issued guidelines indicating that the contribution of apolipoprotein B-100 (ApoB) to cardiovascular risk assessment remains uncertain. The present analysis evaluates whether lipoprotein particle measures convey risk of coronary heart disease (CHD) in 4679 Multi-Ethnic Study of Atherosclerosis (MESA) participants. APPROACH AND RESULTS Cox regression analysis was performed to determine associations between lipids or lipoproteins and primary CHD events. After adjustment for nonlipid variables, lipoprotein particle levels in fourth quartiles were found to convey significantly greater risk of incident CHD when compared to first quartile levels (hazard ratio [HR]; 95% confidence interval [CI]): ApoB (HR, 1.84; 95% CI, 1.25-2.69), ApoB/ApoA-I (HR, 1.91; 95% CI, 1.32-2.76), total low-density lipoprotein-particles (LDL-P; HR, 1.77; 95% CI, 1.21-2.58), and the LDL-P/HDL-P (high-density lipoprotein-P) ratio (HR, 2.28; 95% CI, 1.54-3.37). Associations between lipoprotein particle measures and CHD were attenuated after adjustment for standard lipid panel variables. Using the American Heart Association/American College of Cardiology risk calculator as a baseline model for CHD risk assessment, significant net reclassification improvement scores were found for ApoB/ApoA-I (0.18; P=0.007) and LDL-P/high-density lipoprotein-P (0.15; P<0.001). C-statistics revealed no significant increase in CHD event discrimination for any lipoprotein measure. CONCLUSIONS Lipoprotein particle measures ApoB/ApoA-I and LDL-P/high-density lipoprotein-P marginally improved net reclassification improvement scores, but null findings for corresponding c-statistic are not supportive of lipoprotein testing. The attenuated associations of lipoprotein particle measures with CHD after the adjustment for lipids indicate that their measurement does not detect risk that is unaccounted for by the standard lipid panel. However, the possibility that lipoprotein measures may identify CHD risk in a subpopulation of individuals with normal cholesterol, but elevated lipoprotein particle numbers cannot be ruled out.
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Affiliation(s)
- Brian T Steffen
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Weihua Guan
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Alan T Remaley
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Pathmaja Paramsothy
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Susan R Heckbert
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Robyn L McClelland
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Philip Greenland
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Erin D Michos
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Michael Y Tsai
- From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.).
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568
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Aladin AI, Whelton SP, Al-Mallah MH, Blaha MJ, Keteyian SJ, Juraschek SP, Rubin J, Brawner CA, Michos ED. Relation of resting heart rate to risk for all-cause mortality by gender after considering exercise capacity (the Henry Ford exercise testing project). Am J Cardiol 2014; 114:1701-6. [PMID: 25439450 DOI: 10.1016/j.amjcard.2014.08.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 11/22/2022]
Abstract
Whether resting heart rate (RHR) predicts mortality independent of fitness is not well established, particularly among women. We analyzed data from 56,634 subjects (49% women) without known coronary artery disease or atrial fibrillation who underwent a clinically indicated exercise stress test. Baseline RHR was divided into 5 groups with <60 beats/min as reference. The Social Security Death Index was used to ascertain vital status. Cox hazard models were performed to determine the association of RHR with all-cause mortality, major adverse cardiovascular events, myocardial infarction, or revascularization after sequential adjustment for demographics, cardiovascular disease risk factors, medications, and fitness (metabolic equivalents). The mean age was 53 ± 12 years and mean RHR was 73 ± 12 beats/min. More than half of the participants were referred for chest pain; 81% completed an adequate stress test and mean metabolic equivalents achieved was 9.2 ± 3. There were 6,255 deaths over 11.0-year mean follow-up. There was an increased risk of all-cause mortality with increasing RHR (p trend <0.001). Compared with the lowest RHR group, participants with an RHR ≥90 beats/min had a significantly increased risk of mortality even after adjustment for fitness (hazard ratio 1.22, 95% confidence interval 1.10 to 1.35). This relationship remained significant for men, but not significant for women after adjustment for fitness (p interaction <0.001). No significant associations were seen for men or women with major adverse cardiovascular events, myocardial infarction, or revascularization after accounting for fitness. In conclusion, after adjustment for fitness, elevated RHR was an independent risk factor for all-cause mortality in men but not women, suggesting gender differences in the utility of RHR for risk stratification.
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Affiliation(s)
- Amer I Aladin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mouaz H Al-Mallah
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan; King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | - Stephen P Juraschek
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathan Rubin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.
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569
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Michos ED, Wilson LM, Yeh HC, Berger Z, Suarez-Cuervo C, Stacy SR, Bass EB. Prognostic value of cardiac troponin in patients with chronic kidney disease without suspected acute coronary syndrome: a systematic review and meta-analysis. Ann Intern Med 2014; 161:491-501. [PMID: 25111499 DOI: 10.7326/m14-0743] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS). PURPOSE To systematically review the literature on troponin testing in patients with CKD without ACS. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. STUDY SELECTION Studies examining elevated versus normal troponin levels in patients with CKD without ACS. DATA EXTRACTION Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). Meta-analyses were conducted when studies had sufficient homogeneity of key variables. DATA SYNTHESIS Ninety-eight studies met inclusion criteria. Elevated troponin levels were associated with all-cause and cardiovascular mortality among patients receiving dialysis (moderate SOE). Pooled hazard ratios (HRs) for all-cause mortality from studies that adjusted for age and coronary artery disease or a risk equivalent were 3.0 (95% CI, 2.4 to 4.3) for troponin T and 2.7 (CI, 1.9 to 4.6) for troponin I. The pooled adjusted HRs for cardiovascular mortality were 3.3 (CI, 1.8 to 5.4) for troponin T and 4.2 (CI, 2.0 to 9.2) for troponin I. Findings were similar for patients with CKD who were not receiving dialysis, but there were fewer studies. No study tested treatment strategies by troponin cut points. LIMITATION Studies were heterogeneous regarding assays, troponin cut points, covariate adjustment, and follow-up. CONCLUSION In patients with CKD without suspected ACS, elevated troponin levels were associated with worse prognosis. Future studies should focus on whether this biomarker is more appropriate than clinical models for reclassifying risk of patients with CKD and whether such classification can help guide treatment in those at highest risk for death. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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570
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Stacy SR, Suarez-Cuervo C, Berger Z, Wilson LM, Yeh HC, Bass EB, Michos ED. Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome: a systematic review. Ann Intern Med 2014; 161:502-12. [PMID: 25111593 DOI: 10.7326/m14-0746] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging. PURPOSE To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. STUDY SELECTION Studies examining elevated versus normal troponin levels in terms of their diagnostic performance in detection of ACS, effect on ACS management strategies, and prognostic value for mortality or cardiovascular events after ACS among patients with CKD. DATA EXTRACTION Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). DATA SYNTHESIS Twenty-three studies met inclusion criteria. The sensitivity of troponin T for ACS diagnosis ranged from 71% to 100%, and specificity ranged from 31% to 86% (6 studies; low SOE). The sensitivity and specificity of troponin I ranged from 43% to 94% and from 48% to 100%, respectively (8 studies; low SOE). No studies examined how troponin levels affect management strategies. Twelve studies analyzed prognostic value. Elevated levels of troponin I or troponin T were associated with higher risk for short-term death and cardiac events (low SOE). A similar trend was observed for long-term mortality with troponin I (low SOE), but less evidence was found for long-term cardiac events for troponin I and long-term outcomes for troponin T (insufficient SOE). Patients with advanced CKD tended to have worse prognoses with elevated troponin I levels than those without them (moderate SOE). LIMITATION Studies were heterogeneous in design and in ACS definitions and adjudication methods. CONCLUSION In patients with CKD and suspected ACS, troponin levels can aid in identifying those with a poor prognosis, but the diagnostic utility is limited by varying estimates of sensitivity and specificity. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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571
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Kohli P, Whelton SP, Hsu S, Yancy CW, Stone NJ, Chrispin J, Gilotra NA, Houston B, Ashen MD, Martin SS, Joshi PH, McEvoy JW, Gluckman TJ, Michos ED, Blaha MJ, Blumenthal RS. Clinician's guide to the updated ABCs of cardiovascular disease prevention. J Am Heart Assoc 2014; 3:e001098. [PMID: 25246448 PMCID: PMC4323829 DOI: 10.1161/jaha.114.001098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Payal Kohli
- Division of Cardiology, University of California San Francisco (UCSF), San Francisco, CA (P.K.)
| | - Seamus P. Whelton
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Steven Hsu
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y., N.J.S.)
| | - Neil J. Stone
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y., N.J.S.)
| | - Jonathan Chrispin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Nisha A. Gilotra
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Brian Houston
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - M. Dominique Ashen
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Seth S. Martin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Parag H. Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - John W. McEvoy
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Ty J. Gluckman
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Erin D. Michos
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Roger S. Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
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572
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Michos ED, Carson KA, Schneider ALC, Lutsey PL, Xing L, Sharrett AR, Alonso A, Coker LH, Gross M, Post W, Mosley TH, Gottesman RF. Vitamin D and subclinical cerebrovascular disease: the Atherosclerosis Risk in Communities brain magnetic resonance imaging study. JAMA Neurol 2014; 71:863-71. [PMID: 24861877 DOI: 10.1001/jamaneurol.2014.755] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Vitamin D deficiency has been associated with hypertension, diabetes mellitus, and incident stroke. Little is known about the association between vitamin D and subclinical cerebrovascular disease. OBJECTIVE To examine the relationship of 25-hydroxyvitamin D (25[OH]D) levels with cerebrovascular abnormalities as assessed on brain magnetic resonance imaging (MRI) among participants of the Atherosclerosis Risk in Communities (ARIC) Brain MRI study. DESIGN, SETTING, AND PARTICIPANTS Participants were white and black adults aged 55 to 72 years with no history of clinical stroke who underwent a cerebral MRI at ARIC visit 3 (n = 1622) and a second cerebral MRI approximately 10 years later (n = 888). EXPOSURES The 25(OH)D level was measured by mass spectrometry at visit 3, with levels adjusted for calendar month and categorized using race-specific quartiles. MAIN OUTCOMES AND MEASURES The cross-sectional and prospective associations of 25(OH)D levels with white matter hyperintensities (WMHs) and MRI-defined infarcts were investigated using multivariable regression models. RESULTS The mean age of the participants was 62 years, 59.6% were women, and 48.6% were black. Lower 25(OH)D levels were not significantly associated with WMH score of severity, prevalent high-grade WMH score (≥3), or prevalent infarcts in cross-sectional, multivariable-adjusted models (all P > .05). Similarly, no significant prospective associations were found for lower 25(OH)D levels with change in WMH volume, incident high WMH score (≥3), or incident infarcts on the follow-up MRI, which occurred approximately 10 years later. CONCLUSIONS AND RELEVANCE A single measure of 25(OH)D was not cross-sectionally associated with WMH grade or prevalent subclinical infarcts and was not prospectively associated with WMH progression or subclinical brain infarcts seen on serial cerebral MRIs obtained approximately 10 years apart. These findings do not support optimizing vitamin D levels for brain health.
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Affiliation(s)
- Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland2Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland3Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea L C Schneider
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Li Xing
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Laura H Coker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Myron Gross
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis7Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
| | - Wendy Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland2Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland9Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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573
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Folsom AR, Alonso A, Misialek JR, Michos ED, Selvin E, Eckfeldt JH, Coresh J, Pankow JS, Lutsey PL. Parathyroid hormone concentration and risk of cardiovascular diseases: the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2014; 168:296-302. [PMID: 25173540 DOI: 10.1016/j.ahj.2014.04.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND According to a recent meta-analysis, parathyroid hormone (PTH) excess is associated with increased cardiovascular disease (CVD) risk, but existing studies are limited. We examined in a prospective study the association of PTH with the incidence of CVD, taking into account vitamin D and other confounding variables. METHODS The ARIC study measured PTH using a second-generation assay (Roche, Indianapolis, IN) in stored serum samples from 1990 to 1992 and related levels in 10,392 adults to incident cardiovascular outcomes (coronary heart disease [n = 808], heart failure [n = 1,294], stroke [n = 586], peripheral artery disease [n = 873], atrial fibrillation [n = 1,190], and CVD mortality [n = 647]) through 2010 (median follow-up 19 years). RESULTS Contrary to the hypothesis, PTH level was not associated positively with any CVD outcome. The associations of incident heart failure, peripheral artery disease, and CVD mortality with PTH actually were weakly inverse (P trend = .02-.04) in the most fully adjusted models. For example, the hazard ratios across PTH quartiles were 1.00, 1.07, 1.07, and 0.96 (P trend = .74) for coronary heart disease incidence and were 1.00, 0.69, 0.74, and 0.74 (P trend = .02) for CVD mortality. Patterns were similar when restricted to participants with normal baseline kidney function. CONCLUSIONS This large prospective study failed to support the hypothesis that elevated PTH is an independent risk marker for incident CVD. When our data were added to the previous meta-analysis, the pooled hazard ratio remained statistically significant but weakened.
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574
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Bengtson LG, Chen LY, Chamberlain AM, Michos ED, Whitsel EA, Lutsey PL, Duval S, Rosamond WD, Alonso A. Temporal trends in the occurrence and outcomes of atrial fibrillation in patients with acute myocardial infarction (from the Atherosclerosis Risk in Communities Surveillance Study). Am J Cardiol 2014; 114:692-7. [PMID: 25048343 DOI: 10.1016/j.amjcard.2014.05.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
Atrial fibrillation (AF) frequently coexists in the setting of myocardial infarction (MI), being associated with increased mortality. Nonetheless, temporal trends in the occurrence of AF complicating MI and in the prognosis of these patients are not well described. We examined temporal trends in prevalence of AF in the setting of MI and the effect of AF on prognosis in the community. We studied a population-based sample of 20,049 validated first-incident nonfatal hospitalized MIs among 35- to 74-year old residents of 4 communities in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 through 2009. Prevalence of AF in the setting of MI increased from 11% to 15% during the 23-year study period. The multivariable adjusted odds ratio for prevalent AF, per 5-year increment, was 1.11 (95% confidence interval 1.04 to 1.19). Overall, in patients with MI, AF was associated with increased 1-year case fatality (odds ratio 1.47, 95% confidence interval 1.07 to 2.01) compared with those without AF. However, there was no evidence that the impact of AF on MI survival changed over time or differed over time by sex, race, or MI classification (all p values >0.10). In conclusion, co-occurrence of AF in MI slightly increased between 1987 and 2009. The adverse impact of AF on survival in the setting of MI was consistent throughout. In the setting of MI, co-occurrence of AF should be viewed as a critical clinical event, and treatment needs unique to this population should be explored further.
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575
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Lutsey PL, Alonso A, Michos ED, Loehr LR, Astor BC, Coresh J, Folsom AR. Serum magnesium, phosphorus, and calcium are associated with risk of incident heart failure: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2014; 100:756-64. [PMID: 25030784 PMCID: PMC4135486 DOI: 10.3945/ajcn.114.085167] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major source of morbidity and mortality, particularly among the elderly. Magnesium, phosphorus, and calcium are micronutrients traditionally viewed in relation to bone health or chronic kidney disease. However, they also may be associated with risk of cardiovascular disease through a broad range of physiologic roles. OBJECTIVE With the use of data from the Atherosclerosis Risk in Communities (ARIC) cohort, we tested the hypotheses that the incidence of HF is greater among individuals with low serum magnesium and those with high serum phosphorus and calcium. DESIGN A total of 14,709 African Americans (27%) and whites from the ARIC cohort [aged 45-64 y at baseline (1987-1989)] were observed through 2009. Proportional hazards regression was used to explore associations between biomarkers and incident HF. Serum calcium was corrected for serum albumin. Models were adjusted for demographics, behaviors, and physiologic characteristics. RESULTS A total of 2250 incident HF events accrued over a median follow-up of 20.6 y. Participants in the lowest (≤1.4 mEq/L) compared with the highest (≥1.8 mEq/L) category of magnesium were at greater HF risk (HR: 1.71; 95% CI: 1.46, 1.99). For phosphorus, there appeared to be a threshold whereby only those in the highest quintile were at greater HF risk [HR(Q5 vs Q1): 1.34; 95% CI: 1.16, 1.54]. Higher concentrations of calcium were also associated with greater risk of HF [HR(Q5 vs Q1): 1.24; 95% CI: 1.07, 1.43]. Results were not modified by race, sex, or kidney function and were similar when incident coronary heart disease was included as a time-varying covariate. CONCLUSIONS Low serum magnesium and high serum phosphorus and calcium were independently associated with greater risk of incident HF in this population-based cohort. Whether these biomarkers will be useful candidates for HF risk prediction or targets for prevention remains to be seen.
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Affiliation(s)
- Pamela L Lutsey
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Alvaro Alonso
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Erin D Michos
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Laura R Loehr
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Brad C Astor
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Josef Coresh
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Aaron R Folsom
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
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576
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Lutsey PL, Alonso A, Selvin E, Pankow JS, Michos ED, Agarwal SK, Loehr LR, Eckfeldt JH, Coresh J. Fibroblast growth factor-23 and incident coronary heart disease, heart failure, and cardiovascular mortality: the Atherosclerosis Risk in Communities study. J Am Heart Assoc 2014; 3:e000936. [PMID: 24922628 PMCID: PMC4309096 DOI: 10.1161/jaha.114.000936] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [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: 01/12/2023]
Abstract
BACKGROUND Fibroblast growth factor-23 (FGF-23) is a hormone involved in phosphorous regulation and vitamin D metabolism that may be associated with cardiovascular risk, and it is a potential target for intervention. We tested whether elevated FGF-23 is associated with incident coronary heart disease, heart failure, and cardiovascular mortality, even at normal kidney function. METHODS AND RESULTS A total of 11 638 Atherosclerosis Risk In Communities study participants, median age 57 at baseline (1990-1992), were followed through 2010. Cox regression was used to evaluate the independent association of baseline serum active FGF-23 with incident outcomes. Models were adjusted for traditional cardiovascular risk factors and estimated glomerular filtration rate. During a median follow-up of 18.6 years, 1125 participants developed coronary heart disease, 1515 developed heart failure, and 802 died of cardiovascular causes. For all 3 outcomes, there was a threshold, whereby FGF-23 was not associated with risk at <40 pg/mL but was positively associated with risk at >40 pg/mL. Compared with those with FGF-23 <40 pg/mL, those in the highest FGF-23 category (≥ 58.8 pg/mL) had a higher risk of incident coronary heart disease (adjusted hazard ratio, 95% CIs: 1.65, 1.40 to 1.94), heart failure (1.75, 1.52 to 2.01), and cardiovascular mortality (1.65, 1.36 to 2.01). Associations were modestly attenuated but remained statistically significant after further adjustment for estimated glomerular filtration rate. In stratified analyses, similar results were observed in African Americans and among persons with normal kidney function. CONCLUSIONS High levels of serum FGF-23 were associated with increased risk of coronary heart disease, heart failure, and cardiovascular mortality in this large, biracial, population-based cohort. This association was independent of traditional cardiovascular risk factors and kidney function.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (P.L.L., A.A., J.S.P.)
| | - Alvaro Alonso
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (P.L.L., A.A., J.S.P.)
| | - Elizabeth Selvin
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (E.S., S.K.A., J.C.)
| | - James S Pankow
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (P.L.L., A.A., J.S.P.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.)
| | - Sunil K Agarwal
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (E.S., S.K.A., J.C.)
| | - Laura R Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC (L.R.L.)
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN (J.H.E.)
| | - Josef Coresh
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (E.S., S.K.A., J.C.)
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577
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Schneider ALC, Michos ED. Invited commentary: The association of low vitamin D with cardiovascular disease--getting at the "heart and soul" of the relationship. Am J Epidemiol 2014; 179:1288-90. [PMID: 24699787 DOI: 10.1093/aje/kwu063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Low concentrations of 25-hydroxyvitamin D have been consistently associated with cardiovascular disease (CVD) in many observational studies. In an analysis published in this issue of the American Journal of Epidemiology, Welles et al. (Am J Epidemiol. 2014;179(11):1279-1287) used data from 946 participants with stable CVD who were enrolled in the Heart and Soul Study (San Francisco Bay Area, 2000-2012) and found that the association of low 25-hydroxyvitamin D with increased secondary CVD event risk was attenuated after adjustment for parathyroid hormone level, suggesting that parathyroid hormone may mediate this association. They used observational data to gain insight into potential mechanisms underlying the association between vitamin D and CVD risk. Their study focused on secondary CVD events, whereas many previous observational studies have focused on incident CVD events among persons without a history of CVD. In this commentary, we place the study by Welles et al. in context with the existing literature and propose future directions for vitamin D research. We highlight a number of methodological concepts that are important in analyzing vitamin D data, including racial differences in vitamin D concentrations and adjustment for seasonal variation in vitamin D concentrations. We agree that randomized controlled trials should be conducted before making guidelines for screening and treating vitamin D deficiency for the prevention of CVD events.
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578
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Schneider ALC, Lutsey PL, Alonso A, Gottesman RF, Sharrett AR, Carson KA, Gross M, Post WS, Knopman DS, Mosley TH, Michos ED. Vitamin D and cognitive function and dementia risk in a biracial cohort: the ARIC Brain MRI Study. Eur J Neurol 2014; 21:1211-8, e69-70. [PMID: 24846449 DOI: 10.1111/ene.12460] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/07/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Some recent studies in older, largely white populations suggest that vitamin D, measured by 25-hydroxyvitamin D [25(OH)D], is important for cognition, but such results may be affected by reverse causation. Measuring 25(OH)D in late middle age before poor cognition affects behavior may provide clearer results. METHODS This was a prospective cohort analysis of 1652 participants (52% white, 48% black) in the Atherosclerosis Risk in Communities (ARIC) Brain MRI Study. 25(OH)D was measured from serum collected in 1993-1995. Cognition was measured by the delayed word recall test (DWRT), the digit symbol substitution test (DSST) and the word fluency test (WFT). Dementia hospitalization was defined by ICD-9 codes. Adjusted linear, logistic and Cox proportional hazards models were used. RESULTS Mean age of participants was 62 years and 60% were female. Mean 25(OH)D was higher in whites than blacks (25.5 vs. 17.3 ng/ml, P < 0.001). Lower 25(OH)D was not associated with lower baseline scores or with greater DWRT, DSST or WFT decline over a median of 3 or 10 years of follow-up (P > 0.05). Over a median of 16.6 years, there were 145 incident hospitalized dementia cases. Although not statistically significant, lower levels of 25(OH)D were suggestive of an association with increased dementia risk [hazard ratio for lowest versus highest race-specific tertile: whites 1.32 (95% confidence interval 0.69, 2.55); blacks 1.53 (95% confidence interval 0.84, 2.79)]. CONCLUSIONS In contrast to prior studies performed in older white populations, our study of late middle age white and black participants did not find significant associations between lower levels of 25(OH)D with lower cognitive test scores at baseline, change in scores over time or dementia risk.
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Affiliation(s)
- A L C Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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579
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Swiger KJ, Martin SS, Blaha MJ, Toth PP, Nasir K, Michos ED, Gerstenblith G, Blumenthal RS, Jones SR. Narrowing sex differences in lipoprotein cholesterol subclasses following mid-life: the very large database of lipids (VLDL-10B). J Am Heart Assoc 2014; 3:e000851. [PMID: 24755154 PMCID: PMC4187479 DOI: 10.1161/jaha.114.000851] [Citation(s) in RCA: 43] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Women have less risk of atherosclerotic cardiovascular disease compared with men up until midlife (ages 50 to 60), after which the gap begins to narrow post menopause. We hypothesized that the average lipid profile of women undergoes unfavorable changes compared with men after midlife. Methods and Results We examined lipids by sex and age in the Very Large Database of Lipids 10B (VLDL 10B) study. The analysis included 1 350 908 unique consecutive patients clinically referred for lipoprotein testing by density gradient ultracentrifugation from 2009 to 2011. Ratio variables were created for density subclasses of LDL‐C, HDL‐C, and VLDL‐C (LLDR, LHDR, LVDR, respectively). Men showed higher median LDL‐C values than women for ages 20 to 59, with the greatest difference in their 30s: 146 mg/dL in men versus 130 mg/dL in women. In contrast, women consistently had higher values after midlife (age 60), for example ages 70 to 79: 129 mg/dL in women versus 112 mg/dL in men. After age 50, women had higher LDL‐C each decade, for example 14% higher from their 30s to 50s, while HDL‐C concentrations did not differ. Women had more buoyant LDL‐C and HDL‐C (lower LLDR and LHDR) than men at all ages but the gap closed in higher age groups. In contrast, women had a generally denser VLDL‐C (higher LVDR) leading into midlife, with the gap progressively closing in higher age groups, approximating that of men in their 60s and 70s. Conclusion The narrowing sex differential in cardiovascular disease risk after midlife is mirrored by a higher total atherogenic lipoprotein cholesterol burden in women and a closer approximation of the less favorable density phenotype characteristic of men.
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Affiliation(s)
- Kristopher J Swiger
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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580
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Subedi BH, Joshi PH, Jones SR, Martin SS, Blaha MJ, Michos ED. Current guidelines for high-density lipoprotein cholesterol in therapy and future directions. Vasc Health Risk Manag 2014; 10:205-16. [PMID: 24748800 PMCID: PMC3986285 DOI: 10.2147/vhrm.s45648] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Many studies have suggested that a significant risk factor for atherosclerotic cardiovascular disease (ASCVD) is low high-density lipoprotein cholesterol (HDL-C). Therefore, increasing HDL-C with therapeutic agents has been considered an attractive strategy. In the prestatin era, fibrates and niacin monotherapy, which cause modest increases in HDL-C, reduced ASCVD events. Since their introduction, statins have become the cornerstone of lipoprotein therapy, the benefits of which are primarily attributed to decrease in low-density lipoprotein cholesterol. Findings from several randomized trials involving niacin or cholesteryl ester transfer protein inhibitors have challenged the concept that a quantitative elevation of plasma HDL-C will uniformly translate into ASCVD benefits. Consequently, the HDL, or more correctly, HDL-C hypothesis has become more controversial. There are no clear guidelines thus far for targeting HDL-C or HDL due to lack of solid outcomes data for HDL specific therapies. HDL-C levels are only one marker of HDL out of its several structural or functional properties. Novel approaches are ongoing in developing and assessing agents that closely mimic the structure of natural HDL or replicate its various functions, for example, reverse cholesterol transport, vasodilation, anti-inflammation, or inhibition of platelet aggregation. Potential new approaches like HDL infusions, delipidated HDL, liver X receptor agonists, Apo A-I upregulators, Apo A mimetics, and gene therapy are in early phase trials. This review will outline current therapies and describe future directions for HDL therapeutics.
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Affiliation(s)
- Bishnu H Subedi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA ; Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Parag H Joshi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
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581
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Minder CM, Shaya GE, Michos ED, Keenan TE, Blumenthal RS, Nasir K, Carvalho JA, Conceição RD, Santos RD, Blaha MJ. Relation between self-reported physical activity level, fitness, and cardiometabolic risk. Am J Cardiol 2014; 113:637-43. [PMID: 24360775 DOI: 10.1016/j.amjcard.2013.11.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 10/26/2022]
Abstract
Physical activity and cardiorespiratory fitness are associated with improved cardiovascular health and reduced all-cause mortality. The relation between self-reported physical activity, objective physical fitness, and the association of each with cardiometabolic risk has not been fully described. We studied 2,800 healthy Brazilian subjects referred for an employer-sponsored health screening. Physical activity level was determined as "low," "moderate," or "high" with the International Physical Activity Questionnaire: Short Form (IPAQ-SF). Fitness was measured as METs achieved on a maximal, symptom-limited, treadmill stress test. Using multivariate linear regression analysis, we calculated age, gender, and smoking-adjusted correlation coefficients among IPAQ-SF, fitness, and cardiometabolic risk factors. Mean age of study participants was 43 ± 9 years; 81% were men, and 43% were highly active. Mean METs achieved was 12 ± 2. IPAQ-SF category and fitness were moderately correlated (r = 0.377). Compared with IPAQ-SF category, fitness was better correlated with cardiometabolic risk factors including anthropomorphic measurements, blood pressure, fasting blood glucose, dyslipidemia, high-sensitivity C-reactive protein, and hepatic steatosis (all p <0.01). Among these, anthropomorphic measurements, blood pressure, high-sensitivity C-reactive protein, and hepatic steatosis had the largest discrepancies in correlation, whereas lipid factors had the least discrepant correlation. When IPAQ-SF and fitness were discordant, poor fitness drove associations with elevated cardiometabolic risk. In conclusion, self-reported physical activity level and directly measured fitness are moderately correlated, and the latter is more strongly associated with a protective cardiovascular risk profile.
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582
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Whelton SP, Narla V, Blaha MJ, Nasir K, Blumenthal RS, Jenny NS, Al-Mallah MH, Michos ED. Association between resting heart rate and inflammatory biomarkers (high-sensitivity C-reactive protein, interleukin-6, and fibrinogen) (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2014; 113:644-9. [PMID: 24393259 DOI: 10.1016/j.amjcard.2013.11.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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: 08/12/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 01/14/2023]
Abstract
Heart rate (HR) at rest is associated with adverse cardiovascular events; however, the biologic mechanism for the relation is unclear. We hypothesized a strong association between HR at rest and subclinical inflammation, given their common interrelation with the autonomic nervous system. HR at rest was recorded at baseline in the Multi-Ethnic Study of Atherosclerosis, a cohort of 4 racial or ethnic groups without cardiovascular disease at baseline and then divided into quintiles. Subclinical inflammation was measured using high-sensitivity C-reactive protein, interleukin-6, and fibrinogen. We used progressively adjusted regression models with terms for physical activity and atrioventricular nodal blocking agents in the fully adjusted models. We examined inflammatory markers as both continuous and categorical variables using the clinical cut point of ≥3 mg/L for high-sensitivity C-reactive protein and the upper quartiles of fibrinogen (≥389 mg/dl) and interleukin-6 (≥1.89 pg/ml). Participants had a mean age of 62 years (SD 9.7), mean resting heart rate of 63 beats/min (SD 9.6) and were 47% men. Increased HR at rest was significantly associated with higher levels of all 3 inflammatory markers in both continuous (p for trend <0.001) and categorical (p for trend <0.001) models. Results were similar among all 3 inflammatory markers, and there was no significant difference in the association among the 4 racial or ethnic groups. In conclusion, an increased HR at rest was associated with a higher level of inflammation among an ethnically diverse group of subjects without known cardiovascular disease.
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Affiliation(s)
- Seamus P Whelton
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
| | - Venkata Narla
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Center for Prevention and Wellness, Baptist Health South Florida, Miami, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Nancy S Jenny
- Department of Pathology, University of Vermont College of Medicine, Colchester, Vermont
| | - Mouaz H Al-Mallah
- King Abdul-Aziz Cardiac Center, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
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583
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Smith BM, Prince MR, Hoffman EA, Bluemke DA, Liu CY, Rabinowitz D, Hueper K, Parikh MA, Gomes AS, Michos ED, Lima JAC, Barr RG. Impaired left ventricular filling in COPD and emphysema: is it the heart or the lungs? The Multi-Ethnic Study of Atherosclerosis COPD Study. Chest 2014; 144:1143-1151. [PMID: 23764937 DOI: 10.1378/chest.13-0183] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. METHODS The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions < -910 Hounsfield units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. RESULTS Among 165 participants, the mean (± SD) total pulmonary vein area was 558 ± 159 mm2 in patients with COPD and 623 ± 145 mm2 in control subjects. Total pulmonary vein area was smaller in patients with COPD (-57 mm2; 95% CI, -106 to -7 mm2; P = .03) and inversely associated with percent emphysema (P < .001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defined COPD. CONCLUSIONS Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan.
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Affiliation(s)
- Benjamin M Smith
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, McGill University, Montreal, QC, Canada
| | - Martin R Prince
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Eric A Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Chia-Ying Liu
- Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Dan Rabinowitz
- Department of Statistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Katja Hueper
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Megha A Parikh
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Erin D Michos
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - João A C Lima
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - R Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
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584
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Rieke K, Durazo-Arvizu R, Liu K, Michos ED, Luke A, Kramer H. Association between anxiety levels and weight change in the multiethnic study of atherosclerosis. J Obes 2014; 2014:894627. [PMID: 25374677 PMCID: PMC4206924 DOI: 10.1155/2014/894627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the association between anxiety and weight change in a multiethnic cohort followed for approximately 10 years. METHODS The study population consisted of participants of the multiethnic study of atherosclerosis who met specified inclusion criteria (n = 5,799). Weight was measured at baseline and four subsequent follow-up exams. Anxiety was analyzed as sex-specific anxiety quartiles (QANX). The relationship between anxiety level and weight change was examined using a mixed-effect model with weight as the dependent variable, anxiety and time as the independent variables, and adjusted for covariates. RESULTS Average annual weight change (range) was -0.17 kg (-6.04 to 4.38 kg) for QANX 1 (lowest anxiety), -0.16 kg (-10.71 to 4.45 kg) for QANX 2, -0.15 kg (-8.69 to 6.39 kg) for QANX 3, and -0.20 kg (-7.12 to 3.95 kg) for QANX 4 (highest anxiety). No significant association was noted between QANX and weight change. However, the highest QANX was associated with a -2.48 kg (95% CI = -3.65, -1.31) lower baseline weight compared to the lowest QANX after adjustment for all covariates. CONCLUSIONS Among adults, age 45-84, higher levels of anxiety, defined by the STPI trait anxiety scale, are associated with lower average baseline weight but not with weight change.
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Affiliation(s)
- Katherine Rieke
- Department of Public Health Sciences, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, USA
- *Katherine Rieke:
| | - Ramon Durazo-Arvizu
- Department of Public Health Sciences, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611-4402, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Amy Luke
- Department of Public Health Sciences, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Holly Kramer
- Department of Public Health Sciences, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
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585
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Affiliation(s)
- Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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586
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Remigio-Baker RA, Diez Roux AV, Szklo M, Crum RM, Leoutsakos JM, Franco M, Schreiner PJ, Carnethon MR, Nettleton JA, Mujahid MS, Michos ED, Gary-Webb TL, Golden SH. Physical environment may modify the association between depressive symptoms and change in waist circumference: the multi-ethnic study of atherosclerosis. Psychosomatics 2013; 55:144-54. [PMID: 24388121 DOI: 10.1016/j.psym.2013.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/25/2013] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the bidirectional association between depressive symptoms and adiposity has been recognized, the contribution of neighborhood factors to this relationship has not been assessed. OBJECTIVE This study evaluates whether physical and social neighborhood environments modify the bidirectional relationship between depressive symptoms and adiposity (measured by waist circumference and body mass index). METHODS Using data on 5,122 men and women (ages 45 to 84 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) we investigated whether neighborhood physical (i.e., walking environment and availability of healthy food) and social (i.e., safety, aesthetics, and social coherence) environments modified the association between the following: (1) baseline elevated depressive symptoms (Center for Epidemiologic Study Depression Scale score ≥ 16) and change in adiposity (as measured by waist circumference and body mass index) and (2) baseline overweight/obesity (waist circumference > 102 cm for men and >88 cm for women, or body mass index ≥ 25 kg/m(2)) and change in depressive symptoms using multilevel models. Neighborhood-level factors were obtained from the MESA Neighborhood Study. RESULTS A greater increase in waist circumference in participants with vs without elevated depressive symptoms was observed in those living in poorly-rated physical environments but not in those living in better-rated environments (interaction p = 0.045). No associations were observed with body mass index. Baseline overweight/obesity was not associated with change in depressive symptoms and there was no modification by neighborhood-level factors. CONCLUSIONS Elevated depressive symptoms were associated with greater increase in waist circumference among individuals living in poorly-rated physical environments than in those in better-rated physical environments. No association was found between overweight/obesity and change in depressive symptoms.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Ana V Diez Roux
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rosa M Crum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeannie-Marie Leoutsakos
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Manuel Franco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jennifer A Nettleton
- Department of Nutrition and Obesity, The University of Texas School of Public Health, Houston, TX
| | - Mahasin S Mujahid
- Department of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Sherita H Golden
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD.
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587
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Martin SS, Blaha MJ, Toth PP, Joshi PH, McEvoy JW, Ahmed HM, Elshazly MB, Swiger KJ, Michos ED, Kwiterovich PO, Kulkarni KR, Chimera J, Cannon CP, Blumenthal RS, Jones SR. Very large database of lipids: rationale and design. Clin Cardiol 2013; 36:641-8. [PMID: 24122913 DOI: 10.1002/clc.22214] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/22/2013] [Indexed: 12/23/2022] Open
Abstract
Blood lipids have major cardiovascular and public health implications. Lipid-lowering drugs are prescribed based in part on categorization of patients into normal or abnormal lipid metabolism, yet relatively little emphasis has been placed on: (1) the accuracy of current lipid measures used in clinical practice, (2) the reliability of current categorizations of dyslipidemia states, and (3) the relationship of advanced lipid characterization to other cardiovascular disease biomarkers. To these ends, we developed the Very Large Database of Lipids (NCT01698489), an ongoing database protocol that harnesses deidentified data from the daily operations of a commercial lipid laboratory. The database includes individuals who were referred for clinical purposes for a Vertical Auto Profile (Atherotech Inc., Birmingham, AL), which directly measures cholesterol concentrations of low-density lipoprotein, very low-density lipoprotein, intermediate-density lipoprotein, high-density lipoprotein, their subclasses, and lipoprotein(a). Individual Very Large Database of Lipids studies, ranging from studies of measurement accuracy, to dyslipidemia categorization, to biomarker associations, to characterization of rare lipid disorders, are investigator-initiated and utilize peer-reviewed statistical analysis plans to address a priori hypotheses/aims. In the first database harvest (Very Large Database of Lipids 1.0) from 2009 to 2011, there were 1 340 614 adult and 10 294 pediatric patients; the adult sample had a median age of 59 years (interquartile range, 49-70 years) with even representation by sex. Lipid distributions closely matched those from the population-representative National Health and Nutrition Examination Survey. The second harvest of the database (Very Large Database of Lipids 2.0) is underway. Overall, the Very Large Database of Lipids database provides an opportunity for collaboration and new knowledge generation through careful examination of granular lipid data on a large scale.
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Affiliation(s)
- Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medicine, Baltimore, Maryland
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588
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Michos ED, Abraham TP. Echoing the appropriate use criteria: the role of echocardiography for cardiovascular risk assessment of the asymptomatic individual. JAMA Intern Med 2013; 173:1598-9. [PMID: 23877437 DOI: 10.1001/jamainternmed.2013.7029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erin D Michos
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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589
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Affiliation(s)
- Michael J Blaha
- Department of Medicine/Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, , Baltimore, Maryland, USA
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590
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Blondon M, Sachs M, Hoofnagle AN, Ix JH, Michos ED, Korcarz C, Gepner AD, Siscovick DS, Kaufman JD, Stein JH, Kestenbaum B, de Boer IH. 25-Hydroxyvitamin D and parathyroid hormone are not associated with carotid intima-media thickness or plaque in the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol 2013; 33:2639-45. [PMID: 23814117 DOI: 10.1161/atvbaha.113.301781] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Observational evidence supports independent associations of 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) with cardiovascular risk. A plausible hypothesis for these associations is accelerated development of atherosclerosis. APPROACH AND RESULTS We evaluated cross-sectional and longitudinal associations of 25-OHD and PTH with carotid intima-media thickness (IMT) and carotid plaques among 3251 participants free of cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis. 25-OHD and PTH were measured at baseline by mass spectrometry and immunoassay, respectively. All subjects underwent a carotid ultrasound examination at baseline and 9.4 years later (median, range 8-11.1 years). Multivariable linear and logistic regressions were used to test associations of 25-OHD and PTH with the extent and progression of IMT and the prevalence and incidence of carotid plaque. Mean (SD) 25-OHD and PTH were 25.8 ng/mL (10.6) and 44.2 pg/mL (20.2), respectively. No independent associations were found between 25-OHD or PTH and IMT at baseline (increment of 1.9 μm [95% confidence interval, -5.1 to 8.9] per 10 ng/mL lower 25-OHD; increment of 0.8 μm [95% confidence interval, -3.2 to 4.8] per 10 pg/mL higher PTH) or progression of IMT (increment of 2.6 μm [95% confidence interval, -2.5 to 7.8] per 10 ng/mL lower 25-OHD, increment of 1.6 μm [95% confidence interval, -1.9 to 5.2] per 10 pg/mL higher PTH). No associations were found with the baseline prevalence of carotid plaque or the incidence of new plaques during the study period. We did not observe any interaction by race or ethnicity (White, Chinese, Black, and Hispanic). CONCLUSIONS The consistent lack of association of vitamin D and PTH with carotid IMT and plaque suggests that these hormones may influence cardiovascular risk through pathways not reflected by carotid atherosclerosis.
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Affiliation(s)
- Marc Blondon
- From the Department of Epidemiology (M.B., D.S.S., J.D.K., B.K., I.H.d.B.), Division of Nephrology and Kidney Research Institute (M.S., B.K., I.H.d.B.), Department of Laboratory Medicine (A.N.H.), Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine (D.S.S., J.D.K., B.K., I.H.d.B.), Cardiovascular Health Research Unit (M.B., D.S.S.), University of Washington, Seattle, WA; Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (M.B.); Division of Nephrology, University of California, San Diego, CA (J.H.I.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); and Divison of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (C.K., A.D.G., J.H.S.)
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591
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Smith BM, Kawut SM, Bluemke DA, Basner RC, Gomes AS, Hoffman E, Kalhan R, Lima JAC, Liu CY, Michos ED, Prince MR, Rabbani L, Rabinowitz D, Shimbo D, Shea S, Barr RG. Pulmonary hyperinflation and left ventricular mass: the Multi-Ethnic Study of Atherosclerosis COPD Study. Circulation 2013; 127:1503-11, 1511e1-6. [PMID: 23493320 PMCID: PMC4018203 DOI: 10.1161/circulationaha.113.001653] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Left ventricular (LV) mass is an important predictor of heart failure and cardiovascular mortality, yet determinants of LV mass are incompletely understood. Pulmonary hyperinflation in chronic obstructive pulmonary disease (COPD) may contribute to changes in intrathoracic pressure that increase LV wall stress. We therefore hypothesized that residual lung volume in COPD would be associated with greater LV mass. METHODS AND RESULTS The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers 50 to 79 years of age who were free of clinical cardiovascular disease. LV mass was measured by cardiac magnetic resonance. Pulmonary function testing was performed according to guidelines. Regression models were used to adjust for age, sex, body size, blood pressure, and other cardiac risk factors. Among 119 MESA COPD Study participants, the mean age was 69±6 years, 55% were male, and 65% had COPD, mostly of mild or moderate severity. Mean LV mass was 128±34 g. Residual lung volume was independently associated with greater LV mass (7.2 g per 1-SD increase in residual volume; 95% confidence interval, 2.2-12; P=0.004) and was similar in magnitude to that of systolic blood pressure (7.6 g per 1-SD increase in systolic blood pressure; 95% confidence interval, 4.3-11; P<0.001). Similar results were observed for the ratio of LV mass to end-diastolic volume (P=0.02) and with hyperinflation measured as residual volume to total lung capacity ratio (P=0.009). CONCLUSIONS Pulmonary hyperinflation, as measured by residual lung volume or residual lung volume to total lung capacity ratio, is associated with greater LV mass.
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Affiliation(s)
- Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Steven M. Kawut
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Robert C Basner
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - Eric Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ravi Kalhan
- Asthma and COPD Program, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Johns Hopkins University, Baltimore, MD
| | - João AC Lima
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Chia-Ying Liu
- Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Martin R Prince
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - LeRoy Rabbani
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - Daichi Shimbo
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Steven Shea
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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592
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Vranian MN, Keenan T, Blaha MJ, Silverman MG, Michos ED, Minder CM, Blumenthal RS, Nasir K, Meneghelo RS, Santos RD. Impact of fitness versus obesity on routinely measured cardiometabolic risk in young, healthy adults. Am J Cardiol 2013; 111:991-5. [PMID: 23340029 DOI: 10.1016/j.amjcard.2012.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 02/04/2023]
Abstract
Obesity demonstrates a direct relation with cardiovascular risk and all-cause mortality, while cardiorespiratory fitness demonstrates an inverse relation. In clinical practice, several cardiometabolic (CM) risk factors are commonly measured to gauge cardiovascular risk, but the interaction between fitness and obesity with regard to CM risk has not been fully explored. In this study, 2,634 Brazilian adults referred for employer-sponsored heath exams were assessed. Obesity was defined as body mass index >30 kg/m(2) or waist circumference >102 cm in men or >88 cm in women when body mass index was 25 to 30 kg/m(2). Fitness was quantified by stage achieved on an Ellestad treadmill stress test, with those completing stage 4 considered fit. Hepatic steatosis was determined by ultrasound. CM risk factors were compared after stratifying patients into 4 groups: fit and normal weight, fit and obese, unfit and normal weight, and unfit and obese. Approximately 22% of patients were obese; 12% were unfit. Fitness and obesity were moderately correlated (ρ = 0.38 to 0.50). The sample included 6.5% unfit and normal-weight subjects and 16% fit and obese subjects. In overweight and obese patients, fitness was negatively associated with CM risk (p <0.01 for all values). In fit patients, increasing body mass index was positively associated with CM risk (p <0.01 for all values). In instances of discordance between fitness and obesity, obesity was the stronger determinant of CM risk. In conclusion, fitness and obesity are independently associated with CM risk. The effects of fitness and obesity are additive, but obesity is more strongly associated with CM risk when fitness and obesity are discordant. These findings underscore the need for weight loss in obese patients and suggest an unmeasured benefit of fitness.
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Affiliation(s)
- Michael N Vranian
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
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593
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Auchincloss AH, Mujahid MS, Shen M, Michos ED, Whitt-Glover MC, Diez Roux AV. Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis). Obesity (Silver Spring) 2013; 21:621-8. [PMID: 23592671 PMCID: PMC3511654 DOI: 10.1002/oby.20255] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 03/26/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence. DESIGN AND METHODS Data came from 4,008 adults aged 45-84 at baseline who participated in a neighborhood ancillary study of the Multi-Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000-2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1-mile buffer area. Obesity was defined as BMI ≥ 30 kg/m(2) . Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression. RESULTS Among 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow-up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual-level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15). CONCLUSIONS Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.
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Affiliation(s)
- Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA.
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594
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Michos ED, Martin S, Jones S. 25-HYDROXYVITAMIN D LEVELS AND LIPOPROTEIN CHOLESTEROL SUBFRACTIONS: THE VERY LARGE DATABASE OF LIPIDS-VITAMIN D STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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595
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Mann DM, Shimbo D, Cushman M, Lakoski S, Greenland P, Blumenthal RS, Michos ED, Lloyd-Jones DM, Muntner P. C-reactive protein level and the incidence of eligibility for statin therapy: the multi-ethnic study of atherosclerosis. Clin Cardiol 2012; 36:15-20. [PMID: 22886783 DOI: 10.1002/clc.22046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial, statin initiation may be considered for individuals with elevated high-sensitivity C-reactive protein (hsCRP). However, if followed prospectively, many individuals with elevated CRP may become statin eligible, limiting the impact of elevated CRP as a treatment indication. This analysis estimates the proportion of people with elevated CRP that become statin eligible over time. HYPOTHESIS Most people with elevated CRP become statin eligible over a short period of time. METHODS We followed 2153 Multi-Ethnic Study of Atherosclerosis (MESA) participants free of cardiovascular disease and diabetes with low-density lipoprotein cholesterol <130 mg/dL at baseline to determine the proportion who become eligible for statins over 4.5 years. The proportion eligible for statin therapy, defined by the National Cholesterol Education Program (NCEP) 2004 updated guidelines, was calculated at baseline and during follow-up stratified by baseline CRP level (≥2 mg/L). RESULTS At baseline, 47% of the 2153 participants had elevated CRP. Among participants with elevated CRP, 29% met NCEP criteria for statins, compared with 28% without elevated CRP at baseline. By 1.5 years later, 26% and 22% (P = 0.09) of those with and without elevated CRP at baseline reached NCEP low-density lipoprotein cholesterol criteria and/or had started statins, respectively. These increased to 42% and 39% (P = 0.24) at 3 years and 59% and 52% (P = 0.01) at 4.5 years following baseline. CONCLUSIONS A substantial proportion of those with elevated CRP did not achieve NCEP-based statin eligibility over 4.5 years of follow-up. These findings suggest that many patients with elevated CRP may not receive the benefits of statins if CRP is not incorporated into the NCEP screening strategy.
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Affiliation(s)
- Devin M Mann
- Department of Medicine, Division of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts 02119, USA.
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596
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Okwuosa TM, Greenland P, Burke GL, Eng J, Cushman M, Michos ED, Ning H, Lloyd-Jones DM. Prediction of coronary artery calcium progression in individuals with low Framingham Risk Score: the Multi-Ethnic Study of Atherosclerosis. JACC Cardiovasc Imaging 2012; 5:144-53. [PMID: 22340820 DOI: 10.1016/j.jcmg.2011.11.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/01/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This study sought to determine whether novel markers not involving ionizing radiation could predict coronary artery calcium (CAC) progression in a low-risk population. BACKGROUND Increase in CAC scores over time (CAC progression) improves prediction of coronary heart disease (CHD) events. Due to radiation exposure, CAC measurement represents an undesirable method for repeated risk assessment, particularly in individuals with low predicted risk (Framingham Risk Score [FRS] <10%). METHODS From 6,814 participants in MESA (Multi-Ethnic Study of Atherosclerosis), 2,620 individuals were classified as low risk for CHD events (FRS <10%) and had follow-up CAC measurement. In addition to traditional risk factors (RFs), various combinations of novel marker models were selected on the basis of data-driven, clinical, or backward stepwise selection techniques. RESULTS Mean follow-up was 2.5 years. CAC progression occurred in 574 participants (22% overall; 214 of 1,830 with baseline CAC = 0 and 360 of 790 with baseline CAC >0). Addition of various combinations of novel markers to the base model (c statistic = 0.711) revealed improvements in discrimination of approximately only 0.005 each (c statistics 0.7158, 0.7160, and 0.7164) for the best-fit models. All 3 best-fit novel marker models calibrated well but were similar to the base model in predicting individual risk probabilities for CAC progression. The highest prevalence of CAC progression occurred in the highest compared with the lowest probability quartile groups (39.2% to 40.3% vs. 6.4% to 7.1%). CONCLUSIONS In individuals at low predicted risk according to FRS, traditional risk factors predicted CAC progression in the short term with good discrimination and calibration. Prediction improved minimally when various novel markers were added to the model.
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Affiliation(s)
- Tochi M Okwuosa
- Wayne State University School of Medicine, Division of Cardiology, Detroit, Michigan, USA
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598
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Minder CM, Blaha MJ, Horne A, Michos ED, Kaul S, Blumenthal RS. Evidence-based use of statins for primary prevention of cardiovascular disease. Am J Med 2012; 125:440-6. [PMID: 22387091 DOI: 10.1016/j.amjmed.2011.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 11/28/2011] [Accepted: 11/28/2011] [Indexed: 11/16/2022]
Abstract
Three-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, commonly known as statins, are widely available, inexpensive, and represent a potent therapy for treating elevated cholesterol. Current national guidelines put forth by the Adult Treatment Panel III recommend statins as part of a comprehensive primary prevention strategy for patients with elevated low-density lipoprotein cholesterol at increased risk for developing coronary heart disease within 10 years. Lack of a clear-cut mortality benefit in primary prevention has caused some to question the use of statins for patients without known coronary heart disease. On review of the literature, we conclude that current data support only a modest mortality benefit for statin primary prevention when assessed in the short term (<5 years). Of note, statin primary prevention results in a significant decrease in cardiovascular morbidity over the short and long term and a trend toward increased reduction in mortality over the long term. When appraised together, these data provide compelling evidence to support the use of statins for primary prevention in patients with risk factors for developing coronary heart disease over the next 10 years.
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Affiliation(s)
- C Michael Minder
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
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599
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600
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Michos ED, Reis JP, Post WS, Lutsey PL, Gottesman RF, Mosley TH, Sharrett AR, Melamed ML. 25-Hydroxyvitamin D deficiency is associated with fatal stroke among whites but not blacks: The NHANES-III linked mortality files. Nutrition 2012; 28:367-71. [PMID: 22261577 DOI: 10.1016/j.nut.2011.10.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 10/26/2011] [Accepted: 10/26/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Deficient 25-hydroxyvitamin D (25[OH]D) levels are associated with cardiovascular disease (CVD) events and mortality. 25(OH)D deficiency and stroke are more prevalent in blacks. We examined whether low 25(OH)D contributes to the excess risk of fatal stroke in blacks compared with whites. METHODS The Third National Health and Nutrition Examination Survey, a probability sample of U.S. civilians, measured 25(OH)D levels and CVD risk factors from 1988 through 1994. Vital status through December 2006 was obtained by a linkage with the National Death Index. In white and black adults without CVD reported at baseline (n = 7981), Cox regression models were fit to estimate hazard ratios (HR) for fatal stroke by 25(OH)D status and race. RESULTS During a median of 14.1 y, there were 116 and 60 fatal strokes in whites and blacks, respectively. The risk of fatal stroke was greater in blacks compared with whites in models adjusted for socioeconomic status and CVD risk factors (HR 1.60, 95% confidence interval 1.01-2.53). Mean baseline 25(OH)D levels were significantly lower in blacks compared with whites (19.4 versus 30.8 ng/mL, respectively). In multivariable-adjusted models, deficient 25(OH)D levels lower than 15 ng/mL were associated with fatal stroke in whites (HR 2.13, 1.01-4.50) but not blacks (HR 0.93, 0.49-1.80). CONCLUSIONS Vitamin D deficiency was associated with an increased risk of stroke death in whites but not in blacks. Although blacks had a higher rate of fatal stroke compared with whites, the low 25(OH)D levels in blacks were unrelated to stroke incidence. Therefore 25(OH)D levels did not explain this excess risk.
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Affiliation(s)
- Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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