151
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Penson PE, Mancini GBJ, Toth PP, Martin SS, Watts GF, Sahebkar A, Mikhailidis DP, Banach M. Introducing the 'Drucebo' effect in statin therapy: a systematic review of studies comparing reported rates of statin-associated muscle symptoms, under blinded and open-label conditions. J Cachexia Sarcopenia Muscle 2018; 9:1023-1033. [PMID: 30311434 PMCID: PMC6240752 DOI: 10.1002/jcsm.12344] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The 'placebo effect' and 'nocebo effect' are phenomena whereby beneficial (placebo) or adverse (nocebo) effects result from the expectation that an inert substance will relieve or cause a particular symptom. These terms are often inappropriately applied to effects experienced on drug therapy. Quantifying the magnitude of placebo and nocebo effects in clinical trials is problematic because it requires a 'no treatment' arm. To overcome the difficulties associated with measuring the nocebo effect, and the fact that its definition refers to inert compounds, rather than drugs, we introduce the concept of 'drucebo' (a combination of DRUg and plaCEBO or noCEBO) to relate to beneficial or adverse effects of a drug, which result from expectation and are not pharmacologically caused by the drug. As an initial application of the concept, we have estimated the contribution of the drucebo effect to statin discontinuation and statin-induced muscle symptoms by performing a systematic review of randomized controlled trial of statin therapy. METHODS This preferred reporting items for systematic reviews and meta-analysis-compliant systematic review was prospectively registered in PROSPERO (CRD42017082700). We searched PubMed and Cochrane Central from inception until 3 January 2018 using a search strategy designed to detect studies including the concepts (Statins AND Placebo AND muscle pain). We included studies that allowed us to quantify the drucebo effect for adverse muscle symptoms of statins by (i) comparing reported rates of muscle symptoms in blinded and unblinded phases of randomized controlled trials and (ii) comparing rates of muscle symptoms at baseline and during blinded therapy in trials that included patients with objectively confirmed statin intolerance at baseline. Extraction was performed by two researchers with disagreements settled by a third reviewer. RESULTS Five studies allowed the estimation of the drucebo effect. All trials demonstrated an excess of side effects under open-label conditions. The contribution of the drucebo effect to statin-associated muscle pain ranged between 38% and 78%. The heterogeneity of study methods, outcomes, and reporting did not allow for quantitative synthesis (meta-analysis) of the results. CONCLUSIONS The drucebo effect may be useful in evaluating the safety and efficacy of medicines. Diagnosis of the drucebo effect in patients presenting with statin intolerance will allow restoration of life-prolonging lipid-lowering therapy. Our study was limited by heterogeneity of included studies and lack of access to individual patient data. Further studies are necessary to better understand risk factors for and clinical management of the drucebo effect.
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Affiliation(s)
- Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - G B John Mancini
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gerald F Watts
- Lipid Disorders Clinic, Cardiovascular Medicine, Royal Perth Hospital, School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London, London, UK
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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152
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Plante TB, O'Kelly AC, Urrea B, Macfarlane ZT, Appel LJ, Miller III ER, Blumenthal RS, Martin SS. Auralife Instant Blood Pressure App in Measuring Resting Heart Rate: Validation Study. JMIR Biomed Eng 2018. [DOI: 10.2196/11057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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153
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Affiliation(s)
- Parag H Joshi
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX (P.H.J.).,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (P.H.J., S.S.M.)
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (P.H.J., S.S.M.).,Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
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154
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Wang J, Ashvetiya T, Quaye E, Parakh K, Martin SS. Online Health Searches and Their Perceived Effects on Patients and Patient-Clinician Relationships: ASystematic Review. Am J Med 2018; 131:1250.e1-1250.e10. [PMID: 29730361 DOI: 10.1016/j.amjmed.2018.04.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Online health searches are common and may be impacting patients and their relationships with their clinicians in ways that are not fully understood. We searched PubMed, Embase, Cochrane Reviews, Cochrane Trials, Scopus, and CINAHL from January 1, 1990 to January 29, 2016 for studies in which patients searched online for any aspect of health care and then visited their clinician. We extracted data pertaining to either patients' or clinicians' perceptions of the effects of these online searches on patients and the patient-clinician relationship. Searches seemed to induce patient anxiety but more often led to patient reassurance, clinical understanding, and empowerment. Patients tended to perceive that online health searches had a positive effect on the patient-clinician relationship, although the nature of the effect could depend on the clinician's response to patient queries about the information. Clinicians generally perceived neutral effects on patients and the patient-clinician relationship and commonly raised concerns about the accuracy of online content. Significant methodologic heterogeneity prevented quantitative synthesis. Accuracy of online health search content was not assessed, and randomized controlled trials were notably lacking.
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Affiliation(s)
- Jane Wang
- Johns Hopkins University School of Medicine, Baltimore, Md.
| | | | - Emmanuel Quaye
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | | | - Seth S Martin
- Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
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155
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Sniderman AD, de Graaf J, Thanassoulis G, Tremblay AJ, Martin SS, Couture P. The spectrum of type III hyperlipoproteinemia. J Clin Lipidol 2018; 12:1383-1389. [PMID: 30318453 DOI: 10.1016/j.jacl.2018.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 03/28/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Type III hyperlipoproteinemia is a highly atherogenic dyslipoproteinemia characterized by hypercholesterolemia and hypertriglyceridemia due to markedly increased numbers of cholesterol-enriched chylomicron and very-low-density lipoprotein (VLDL) remnant lipoprotein particles. Type III can be distinguished from mixed hyperlipidemia based on a simple diagnostic algorithm, which involves total cholesterol, triglycerides, and apolipoprotein B (apoB). However, apoB is not measured routinely. OBJECTIVE The objective of the present study was to determine if patients with type III could be distinguished from mixed hyperlipidemia based on lipoprotein lipids. METHODS Classification was based first on total cholesterol and triglyceride and then on the apoB diagnostic algorithm using apoB plus total cholesterol plus triglycerides, and validated by sequential ultracentrifugation. Four hundred and forty normals, 637 patients with hypertriglyceridemia, and 714 with hypertriglyceridemia and hypercholesterolemia were studied. Plasma lipoproteins were separated by sequential ultracentrifugation and heparin-manganese precipitation. Cholesterol, triglyceride, and apoB were measured in plasma and isolated lipoprotein fractions. RESULTS Of the 1351 patients with hypertriglyceridemia, 49 had type III hyperlipoproteinemia, as diagnosed by the apoB algorithm and validated by ultracentrifugation. Plasma triglycerides were higher in the type III subjects: 4.16 mmol/L (3.35-6.08, 25th-75th percentile), but there was considerable overlap with the hypertriglyceridemic subjects 2.65 mmol/L (1.91-4.20, 25th-75th percentile) and the combined hyperlipidemic subjects 3.02 mmol/L (2.07-5.32, 25th-75th percentile). Similarly, total cholesterol was 4.79 mmol/L (4.31-5.58, 25th-75th percentile) for type III vs 5.5 mmol/L (4.64-5.78, 25th-75th percentile) and 7.02 mmol/L (6.39-7.96, 25th-75th percentile), respectively. By contrast, as identified by the apoB algorithm, the VLDL-C/TG, VLDL-C/VLDL-TG, VLDL-C/VLDL apoB, and VLDL apoB/LDL apoB ratios were all higher in type III than in the other hypertriglyceridemic dyslipoproteinemias with the exception of type V as diagnosed by the apoB algorithm. CONCLUSION Cholesterol and triglycerides cannot reliably distinguish type III hyperlipoproteinemia from mixed hyperlipidemia. Adding apoB and applying the apoB algorithm makes reliable diagnosis possible and easy. However, unless apoB is introduced into routine clinical care, type III hyperlipoproteinemia will often not be recognized. Given the cardiovascular risk associated with type III and its responsiveness to treatment, this should not be acceptable.
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Affiliation(s)
- Allan D Sniderman
- Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Jacqueline de Graaf
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - George Thanassoulis
- Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - André J Tremblay
- Centre Hospitalier de l'Universite Laval, Quebec, Quebec, Canada
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick Couture
- Centre Hospitalier de l'Universite Laval, Quebec, Quebec, Canada
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156
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Pallazola VA, Quispe R, Elshazly MB, Vakil R, Sathiyakumar V, Jones SR, Martin SS. Time to Make a Change: Assessing LDL-C Accurately in the Era of Modern Pharmacotherapeutics and Precision Medicine. Curr Cardiovasc Risk Rep 2018. [DOI: 10.1007/s12170-018-0590-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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157
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Affiliation(s)
- Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.
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158
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Affiliation(s)
- Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (R.S.B., K.N., S.S.M.)
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (R.S.B., K.N., S.S.M.).,Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (K.N.).,Center for Outcomes Research & Evaluation (CORE), Yale New Haven Health Services Corp, CT (K.N.)
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (R.S.B., K.N., S.S.M.)
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159
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Plante TB, O’Kelly AC, Urrea B, MacFarlane ZT, Blumenthal RS, Charleston J, Miller ER, Appel LJ, Martin SS. User experience of instant blood pressure: exploring reasons for the popularity of an inaccurate mobile health app. NPJ Digit Med 2018; 1:31. [PMID: 31304313 PMCID: PMC6550164 DOI: 10.1038/s41746-018-0039-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/12/2018] [Accepted: 06/20/2018] [Indexed: 01/21/2023] Open
Abstract
Instant blood pressure (IBP) is a top-selling yet inaccurate blood pressure (BP)-measuring app that underreports elevated BP. Its iTunes app store user ratings and reviews were generally positive. Whether underreporting of elevated BP improves user experience is unknown. Participants enrolled at five clinics estimated their BP, measured their BP with IBP, then completed a user experience survey. Participants were grouped based on how their IBP BP measurements compared to their estimated BP (IBP Lower, IBP Similar, or IBP Higher). Logistic regressions compared odds of rating "agree" or "strongly agree" on survey questions by group. Most participants enjoyed using the app. In the adjusted model, IBP Higher had significantly lower proportions reporting enjoyment and motivation to check BP in the future than IBP Similar. All three groups were comparable in perceived accuracy of IBP and most participants perceived it to be accurate. However, user enjoyment and likelihood of future BP monitoring were negatively associated with higher-than-expected reported systolic BP. These data suggest reassuring app results from an inaccurate BP-measuring app may have improved user experience, which may have led to more positive user reviews and greater sales. Systematic underreporting of elevated BPs may have been a contributor to the app's success. Further studies are needed to confirm whether falsely reassuring output from other mobile health apps improve user experience and drives uptake.
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Affiliation(s)
- Timothy B. Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT USA
| | - Anna C. O’Kelly
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Bruno Urrea
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Zane T. MacFarlane
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD USA
| | - Roger S. Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Chemistry, Pomona College, Claremont, CA USA
| | - Jeanne Charleston
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Edgar R. Miller
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD USA
| | - Seth S. Martin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD USA
- Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD USA
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160
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Feldman DI, Theodore Robison W, Pacor JM, Caddell LC, Feldman EB, Deitz RL, Feldman T, Martin SS, Nasir K, Blaha MJ. Harnessing mHealth technologies to increase physical activity and prevent cardiovascular disease. Clin Cardiol 2018; 41:985-991. [PMID: 29671879 DOI: 10.1002/clc.22968] [Citation(s) in RCA: 26] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/04/2018] [Accepted: 04/16/2018] [Indexed: 11/11/2022] Open
Abstract
Research into prevention of cardiovascular disease has increasingly focused on mobile health (mHealth) technologies and their efficacy in helping individuals adhere to heart-healthy recommendations, including daily physical activity levels. By including the use of mHealth technologies in the discussion of physical activity recommendations, clinicians empower patients to play an active daily role in modifying their cardiovascular risk-factor profile. In this review, we critically evaluate the mHealth and physical activity literature to determine how these tools may lower cardiovascular risk while providing real-time tracking, feedback, and motivation on physical activity levels. We analyze the various domains-including user knowledge, social support, behavioral change theory, and self-motivation-that potentially influence the effectiveness of smartphone applications to impact individual physical activity levels. In doing so, we hope to provide a thorough overview of the mHealth landscape, in addition to highlighting many of the administrative, reimbursement, and patient-privacy challenges of using these technologies in patient care. Finally, we propose a behavioral change model and checklist for clinicians to assist patients in utilizing mHealth technology to best achieve meaningful changes in daily physical activity levels.
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Affiliation(s)
- David I Feldman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - W Theodore Robison
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin M Pacor
- Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Luke C Caddell
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Erica B Feldman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Rachel L Deitz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Theodore Feldman
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
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161
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Kallergi G, Aggouraki D, Zacharopoulou N, Stournaras C, Georgoulias V, Martin SS. Evaluation of α-tubulin, detyrosinated α-tubulin, and vimentin in CTCs: identification of the interaction between CTCs and blood cells through cytoskeletal elements. Breast Cancer Res 2018; 20:67. [PMID: 29976237 PMCID: PMC6034292 DOI: 10.1186/s13058-018-0993-z] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 05/25/2018] [Indexed: 01/16/2023] Open
Abstract
Background Circulating tumor cells (CTCs) are the major players in the metastatic process. A potential mechanism of cell migration and invasion is the formation of microtentacles in tumor cells. These structures are supported by α-tubulin (TUB), detyrosinated α-tubulin (GLU), and vimentin (VIM). In the current study, we evaluated the expression of those cytoskeletal proteins in CTCs. Methods Forty patients with breast cancer (BC) (16 early and 24 metastatic) were enrolled in the study. CTCs were isolated using the ISET platform and stained with the following combinations of antibodies: pancytokeratin (CK)/VIM/TUB and CK/VIM/GLU. Samples were analyzed with the ARIOL platform and confocal laser scanning microscopy. Results Fluorescence quantification revealed that the ratios CK/TUB, CK/VIM, and CK/GLU were statistically increased in MCF7 compared with more aggressive cell lines (SKBR3 and MDA-MB-231). In addition, all of these ratios were statistically increased in MCF7 cells compared with metastatic BC patients’ CTCs (p = 0.0001, p = 0.0001, and p = 0.003, respectively). Interestingly, intercellular connections among CTCs and between CTCs and blood cells through cytoskeleton bridges were revealed, whereas microtentacles were increased in patients with CTC clusters. These intercellular connections were supported by TUB, VIM, and GLU. Quantification of the examined molecules revealed that the median intensity of TUB, GLU, and VIM was significantly increased in patients with metastatic BC compared with those with early disease (TUB, 62.27 vs 11.5, p = 0.0001; GLU, 6.99 vs 5.29, p = 0.029; and VIM, 8.24 vs 5.38, p = 0.0001, respectively). Conclusions CTCs from patients with BC aggregate to each other and to blood cells through cytoskeletal protrusions, supported by VIM, TUB, and GLU. Quantification of these molecules could potentially identify CTCs related to more aggressive disease. Electronic supplementary material The online version of this article (10.1186/s13058-018-0993-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G Kallergi
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Heraklion, Greece. .,Department of Biochemistry, University of Crete, Greece Medical School, Heraklion, Greece.
| | - D Aggouraki
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Heraklion, Greece
| | - N Zacharopoulou
- Department of Biochemistry, University of Crete, Greece Medical School, Heraklion, Greece
| | - C Stournaras
- Department of Biochemistry, University of Crete, Greece Medical School, Heraklion, Greece
| | - V Georgoulias
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Heraklion, Greece
| | - S S Martin
- Department of Physiology, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, USA
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162
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Sathiyakumar V, Kapoor K, Jones SR, Banach M, Martin SS, Toth PP. Novel Therapeutic Targets for Managing Dyslipidemia. Trends Pharmacol Sci 2018; 39:733-747. [PMID: 29970260 DOI: 10.1016/j.tips.2018.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/16/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in developed nations. Therapeutic modulation of dyslipidemia by inhibiting 3'-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase is standard practice throughout the world. However, based on findings from Mendelian studies and genetic sequencing in prospective longitudinal cohorts from around the world, novel therapeutic targets regulating lipid and lipoprotein metabolism, such as apoprotein C3, angiopoietin-like proteins 3 and 4, and lipoprotein(a), have been identified. These targets may provide additional avenues to prevent and treat atherosclerotic disease. We therefore review these novel molecular targets by addressing available Mendelian and observational data, therapeutic agents in development, and early outcomes results.
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Affiliation(s)
- Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karan Kapoor
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, CGH Medical Center, Sterling, IL, USA.
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163
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Lenga L, Czwikla R, Wichmann JL, Leithner D, Albrecht MH, D'Angelo T, Arendt CT, Booz C, Hammerstingl R, Vogl TJ, Martin SS. Dual-energy CT in patients with abdominal malignant lymphoma: impact of noise-optimised virtual monoenergetic imaging on objective and subjective image quality. Clin Radiol 2018; 73:833.e19-833.e27. [PMID: 29884524 DOI: 10.1016/j.crad.2018.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/25/2018] [Indexed: 12/12/2022]
Abstract
AIM To investigate the impact of noise-optimised virtual monoenergetic imaging (VMI+) reconstructions on quantitative and qualitative image parameters in patients with malignant lymphoma at dual-energy computed tomography (DECT) examinations of the abdomen. MATERIALS AND METHODS Thirty-five consecutive patients (mean age, 53.8±18.6 years; range, 21-82 years) with histologically proven malignant lymphoma of the abdomen were included retrospectively. Images were post-processed with standard linear blending (M_0.6), traditional VMI, and VMI+ technique at energy levels ranging from 40 to 100 keV in 10 keV increments. Signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were objectively measured in lymphoma lesions. Image quality, lesion delineation, and image noise were rated subjectively by three blinded observers using five-point Likert scales. RESULTS Quantitative image quality parameters peaked at 40-keV VMI+ (SNR, 15.77±7.74; CNR, 18.27±8.04) with significant differences compared to standard linearly blended M_0.6 (SNR, 7.96±3.26; CNR, 13.55±3.47) and all traditional VMI series (p<0.001). Qualitative image quality assessment revealed significantly superior ratings for image quality at 60-keV VMI+ (median, 5) in comparison with all other image series (p<0.001). Assessment of lesion delineation showed the highest rating scores for 40-keV VMI+ series (median, 5), while lowest subjective image noise was found for 100-keV VMI+ reconstructions (median, 5). CONCLUSION Low-keV VMI+ reconstructions led to improved image quality and lesion delineation of malignant lymphoma lesions compared to standard image reconstruction and traditional VMI at abdominal DECT examinations.
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Affiliation(s)
- L Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - R Czwikla
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - J L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
| | - D Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - M H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - T D'Angelo
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - C T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - C Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - R Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - T J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - S S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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164
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Sniderman AD, Couture P, Martin SS, DeGraaf J, Lawler PR, Cromwell WC, Wilkins JT, Thanassoulis G. Hypertriglyceridemia and cardiovascular risk: a cautionary note about metabolic confounding. J Lipid Res 2018; 59:1266-1275. [PMID: 29769239 DOI: 10.1194/jlr.r082271] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 11/30/2017] [Revised: 05/14/2018] [Indexed: 12/22/2022] Open
Abstract
Triglycerides are the conventional tool to measure VLDLs, whereas LDL cholesterol (LDL-C) is the conventional tool to measure LDLs. Multiple epidemiological studies, including a series of genetically based analyses, have demonstrated that cardiovascular risk is related to triglycerides independently of LDL-C, and this has led to a series of new therapeutic agents designed specifically to reduce plasma triglycerides. The triglyceride hypothesis posits that increased levels of triglycerides increase cardiovascular risk and decreasing plasma triglycerides decreases cardiovascular risk. In this work, we will examine the validity of the triglyceride hypothesis by detailing the biological complexities associated with hypertriglyceridemia, the genetic epidemiological evidence in favor of hypertriglyceridemia, the evidence from the fibrate randomized clinical trials relating triglycerides and clinical outcomes, and the completeness of the evidence from the initial studies of novel mutations and the therapeutic agents based on these mutations that lower triglycerides. Because of the multiple metabolic links between VLDL and LDL, we will try to demonstrate that measuring triglycerides and LDL-C alone are inadequate to document the lipoprotein profile. We will try to demonstrate that apoB must be measured, as well as triglycerides and cholesterol, to have an accurate estimate of lipoprotein status.
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Affiliation(s)
| | - Patrick Couture
- Centre Hospitalier Universitaire de Québec, Quebec, Quebec, Canada
| | - Seth S Martin
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, John Hopkins University School of Medicine, Baltimore, MD
| | - Jacqueline DeGraaf
- Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, Heart and Stroke, Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, Toronto, Ontario, Canada
| | | | - John T Wilkins
- Departments of Medicine (Cardiology) and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Silverman-Lloyd LG, Kianoush S, Blaha MJ, Sabina AB, Graham GN, Martin SS. mActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges. JMIR Mhealth Uhealth 2018; 6:e121. [PMID: 29752250 PMCID: PMC5970286 DOI: 10.2196/mhealth.9292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/23/2018] [Accepted: 03/20/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Evidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment. OBJECTIVE This study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study. METHODS We enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey. RESULTS A total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=-6.95×10-3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=-.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=-.153 per 1000 steps) and 30-min level (mean individualized beta=-1.66 per 1000 steps). CONCLUSIONS Although there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study.
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Affiliation(s)
- Luke G Silverman-Lloyd
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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166
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Quispe R, Baradaran Noveiry B, Faridi KF, Martin SS, Toth PP, Jones SR. Abstract 422: Association of Remnant Lipoprotein Cholesterol and Levels of Glucose and Insulin: the Very Large Database of Lipids. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
A defining feature of diabetic dyslipidemia is elevation of triglyceride-rich lipoproteins, particularly remnant lipoprotein cholesterol (RLP-C). Lowering these lipoproteins may reduce risk of atherosclerotic cardiovascular disease in diabetic patients, though the relationship between RLP-C and hyperglycemia as well as hyperinsulinemia remains inadequately characterized. The purpose of this study was to determine the association of RLP-C with serum glucose and insulin across a broad range of insulin resistance.
Methods:
We used a sample of individuals from the Very Large Database of Lipids with measured fasting serum glucose and insulin levels, as well as lipoprotein cholesterol levels measured by the Vertical Auto Profile test (Atherotech, Birmingham, AL). RLP-C was defined as the sum of VLDL
3
-C + IDL-C. The study population was divided into deciles of HOMA-IR, calculated as [Insulin х Glucose/405]. We performed multivariable linear regression models to determine associations of RLP-C with insulin and glucose after adjusting for age, sex, real LDL-C, triglycerides, AST, BUN and creatinine. Covariates not normally distributed were log-transformed. Analysis was performed in overall population and across HOMA-IR deciles.
Results:
We included a total of 146,826 individuals (43.6% male, mean age 54.9 ± 15.9 years). Median values were: insulin, 9 uU/mL; glucose, 95 mg/dL; RLP-C, 26 mg/dL. The models in our Table explained 60% of variance in RLP-C. Overall, insulin (β=-1.85, p<0.001) and glucose (β=-0.84, p<0.001) had significant negative associations with RLP-C. However, levels of RLP-C were significantly associated with insulin but not glucose across most HOMA-IR deciles (Table).
Conclusion:
RLP-C is significantly associated with levels of serum insulin but not with glucose across a spectrum of insulin resistance. Further characterization of the relationship between RLP-C and serum insulin is needed to help guide future therapies for patients with diabetes.
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Affiliation(s)
- Renato Quispe
- Johns Hopkins Univ, Jacobi Med Cntr/Albert Einstein College of Medicine, New York, NY
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167
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Al Rifai M, Martin SS, McEvoy JW, Nasir K, Blankstein R, Yeboah J, Miedema M, Shea SJ, Polak JF, Ouyang P, Blumenthal RS, Bittencourt M, Bensenor I, Santos RD, Duncan BB, Santos IS, Lotufo PA, Blaha MJ. The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol <70 mg/dL: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Atherosclerosis 2018; 274:61-66. [PMID: 29751286 DOI: 10.1016/j.atherosclerosis.2018.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The prevalence and correlates of subclinical atherosclerosis when low-density lipoprotein cholesterol (LDL-C) levels are low remain unclear. Therefore, we examined the association of cardiovascular risk factors and subclinical atherosclerosis among individuals with untreated LDL-C <70 mg/dL. METHODS We included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohorts. To optimize accuracy, LDL-C was calculated by the validated Martin/Hopkins equation that uses an adjustable factor for the ratio of triglycerides to very low-density lipoprotein cholesterol. We defined subclinical atherosclerosis as a coronary artery calcium (CAC) score >0 in the combined cohort or common carotid intima media thickness (cIMT) in the 4th quartile, using cohort-specific cIMT distributions at baseline. Logistic regression models examined the cross-sectional associations of cardiovascular risk factors and subclinical atherosclerosis. RESULTS Among 9411 participants not on lipid lowering therapy, 263 (3%) had LDL-C <70 mg/dL (MESA: 206, ELSA: 57). Mean age in this population was 58 (SD 12) years, with 43% men, and 41% Black. The prevalence of CAC >0 in those with untreated LDL-C<70 mg/dL was 30%, and 18% were in 4th quartile of cIMT. In demographically adjusted models, only ever smoking was significantly associated with both CAC and cIMT. Similar results were obtained in risk factor-adjusted models (smoking: OR, 2.29; 95% CI, 1.10-4.80 and OR, 3.44; 95% CI, 1.41-8.37 for CAC and cIMT, respectively). CONCLUSIONS Among middle-aged to older individuals with untreated LDL-C <70 mg/dL, subclinical atherosclerosis remains moderately common and is associated with cigarette smoking.
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Affiliation(s)
- Mahmoud Al Rifai
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; Department of Internal Medicine, Kansas University School of Medicine, Wichita, KS, USA
| | - Seth S Martin
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - John W McEvoy
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph Yeboah
- Department of Cardiology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Michael Miedema
- Minneapolis Heart Institute Foundation, Minneapolis, MS, USA
| | - Steven J Shea
- Departments of Medicine and Epidemiology, Columbia University, New York, NY, USA
| | - Joseph F Polak
- Department of Radiology, Tufts University School of Medicine, Boston, MA, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - Marcio Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil
| | - Raul D Santos
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Bruce B Duncan
- Faculty of Medicine, Federal University of Rio Grande do Sul, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
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Gandapur Y, Kianoush S, Kelli HM, Misra S, Urrea B, Blaha MJ, Graham G, Marvel FA, Martin SS. The role of mHealth for improving medication adherence in patients with cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes 2018; 2:237-244. [PMID: 29474713 DOI: 10.1093/ehjqcco/qcw018] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality worldwide, and a key barrier to improved outcomes is medication non-adherence. The aim of this study is to review the role of mobile health (mHealth) tools for improving medication adherence in patients with cardiovascular disease. We performed a systematic search for randomized controlled trials that primarily investigated mHealth tools for improving adherence to cardiovascular disease medications in patients with hypertension, coronary artery disease, heart failure, peripheral arterial disease, and stroke. We extracted and reviewed data on the types of mHealth tools used, preferences of patients and healthcare providers, the effect of the mHealth interventions on medication adherence, and the limitations of trials. We identified 10 completed trials matching our selection criteria, mostly with <100 participants, and ranging in duration from 1 to 18 months. mHealth tools included text messages, Bluetooth-enabled electronic pill boxes, online messaging platforms, and interactive voice calls. Patients and healthcare providers generally preferred mHealth to other interventions. All 10 studies reported that mHealth interventions improved medication adherence, though the magnitude of benefit was not consistently large and in one study was not greater than a telehealth comparator. Limitations of trials included small sample sizes, short duration of follow-up, self-reported outcomes, and insufficient assessment of unintended harms and financial implications. Current evidence suggests that mHealth tools can improve medication adherence in patients with cardiovascular diseases. However, high-quality clinical trials of sufficient size and duration are needed to move the field forward and justify use in routine care.
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Affiliation(s)
- Yousuf Gandapur
- Department of Internal Medicine, Good Samaritan/Union Memorial Hospital, 201 East University Parkway, Baltimore, MD 21218, USA
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Satish Misra
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruno Urrea
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garth Graham
- Aetna Foundation, Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Francoise A Marvel
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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169
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Rahman F, Martin SS, Whelton SP, Mody FV, Vaishnav J, McEvoy JW. Inflammation and Cardiovascular Disease Risk: A Case Study of HIV and Inflammatory Joint Disease. Am J Med 2018; 131:442.e1-442.e8. [PMID: 29269230 DOI: 10.1016/j.amjmed.2017.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 11/25/2017] [Accepted: 11/29/2017] [Indexed: 02/07/2023]
Abstract
The epidemiologic data associating infection and inflammation with increased risk of cardiovascular disease is well established. Patients with chronically upregulated inflammatory pathways, such as those with HIV and inflammatory joint diseases, often have a risk of future cardiovascular risk that is similar to or higher than patients with diabetes. Thus, it is of heightened importance for clinicians to consider the cardiovascular risk of patients with these conditions. HIV and inflammatory joint diseases are archetypal examples of how inflammatory disorders contribute to vascular disease and provide illustrative lessons that can be leveraged in the prevention of cardiovascular disease. Managing chronic inflammatory diseases calls for a multifaceted approach to evaluation and treatment of suboptimal lifestyle habits, accurate estimation of cardiovascular disease risk with potential upwards recalibration due to chronic inflammation, and more intensive treatment of risk factors because current tools often underestimate the risk in this population. This approach is further supported by the recently published CANTOS trial demonstrating that reducing inflammation can serve as a therapeutic target among persons with residual inflammatory risk for cardiovascular disease.
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Affiliation(s)
- Faisal Rahman
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Seth S Martin
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Seamus P Whelton
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Freny V Mody
- Department of Medicine, Greater Los Angeles Veterans Affairs Medical and Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at University of California, Los Angeles
| | | | - John William McEvoy
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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170
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Ong KL, Morris MJ, McClelland RL, Hughes TM, Maniam J, Fitzpatrick AL, Martin SS, Luchsinger JA, Rapp SR, Hayden KM, Sandfort V, Allison MA, Rye KA. Relationship of Lipids and Lipid-Lowering Medications With Cognitive Function: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2018; 187:767-776. [PMID: 29617947 DOI: 10.1093/aje/kwx329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/03/2017] [Indexed: 12/23/2022] Open
Abstract
Studies on the relationship of cholesterol concentrations and lipid-lowering medications with dementia risk have yielded inconsistent findings. Therefore, we investigated the association of lipid concentrations and lipid-lowering medications with cognitive function in the Multi-Ethnic Study of Atherosclerosis across 3 different cognitive domains assessed by means of the Cognitive Abilities Screening Instrument (CASI; version 2), the Digit Symbol Coding (DSC) Test, and the Digit Span (DS) Test in 2010-2012. After adjustment for sociodemographic and confounding factors, including concentrations of other lipids and use of lipid-lowering medication, higher total cholesterol, low-density lipoprotein cholesterol, and non-high-density-lipoprotein cholesterol concentrations were modestly associated with higher DS Test scores. None of the lipid parameters were associated with CASI or DSC Test scores. Similarly, changes in lipid concentrations were not associated with any cognitive function test score. Using treatment effects model analysis and after adjusting for confounding factors, including lipid concentrations, the use of any lipid-lowering medication, especially statins, was associated with higher scores on the CASI and backward DS tests but not on the DSC and forward DS tests. Our study does not support a robust association between lipid concentrations and cognitive function or between the use of lipid-lowering medication, especially statins, and worse cognitive function.
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Affiliation(s)
- Kwok Leung Ong
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Margaret J Morris
- Department of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn L McClelland
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Timothy M Hughes
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jayanthi Maniam
- Department of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Annette L Fitzpatrick
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, Washington
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - José A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, New York
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Veit Sandfort
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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171
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Sathiyakumar V, Park J, Quispe R, Elshazly MB, Michos ED, Banach M, Toth PP, Whelton SP, Blumenthal RS, Jones SR, Martin SS. Impact of Novel Low-Density Lipoprotein-Cholesterol Assessment on the Utility of Secondary Non-High-Density Lipoprotein-C and Apolipoprotein B Targets in Selected Worldwide Dyslipidemia Guidelines. Circulation 2018; 138:244-254. [PMID: 29506984 DOI: 10.1161/circulationaha.117.032463] [Citation(s) in RCA: 31] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Selected dyslipidemia guidelines recommend non-high-density lipoprotein-cholesterol (non-HDL-C) and apolipoprotein B (apoB) as secondary targets to the primary target of low-density lipoprotein-cholesterol (LDL-C). After considering 2 LDL-C estimates that differ in accuracy, we examined: (1) how frequently non-HDL-C guideline targets could change management; and (2) the utility of apoB targets after meeting LDL-C and non-HDL-C targets. METHODS We analyzed 2518 adults representative of the US population from the 2011 to 2012 National Health and Nutrition Examination Survey and 126 092 patients from the Very Large Database of Lipids study with apoB. We identified all individuals as well as those with high-risk clinical features, including coronary artery disease, diabetes mellitus, and metabolic syndrome who met very high- and high-risk guideline targets of LDL-C <70 and <100 mg/dL using Friedewald estimation (LDL-CF) and a novel, more accurate method (LDL-CN). Next, we examined those not meeting non-HDL-C (<100, <130 mg/dL) and apoB (<80, <100 mg/dL) guideline targets. In those meeting dual LDL-C and non-HDL-C targets (<70 and <100 mg/dL, respectively, or <100 and <130 mg/dL, respectively), we determined the proportion of individuals who did not meet guideline apoB targets (<80 or <100 mg/dL). RESULTS A total of 7% to 9% and 31% to 36% of individuals had LDL-C <70 and <100 mg/dL, respectively. Among those with LDL-CF<70 mg/dL, 14% to 15% had non-HDL-C ≥100 mg/dL, and 7% to 8% had apoB ≥80 mg/dL. Among those with LDL-CF<100 mg/dL, 8% to 10% had non-HDL-C ≥130 mg/dL and 2% to 3% had apoB ≥100 mg/dL. In comparison, among those with LDL-CN<70 or 100 mg/dL, only ≈2% and ≈1% of individuals, respectively, had non-HDL-C and apoB values above guideline targets. Similar trends were upheld among those with high-risk clinical features: ≈0% to 3% of individuals with LDL-CN<70 mg/dL had non-HDL-C ≥100 mg/dL or apoB ≥80 mg/dL compared with 13% to 38% and 9% to 25%, respectively, in those with LDL-CF<70 mg/dL. With LDL-CF or LDL-CN<70 mg/dL and non-HDL-C <100 mg/dL, 0% to 1% had apoB ≥80 mg/dL. Among all dual LDL-CF or LDL-CN<100 mg/dL and non-HDL-C <130 mg/dL individuals, 0% to 0.4% had apoB ≥100 mg/dL. These findings were robust to sex, fasting status, and lipid-lowering therapy status. CONCLUSIONS After more accurately estimating LDL-C, guideline-suggested non-HDL-C targets could alter management in only a small fraction of individuals, including those with coronary artery disease and other high-risk clinical features. Furthermore, current guideline-suggested apoB targets provide modest utility after meeting cholesterol targets. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01698489.
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Affiliation(s)
- Vasanth Sathiyakumar
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Jihwan Park
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.P.)
| | - Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Mohamed B Elshazly
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College-Qatar, Education City, Doha, Qatar (M.B.E.)
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Maciej Banach
- Department of Hypertension, Division of Nephrology and Hypertension, Medical University of Lodz, Poland (M.B.)
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.).,Department of Preventive Cardiology, CGH Medical Center, Sterling, IL (P.P.T.).,College of Medicine, University of Illinois, Peoria, IL (P.P.T.)
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.). .,Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M.)
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Rahman F, Blumenthal RS, Jones SR, Martin SS, Gluckman TJ, Whelton SP. Fasting or Non-fasting Lipids for Atherosclerotic Cardiovascular Disease Risk Assessment and Treatment? Curr Atheroscler Rep 2018; 20:14. [DOI: 10.1007/s11883-018-0713-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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173
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Aronis KN, Zhao D, Hoogeveen RC, Alonso A, Ballantyne CM, Guallar E, Jones SR, Martin SS, Nazarian S, Steffen BT, Virani SS, Michos ED. Associations of Lipoprotein(a) Levels With Incident Atrial Fibrillation and Ischemic Stroke: The ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc 2017; 6:JAHA.117.007372. [PMID: 29246963 PMCID: PMC5779047 DOI: 10.1161/jaha.117.007372] [Citation(s) in RCA: 30] [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: 12/24/2022]
Abstract
Background Lipoprotein(a) (Lp[a]) is proatherosclerotic and prothrombotic, causally related to coronary disease, and associated with other cardiovascular diseases. The association of Lp(a) with incident atrial fibrillation (AF) and with ischemic stroke among individuals with AF remains to be elucidated. Methods and Results In the community‐based ARIC (Atherosclerosis Risk in Communities) study cohort, Lp(a) levels were measured by a Denka Seiken assay at visit 4 (1996–1998). We used multivariable‐adjusted Cox models to compare AF and ischemic stroke risk across Lp(a) levels. First, we evaluated incident AF in 9908 participants free of AF at baseline. AF was ascertained by electrocardiography at study visits, hospital International Statistical Classification of Diseases, 9th Revision (ICD‐9) codes, and death certificates. We then evaluated incident ischemic stroke in 10 127 participants free of stroke at baseline. Stroke was identified by annual phone calls, hospital ICD‐9 Revision codes, and death certificates. The baseline age was 62.7±5.6 years. Median Lp(a) levels were 13.3 mg/dL (interquartile range, 5.2–39.7 mg/dL). Median follow‐up was 13.9 and 15.8 years for AF and stroke, respectively. Lp(a) was not associated with incident AF (hazard ratio, 0.98; 95% confidence interval, 0.82–1.17), comparing those with Lp(a) ≥50 with those with Lp(a) <10 mg/dL. High Lp(a) was associated with a 42% relative increase in stroke risk among participants without AF (hazard ratio, 1.42; 95% confidence interval, 1.07–1.90) but not in those with AF (hazard ratio, 1.06; 95% confidence interval, 0.70–1.61 [P interaction for AF=0.25]). There were no interactions by race or sex. No association was found for cardioembolic stroke subtype. Conclusions High Lp(a) levels were not associated with incident AF. Lp(a) levels were associated with increased ischemic stroke risk, primarily among individuals without AF but not in those with AF.
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Affiliation(s)
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ron C Hoogeveen
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Christie M Ballantyne
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Steven R Jones
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Seth S Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Saman Nazarian
- Division of Cardiology, University of Pennsylvania Medical System University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Brian T Steffen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Sathiyakumar V, Park J, Golozar A, Lazo M, Quispe R, Guallar E, Blumenthal RS, Jones SR, Martin SS. Fasting Versus Nonfasting and Low-Density Lipoprotein Cholesterol Accuracy. Circulation 2017; 137:10-19. [PMID: 29038168 DOI: 10.1161/circulationaha.117.030677] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/25/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent recommendations favoring nonfasting lipid assessment may affect low-density lipoprotein cholesterol (LDL-C) estimation. The novel method of LDL-C estimation (LDL-CN) uses a flexible approach to derive patient-specific ratios of triglycerides to very low-density lipoprotein cholesterol. This adaptability may confer an accuracy advantage in nonfasting patients over the fixed approach of the classic Friedewald method (LDL-CF). METHODS We used a US cross-sectional sample of 1 545 634 patients (959 153 fasting ≥10-12 hours; 586 481 nonfasting) from the second harvest of the Very Large Database of Lipids study to assess for the first time the impact of fasting status on novel LDL-C accuracy. Rapid ultracentrifugation was used to directly measure LDL-C content (LDL-CD). Accuracy was defined as the percentage of LDL-CD falling within an estimated LDL-C (LDL-CN or LDL-CF) category by clinical cut points. For low estimated LDL-C (<70 mg/dL), we evaluated accuracy by triglyceride levels. The magnitude of absolute and percent differences between LDL-CD and estimated LDL-C (LDL-CN or LDL-CF) was stratified by LDL-C and triglyceride categories. RESULTS In both fasting and nonfasting samples, accuracy was higher with the novel method across all clinical LDL-C categories (range, 87%-94%) compared with the Friedewald estimation (range, 71%-93%; P≤0.001). With LDL-C <70 mg/dL, nonfasting LDL-CN accuracy (92%) was superior to LDL-CF accuracy (71%; P<0.001). In this LDL-C range, 19% of fasting and 30% of nonfasting patients had differences ≥10 mg/dL between LDL-CF and LDL-CD, whereas only 2% and 3% of patients, respectively, had similar differences with novel estimation. Accuracy of LDL-C <70 mg/dL further decreased as triglycerides increased, particularly for Friedewald estimation (range, 37%-96%) versus the novel method (range, 82%-94%). With triglycerides of 200 to 399 mg/dL in nonfasting patients, LDL-CN <70 mg/dL accuracy (82%) was superior to LDL-CF (37%; P<0.001). In this triglyceride range, 73% of fasting and 81% of nonfasting patients had ≥10 mg/dL differences between LDL-CF and LDL-CD compared with 25% and 20% of patients, respectively, with LDL-CN. CONCLUSIONS Novel adaptable LDL-C estimation performs better in nonfasting samples than the fixed Friedewald estimation, with a particular accuracy advantage in settings of low LDL-C and high triglycerides. In addition to stimulating further study, these results may have immediate relevance for guideline committees, laboratory leadership, clinicians, and patients. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01698489.
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Affiliation(s)
- Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
| | - Jihwan Park
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
| | - Asieh Golozar
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mariana Lazo
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
| | - Renato Quispe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Eliseo Guallar
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.).
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Pokharel Y, Tang Y, Bhardwaj B, Patel KK, Qintar M, O'Keefe JH, Kulkarni KR, Jones PH, Martin SS, Virani SS, Spertus JA. Association of low-density lipoprotein pattern with mortality after myocardial infarction: Insights from the TRIUMPH study. J Clin Lipidol 2017; 11:1458-1470.e4. [PMID: 29050980 DOI: 10.1016/j.jacl.2017.09.002] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/21/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies of incident coronary heart disease risk within low-density lipoprotein (LDL) subclass (small, dense vs large, buoyant) have shown mixed results. No prospective cohort study has examined the association of small, dense, or large, buoyant LDL with mortality after myocardial infarction (MI). OBJECTIVE The objective of the study was to examine association of LDL pattern after MI and death. METHODS In 2476 patients hospitalized for MI, LDL pattern (A [large, buoyant], A/B [mixed], and B [small, dense]) was established by ultracentrifugation using Vertical Auto Profile. Using time-to-event analysis, we examined the association with 5-year mortality within LDL patterns, after adjusting for important patient and treatment characteristics. We additionally adjusted for LDL cholesterol (LDL-C) and triglyceride levels and used directly measured LDL-C and non-high-density lipoprotein cholesterol as exposures. RESULTS Patterns A, A/B, and B were present in 39%, 28%, and 33% of patients, respectively, with incident rates (per 1000 patient-years) of 50, 34, and 24 for all-cause and 24, 19, and 10 for CV mortality. The hazard ratios (95% confidence interval) with LDL patterns A/B and B compared with pattern A were 0.77 (0.61, 0.99) and 0.67 (0.51, 0.88) for all-cause, 0.94 (0.67, 1.33) and 0.69 (0.46, 1.03) for cardiovascular, and 0.64 (0.45, 0.91) and 0.65 (0.45, 0.93) for noncardiovascular mortalities, respectively. Results were similar when further adjusted for LDL-C and triglycerides, or with LDL-C and non-high-density lipoprotein cholesterol as exposures. CONCLUSION Compared with LDL pattern A, pattern B was significantly associated with reduced all-cause and non-CV mortalities with a trend for lower CV mortality after MI, independent of LDL-C and triglycerides.
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Affiliation(s)
- Yashashwi Pokharel
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
| | - Yuanyuan Tang
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Bhaskar Bhardwaj
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Krishna K Patel
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Mohammed Qintar
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - James H O'Keefe
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Krishnaji R Kulkarni
- VAP Diagnostics Laboratory (formerly Atherotech Diagnostics Lab), Birmingham, AL, USA
| | - Peter H Jones
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Seth S Martin
- Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX, USA
| | - John A Spertus
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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Martin SS, Daya N, Lutsey PL, Matsushita K, Fretz A, McEvoy JW, Blumenthal RS, Coresh J, Greenland P, Kottgen A, Selvin E. Thyroid Function, Cardiovascular Risk Factors, and Incident Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study. J Clin Endocrinol Metab 2017; 102:3306-3315. [PMID: 28605456 PMCID: PMC5587060 DOI: 10.1210/jc.2017-00986] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/07/2017] [Indexed: 12/31/2022]
Abstract
CONTEXT Cardiovascular outcomes in mild thyroid dysfunction (treatment controversial) and moderate or severe dysfunction (treatment standard) remain uncertain. OBJECTIVE To examine cross-sectional and prospective associations of thyroid function with cardiovascular risk factors and events. DESIGN In the Atherosclerosis Risk in Communities Study, we measured concentrations of thyrotropin, free thyroxine, and total triiodothyronine (T3) in stored serum samples originally collected in 1990-1992. We used multivariable linear regression to assess cross-sectional associations of thyroid function with cardiovascular risk factors and Cox regression to assess prospective associations with cardiovascular events. Follow-up occurred through 31 December 2014. SETTING General community. PARTICIPANTS Black and white men and women from the United States, without prior myocardial infarction (MI), stroke, or heart failure. MAIN OUTCOMES AND MEASURES Cross-sectional outcomes were blood pressure, glycemic markers, and blood lipids. Prospective outcomes were adjudicated fatal and nonfatal MI and stroke. RESULTS Among 11,359 participants (57 ± 6 years, 58% women), thyroid function was more strongly associated with blood lipids than blood pressure or glycemic measures. Mean adjusted differences in low-density lipoprotein cholesterol were +15.1 (95% confidence interval: 10.5 to 19.7) and +3.2 (0.0 to 6.4) mg/dL in those with moderate/severe and mild chemical hypothyroidism, relative to euthyroidism; an opposite pattern was seen in hyperthyroidism. Similar differences were seen in triglycerides and non-high-density lipoprotein cholesterol. With a 22.5-year median follow-up, 1102 MIs and 838 strokes occurred, with similar outcomes among baseline thyroid function groups and by T3 concentrations. CONCLUSIONS Hypothyroidism is associated with hyperlipidemia, but the magnitude is small in mild chemical hypothyroidism, and cardiovascular outcomes are similar between thyroid function groups.
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Affiliation(s)
- Seth S. Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55454
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
| | - Anna Fretz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
| | - John W. McEvoy
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Anna Kottgen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
- Division of Genetic Epidemiology, Medical Center–University of Freiburg, 79106 Freiburg, Germany
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland 21205
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Streed CG, Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular Disease Among Transgender Adults Receiving Hormone Therapy: A Narrative Review. Ann Intern Med 2017; 167:256-267. [PMID: 28738421 DOI: 10.7326/m17-0577] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The lack of research to characterize cardiovascular disease (CVD) and CVD risk factors in transgender populations receiving cross-sex hormone therapy (CSHT) limits appropriate primary and specialty care. As with hormone therapy in cisgender persons (that is, those whose sex assigned at birth aligns with their gender identity), existing research in transgender populations suggests that CVD risk factors are altered by CSHT. Currently, systemic hormone replacement for cisgender adults requires a nuanced discussion based on baseline risk factors and age of administration of exogenous hormones because of concern regarding an increased risk for myocardial infarction and stroke. For transgender adults, CSHT has been associated with the potential for worsening CVD risk factors (such as blood pressure elevation, insulin resistance, and lipid derangements), although these changes have not been associated with increases in morbidity or mortality in transgender men receiving CSHT. For transgender women, CSHT has known thromboembolic risk, and lower-dose transdermal estrogen formulations are preferred over high-dose oral formulations. In addition, many studies of transgender adults focus predominantly on younger persons, limiting the generalizability of CSHT in older transgender adults. The lack of randomized controlled trials comparing various routes and formulations of CSHT, as well as the paucity of prospective cohort studies, limits knowledge of any associations between CSHT and CVD.
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Affiliation(s)
- Carl G Streed
- From Brigham and Women's Hospital, Boston, Massachusetts, and Johns Hopkins University, Baltimore, Maryland
| | - Omar Harfouch
- From Brigham and Women's Hospital, Boston, Massachusetts, and Johns Hopkins University, Baltimore, Maryland
| | - Francoise Marvel
- From Brigham and Women's Hospital, Boston, Massachusetts, and Johns Hopkins University, Baltimore, Maryland
| | - Roger S Blumenthal
- From Brigham and Women's Hospital, Boston, Massachusetts, and Johns Hopkins University, Baltimore, Maryland
| | - Seth S Martin
- From Brigham and Women's Hospital, Boston, Massachusetts, and Johns Hopkins University, Baltimore, Maryland
| | - Monica Mukherjee
- From Brigham and Women's Hospital, Boston, Massachusetts, and Johns Hopkins University, Baltimore, Maryland
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Affiliation(s)
- Elizabeth V Ratchford
- 1 Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S Martin
- 2 Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Brown WV, Handelsman Y, Martin SS, Morris PB. JCL roundtable: Future of the lipid laboratory: Using the laboratory to manage the patient (part 2). J Clin Lipidol 2017. [DOI: 10.1016/j.jacl.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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180
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Whelton SP, Meeusen JW, Donato LJ, Jaffe AS, Saenger A, Sokoll LJ, Blumenthal RS, Jones SR, Martin SS. Evaluating the atherogenic burden of individuals with a Friedewald-estimated low-density lipoprotein cholesterol <70 mg/dL compared with a novel low-density lipoprotein estimation method. J Clin Lipidol 2017; 11:1065-1072. [DOI: 10.1016/j.jacl.2017.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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Faridi KF, Lupton JR, Martin SS, Banach M, Quispe R, Kulkarni K, Jones SR, Michos ED. Vitamin D deficiency and non-lipid biomarkers of cardiovascular risk. Arch Med Sci 2017; 13:732-737. [PMID: 28721139 PMCID: PMC5510501 DOI: 10.5114/aoms.2017.68237] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/11/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Deficient 25-hydroxyvitamin D (25(OH)D) levels have been associated with dyslipidemia and cardiovascular diseases, though the underlying mechanism of these associations is uncertain. We analyzed associations between vitamin D and other non-lipid biomarkers of cardiovascular risk to better elucidate possible relationships between deficient 25(OH)D and cardiovascular disease. MATERIAL AND METHODS We performed a cross-sectional analysis of 4,591 adults included in a clinical laboratory database from 2009 to 2011 with available measurements for 25(OH)D and the following biomarkers: homocysteine (Hcy), high-sensitivity C-reactive protein (hs-CRP), cystatin-C, creatinine, γ-glutamyltransferase (GGT), uric acid, and hemoglobin A1c (HbA1c). We calculated odds ratios (OR) of having high levels of each biomarker associated with 25(OH)D deficiency (< 20 ng/ml) compared to optimal levels (≥ 30 ng/ml) using logistic regression adjusted for age, sex, and lipids. RESULTS The mean ± SD age was 60 ±14 years and 46% of patients were women. In multivariable-adjusted models, adults with deficient 25(OH)D compared to those with optimal levels had increased odds of elevated biomarkers as follows: Hcy (OR = 2.53, 95% CI: 1.92-3.34), hs-CRP (1.62, 1.36-1.93), cystatin-C (2.02, 1.52-2.68), creatinine (2.06, 1.35-3.14), GGT (1.39, 1.07-1.80), uric acid (1.60, 1.31-1.95), and HbA1c (2.47, 1.95-3.13). In analyses evaluating women and men separately, 25(OH)D deficient women but not men had increased odds of elevated levels of all biomarkers studied. There were significant interactions based on sex between 25(OH)D and Hcy (p = 0.003), creatinine (p = 0.004), uric acid (p = 0.040), and HbA1c (p = 0.037). CONCLUSIONS Deficient 25(OH)D is associated with elevated levels of many biomarkers of cardiovascular risk, particularly among women, in a United States population.
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Affiliation(s)
- Kamil F. Faridi
- Division of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Joshua R. Lupton
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Seth S. Martin
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Renato Quispe
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | | | - Steven R. Jones
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Erin D. Michos
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
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Abstract
Shared decision-making, central to evidence-based medicine and good patient care, begins and ends with the patient. It is the process by which a clinician and a patient jointly make a health decision after discussing options, potential benefits and harms, and considering the patient's values and preferences. Patient empowerment is crucial to shared decision-making and occurs when a patient accepts responsibility for his or her health. They can then learn to solve their own problems with information and support from professionals. Patient empowerment begins with the provider acknowledging that patients are ultimately in control of their care and aims to increase a patient's capacity to think critically and make autonomous, informed decisions about their health. This article explores the various components of shared decision-making in scenarios such as hypertension and hyperlipidemia, heart failure, and diabetes. It explores barriers and the potential for improving medication adherence, disease awareness, and self-management of chronic disease.
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Affiliation(s)
- Swetha Kambhampati
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.
| | - Tamara Ashvetiya
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
| | - Neil J Stone
- McGaw Medical Center, Northwestern University, Chicago, IL, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
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Brown WV, Handelsman Y, Martin SS, Morris PB. JCL roundtable: Future of the lipid laboratory: Choosing valuable measures among the lipoproteins (part 1). J Clin Lipidol 2017; 11:587-595. [DOI: 10.1016/j.jacl.2017.04.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sathiyakumar V, Martin SS, Jones S, Quinn J, Green R, Lesko A, Byrne K, Brown E. Real-World PCSK9i Experience: the Importance of a Multidisciplinary Approach. J Clin Lipidol 2017. [DOI: 10.1016/j.jacl.2017.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Joshi PH, Miller PE, Martin SS, Jones SR, Massaro JM, D’Agostino RB, Kulkarni KR, Sponseller C, Toth PP. Greater remnant lipoprotein cholesterol reduction with pitavastatin compared with pravastatin in HIV-infected patients. AIDS 2017; 31:965-971. [PMID: 28121706 DOI: 10.1097/qad.0000000000001423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in those with HIV. An emerging CVD risk factor is triglyceride-rich remnant lipoprotein cholesterol (RLP-C: the sum of intermediate-density lipoprotein and very low-density lipoprotein cholesterol). The effects of statin therapy on lipoprotein subfractions, including RLP-C, in HIV dyslipidemia are unknown. METHODS This is a post hoc analysis of the randomized INTREPID trial (NCT 01301066) comparing pitavastatin 4 mg daily vs. pravastatin 40 mg daily in study participants with HIV. We measured apolipoproteins AI and B and lipoprotein cholesterol subfractions separated by density gradient ultracentrifugation at baseline and 12 weeks. We compared changes in atherogenic subfractions over 12 weeks in INTREPID participants using analysis of covariance. RESULTS Lipoprotein subfraction data were available for 213 study participants (pitavastatin n = 104, pravastatin n = 109). Baseline characteristics were similar between treatment groups. Reductions in RLP-C were significantly greater in the pitavastatin group compared with pravastatin group (-11.6 mg/dl vs. -8.5 mg/dl; P = 0.01). Similarly, ratios of risk [apolipoproteins B/apolipoproteins AI, total cholesterol/high-density lipoprotein cholesterol (HDL-C)] showed greater reductions with pitavastatin (P < 0.05). There were no differences in changes in HDL-C, HDL-C subfractions or lipoprotein(a) cholesterol levels. CONCLUSION In patients with HIV, pitavastatin 4 mg/dl lowered both RLP-C and established apolipoprotein and lipid risk ratios more so than pravastatin 40 mg/dl. The impact of RLP-C reduction on CVD in HIV dyslipidemic patients merits further study.
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186
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Quispe R, Hendrani A, Elshazly MB, Michos ED, McEvoy JW, Blaha MJ, Banach M, Kulkarni KR, Toth PP, Coresh J, Blumenthal RS, Jones SR, Martin SS. Accuracy of low-density lipoprotein cholesterol estimation at very low levels. BMC Med 2017; 15:83. [PMID: 28427464 PMCID: PMC5399386 DOI: 10.1186/s12916-017-0852-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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] [Received: 11/28/2016] [Accepted: 04/04/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As the approach to low-density lipoprotein cholesterol (LDL-C) lowering becomes increasingly intensive, accurate assessment of LDL-C at very low levels warrants closer attention in individualized clinical efficacy and safety evaluation. We aimed to assess the accuracy of LDL-C estimation at very low levels by the Friedewald equation, the de facto clinical standard, and compare its accuracy with a novel, big data-derived LDL-C estimate. METHODS In 191,333 individuals with Friedewald LDL-C < 70 mg/dL, we compared the accuracy of Friedewald and novel LDL-C values in relation to direct measurements by Vertical Auto Profile ultracentrifugation. We examined differences (estimate minus ultracentrifugation) and classification according to levels initiating additional safety precautions per clinical practice guidelines. RESULTS Friedewald values were less than ultracentrifugation measurement, with a median difference (25th to 75th percentile) of -2.4 (-7.4 to 0.6) at 50-69 mg/dL, -7.0 (-16.2 to -1.2) at 25-39 mg/dL, and -29.0 (-37.4 to -19.6) at < 15 mg/dL. The respective values by novel estimation were -0.1 (-1.5 to 1.3), -1.1 (-2.5 to 0.3), and -2.7 (-4.9 to 0.0) mg/dL. Among those with Friedewald LDL-C < 15, 15 to < 25, and 25 to < 40 mg/dL, the classification was discordantly low in 94.9%, 82.6%, and 59.9% of individuals as compared with 48.3%, 42.4%, and 22.4% by novel estimation. CONCLUSIONS Estimation of even lower LDL-C values (by Friedewald and novel methods) is even more inaccurate. More often than not, a Friedewald value < 40 mg/dL is underestimated, which translates into unnecessary safety alarms that could be reduced in half by estimation using our novel method.
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Affiliation(s)
- Renato Quispe
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.
| | - Aditya Hendrani
- Department of Medicine, Medstar Good Samaritan/Union Memorial Hospital, Baltimore, MD, USA
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John W McEvoy
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | | | - Peter P Toth
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.,Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA.,University of Illinois College of Medicine, Peoria, IL, USA
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
| | - Steven R Jones
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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187
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Blumenthal RS, Gluckman TJ, Martin SS. Trends in the Use of Moderate-Intensity to High-Intensity Statin and Nonstatin Lipid-Lowering Therapy: Turning Off the Faucet Is Much More Valuable Than Mopping Up the Floor. JAMA Cardiol 2017; 2:355-356. [DOI: 10.1001/jamacardio.2016.6007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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)
- Roger S. Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ty J. Gluckman
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins University School of Medicine, Baltimore, Maryland2Providence Heart and Vascular Institute, Portland, Oregon
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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188
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Chin K, Zhao D, Tibuakuu M, Martin SS, Ndumele CE, Florido R, Windham BG, Guallar E, Lutsey PL, Michos ED. Physical Activity, Vitamin D, and Incident Atherosclerotic Cardiovascular Disease in Whites and Blacks: The ARIC Study. J Clin Endocrinol Metab 2017; 102:1227-1236. [PMID: 28323928 PMCID: PMC5460730 DOI: 10.1210/jc.2016-3743] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/13/2017] [Indexed: 01/01/2023]
Abstract
CONTEXT Physical activity (PA) is associated with 25-hydroxyvitamin D [25(OH)D] levels. Both are associated with atherosclerotic cardiovascular disease (ASCVD), but their joint association with ASCVD risk is unknown. OBJECTIVE To examine the relationship between PA and 25(OH)D, and assess effect modification of 25(OH)D and PA with ASCVD. DESIGN Cross-sectional and prospective study. SETTING Community-dwelling cohort. PARTICIPANTS A total of 10,342 participants free of ASCVD, with moderate- to vigorous-intensity PA assessed (1987 to 1989) and categorized per American Heart Association (AHA) guidelines (recommended, intermediate, or poor). MAIN OUTCOME MEASURES Serum 25(OH)D levels (1990 to 1992) and ASCVD events (i.e., incident myocardial infarction, fatal coronary disease, or stroke) through 2013. RESULTS Participants had mean age of 54 years, and were 57% women, 21% black, 30% 25(OH)D deficient [<20 ng/mL (<50 nmol/L)], and <40% meeting AHA-recommended PA. PA was linearly associated with 25(OH)D levels in whites. Whites meeting recommended PA were 37% less likely to have 25(OH)D deficiency [relative risk, 0.63 (95% confidence interval [CI], 0.56, 0.71)]; there was no significant association in blacks. Over 19.3 years of follow-up, 1800 incident ASCVD events occurred. Recommended PA was associated with reduced ASCVD risk [hazard ratio [HR], 0.78 (95% CI, 0.65, 0.93) and 0.76 (95% CI, 0.62, 0.93)] among participants with intermediate [20 to <30 ng/mL (50 to <75 nmol/L)] and optimal [≥30 ng/mL (≥75 nmol/L)] 25(OH)D, respectively, but not among those with deficient 25(OH)D (P for interaction = 0.04). CONCLUSION PA is linearly associated with higher 25(OH)D levels in whites. PA and 25(OH)D may have synergistic beneficial effects on ASCVD risk.
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Affiliation(s)
- Kathleen Chin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Chiadi E. Ndumele
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
| | - Roberta Florido
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
| | - B. Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
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189
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Faridi KF, Zhao D, Martin SS, Lupton JR, Jones SR, Guallar E, Ballantyne CM, Lutsey PL, Michos ED. Serum vitamin D and change in lipid levels over 5 y: The Atherosclerosis Risk in Communities study. Nutrition 2017; 38:85-93. [PMID: 28526388 DOI: 10.1016/j.nut.2017.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 08/20/2016] [Revised: 01/02/2017] [Accepted: 01/12/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Deficiency of 25-hydroxyvitamin D (25[OH]D) is associated with increased risk for cardiovascular disease, perhaps mediated through dyslipidemia. Deficient 25(OH)D is cross-sectionally associated with dyslipidemia, but little is known about longitudinal lipid changes. The aim of this study was to determine the relationship of 25(OH)D deficiency to longitudinal lipid changes and risk for incident dyslipidemia. METHODS This was a longitudinal community-based study of 13 039 participants from the ARIC (Atherosclerosis Risk in Communities) study who had 25(OH)D and lipids measured at baseline (1990-1992) and lipids remeasured in 1993 to 1994 and 1996 to 1998. Mixed-effect models were used to assess the association of 25(OH)D and lipid trends after adjusting for clinical characteristics and for baseline or incident use of lipid-lowering therapy. Risk for incident dyslipidemia was determined for those without baseline dyslipidemia. RESULTS Baseline mean ± SD age was 57 ± 6 y and 25(OH)D was 24 ± 9 ng/mL. Participants were 57% women, 24% black. Over a mean follow-up of 5.2 y, the fully adjusted average differences (95% confidence interval [CI]) comparing deficient (<20 ng/mL) to optimal (≥30 ng/mL) 25(OH)D were: total cholesterol (TC) -2.40 mg/dL (-4.21 to -0.60), high-density lipoprotein cholesterol (HDL-C) -3.02 mg/dL (-3.73 to -2.32) and the ratio of TC to HDL-C 0.18 (0.11-0.26). Those with deficient compared with optimal 25(OH)D had modestly increased risk for incident dyslipidemia in demographic-adjusted models (relative risk [RR], 1.19; 95% CI, 1.02-1.39), which was attenuated in fully adjusted models (RR, 1.12; 95% CI, 0.95-1.32). CONCLUSIONS Deficient 25(OH)D was prospectively associated with lower TC and HDL-C and a greater ratio of TC to HDL-C after considering factors such as diabetes and adiposity. Further work including randomized controlled trials is needed to better assess how 25(OH)D may affect lipids and cardiovascular risk.
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Affiliation(s)
- Kamil F Faridi
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seth S Martin
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua R Lupton
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven R Jones
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erin D Michos
- Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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190
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Miller PE, Zhao D, Frazier-Wood AC, Michos ED, Averill M, Sandfort V, Burke GL, Polak JF, Lima JAC, Post WS, Blumenthal RS, Guallar E, Martin SS. Associations of Coffee, Tea, and Caffeine Intake with Coronary Artery Calcification and Cardiovascular Events. Am J Med 2017; 130:188-197.e5. [PMID: 27640739 PMCID: PMC5263166 DOI: 10.1016/j.amjmed.2016.08.038] [Citation(s) in RCA: 30] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Coffee and tea are 2 of the most commonly consumed beverages in the world. The association of coffee and tea intake with coronary artery calcium and major adverse cardiovascular events remains uncertain. METHODS We examined 6508 ethnically diverse participants with available coffee and tea data from the Multi-Ethnic Study of Atherosclerosis. Intake for each was classified as never, occasional (<1 cup per day), and regular (≥1 cup per day). A coronary artery calcium progression ratio was derived from mixed effect regression models using loge(calcium score+1) as the outcome, with coefficients exponentiated to reflect coronary artery calcium progression ratio versus the reference. Cox proportional hazards analyses were used to evaluate the association between beverage intake and incident cardiovascular events. RESULTS Over a median follow-up of 5.3 years for coronary artery calcium and 11.1 years for cardiovascular events, participants who regularly drank tea (≥1 cup per day) had a slower progression of coronary artery calcium compared with never drinkers after multivariable adjustment. This correlated with a statistically significant lower incidence of cardiovascular events for ≥1 cup per day tea drinkers (adjusted hazard ratio 0.71; 95% confidence interval 0.53-0.95). Compared with never coffee drinkers, regular coffee intake (≥1 cup per day) was not statistically associated with coronary artery calcium progression or cardiovascular events (adjusted hazard ratio 0.97; 95% confidence interval 0.78-1.20). Caffeine intake was marginally inversely associated with coronary artery calcium progression. CONCLUSIONS Moderate tea drinkers had slower progression of coronary artery calcium and reduced risk for cardiovascular events. Future research is needed to understand the potentially protective nature of moderate tea intake.
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Affiliation(s)
- P Elliott Miller
- Department of Critical Care Medicine, National Institutes of Health, Bethesda, Md; Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Di Zhao
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | | | - Erin D Michos
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Michelle Averill
- Department of Environmental and Occupational Health, University of Washington, Seattle
| | - Veit Sandfort
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md
| | - Gregory L Burke
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph F Polak
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Md
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Eliseo Guallar
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Seth S Martin
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md
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191
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Sathiyakumar V, Blumenthal RS, Nasir K, Martin SS. Addressing Knowledge Gaps in the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: a Review of Recent Coronary Artery Calcium Literature. Curr Atheroscler Rep 2017; 19:7. [DOI: 10.1007/s11883-017-0643-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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192
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Plante TB, Martin SS. Wearable Technology and Long-term Weight Loss. JAMA 2017; 317:318-319. [PMID: 28114543 DOI: 10.1001/jama.2016.19265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Timothy B Plante
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seth S Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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193
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McEvoy JW, Martin SS, Dardari ZA, Miedema MD, Sandfort V, Yeboah J, Budoff MJ, Goff DC, Psaty BM, Post WS, Nasir K, Blumenthal RS, Blaha MJ. Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of Antihypertensive Therapy. Circulation 2017; 135:153-165. [PMID: 27881560 PMCID: PMC5225077 DOI: 10.1161/circulationaha.116.025471] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [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: 07/25/2016] [Accepted: 11/02/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The use of atherosclerotic cardiovascular disease (ASCVD) risk to personalize systolic blood pressure (SBP) treatment goals is a topic of increasing interest. Therefore, we studied whether coronary artery calcium (CAC) can further guide the allocation of anti-hypertensive treatment intensity. METHODS We included 3733 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with SBP between 120 and 179 mm Hg. Within subgroups categorized by both SBP (120-139 mm Hg, 140-159 mm Hg, and 160-179 mm Hg) and estimated 10-year ASCVD risk (using the American College of Cardiology/American Heart Assocation pooled-cohort equations), we compared multivariable-adjusted hazard ratios for the composite outcome of incident ASCVD or heart failure after further stratifying by CAC (0, 1-100, or >100). We estimated 10-year number-needed-to-treat for an intensive SBP goal of 120 mm Hg by applying the treatment benefit recorded in meta-analyses to event rates within CAC strata. RESULTS The mean age was 65 years, and 642 composite events took place over a median of 10.2 years. In persons with SBP <160 mm Hg, CAC stratified risk for events. For example, among those with an ASCVD risk of <15% and who had an SBP of either 120 to 139 mm Hg or 140 to 159 mm Hg, respectively, we found increasing hazard ratios for events with CAC 1 to 100 (1.7 [95% confidence interval, 1.0-2.6] or 2.0 [1.1-3.8]) and CAC >100 (3.0 [1.8-5.0] or 5.7 [2.9-11.0]), all relative to CAC=0. There appeared to be no statistical association between CAC and events when SBP was 160 to 179 mm Hg, irrespective of ASCVD risk level. Estimated 10-year number-needed-to-treat for a SBP goal of 120mmHg varied substantially according to CAC levels when predicted ASCVD risk <15% and SBP <160mmHg (eg, 10-year number-needed-to-treat of 99 for CAC=0 and 24 for CAC>100, when SBP 120-139mm Hg). However, few participants with ASCVD risk <5% had elevated CAC. Furthermore, 10-year number-needed-to-treat estimates were consistently low and varied less among CAC strata when SBP was 160 to 179 mm Hg or when ASCVD risk was ≥15% at any SBP level. CONCLUSIONS Combined CAC imaging and assessment of global ASCVD risk has the potential to guide personalized SBP goals (eg, choosing a traditional goal of 140 or a more intensive goal of 120 mm Hg), particularly among adults with an estimated ASCVD risk of 5% to 15% and prehypertension or mild hypertension.
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Affiliation(s)
- John W McEvoy
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.).
| | - Seth S Martin
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Zeina A Dardari
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Michael D Miedema
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Veit Sandfort
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Joseph Yeboah
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Matthew J Budoff
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - David C Goff
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Bruce M Psaty
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Wendy S Post
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Khurram Nasir
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Roger S Blumenthal
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
| | - Michael J Blaha
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.)
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Dahagam C, Hahn VS, Goud A, D’Souza J, Abdelqader A, Blumenthal RS, Martin SS. Role of Statins in Glucose Homeostasis and Insulin Resistance. Curr Cardiovasc Risk Rep 2016. [DOI: 10.1007/s12170-016-0523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Driver S, Martin SS, Gluckman TJ, Clary JM, Blumenthal RS, Stone NJ. Reply: Lipid Measurements: Fasting or Nonfasting, Women or Men. J Am Coll Cardiol 2016; 68:1710-1711. [PMID: 27712790 DOI: 10.1016/j.jacc.2016.07.749] [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] [Received: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022]
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Elshazly MB, Nicholls SJ, Nissen SE, St. John J, Martin SS, Jones SR, Quispe R, Stegman B, Kapadia SR, Tuzcu EM, Puri R. Implications of Total to High-Density Lipoprotein Cholesterol Ratio Discordance With Alternative Lipid Parameters for Coronary Atheroma Progression and Cardiovascular Events. Am J Cardiol 2016; 118:647-55. [PMID: 27392507 DOI: 10.1016/j.amjcard.2016.06.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/26/2022]
Abstract
The total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio may quantify atherogenic lipoproteins beyond low-density lipoprotein cholesterol (LDL-C), non-HDL-C and apolipoprotein B (apoB). We analyzed pooled data from 9 trials involving 4,957 patients with coronary artery disease undergoing serial intravascular ultrasonography to assess changes in percent atheroma volume (ΔPAV) and 2-year major adverse cardiovascular event (MACE) rates when TC/HDL-C levels were discordant with LDL-C, non-HDL-C, and apoB. Discordance was investigated when lipid levels were stratified by </≥median levels (TC/HDL-C 3.3 vs LDL-C 80, non-HDL-C 107, and apoB 76 mg/dl) or </≥very low percentile equivalent cutoffs (TC/HDL-C 2.5 vs LDL-C 70, non-HDL-C 89, and apoB 59 mg/dl). When stratified by median levels, TC/HDL-C was commonly observed to be discordant with LDL-C (26%), non-HDL-C (20%), and apoB (27%). In patients with LDL-C, non-HDL-C, or apoB <median, those with a discordant TC/HDL-C ≥median demonstrated less PAV regression and greater MACE (18.9%, 17.7%, 19.8%, respectively) compared with TC/HDL-C <median (14.4%, 14.0%, 12.8%; p = 0.02, 0.14, 0.003, respectively). In patients with LDL-C, non-HDL-C, or apoB ≥median, those with a discordant TC/HDL-C <median demonstrated less PAV progression and lower MACE (15.0%, 17.3%, 19.9%, respectively) compared with TC/HDL-C ≥median (24.7%, 24.2%, 26.4%; p <0.001, 0.003, 0.03, respectively). In conclusion, the TC/HDL-C ratio reclassifies atheroma progression and MACE rates when discordant with LDL-C, non-HDL-C, and apoB within subjects. Thus, using the ratio, in addition to individual lipid parameters, may identify patients who may benefit from more intensive lipid modification.
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Affiliation(s)
- Timothy B Plante
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland2Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seth S Martin
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland3Ciccarone Center for Prevention of Heart Disease, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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McEvoy JW, Martin SS, Blaha MJ, Polonsky TS, Nasir K, Kaul S, Greenland P, Blumenthal RS. The Case For and Against a Coronary Artery Calcium Trial. JACC Cardiovasc Imaging 2016; 9:994-1002. [DOI: 10.1016/j.jcmg.2016.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/16/2022]
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Cheng HG, Patel BS, Martin SS, Blaha M, Doneen A, Bale B, Jones SR. Effect of comprehensive cardiovascular disease risk management on longitudinal changes in carotid artery intima-media thickness in a community-based prevention clinic. Arch Med Sci 2016; 12:728-35. [PMID: 27478452 PMCID: PMC4947619 DOI: 10.5114/aoms.2016.60955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Received: 04/25/2015] [Accepted: 05/11/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The aim of the study was to examine changes in carotid intima-media thickness (CIMT) and carotid plaque morphology in patients receiving multifactorial cardiovascular disease (CVD) risk factor management in a community-based prevention clinic. Quantitative changes in CIMT and qualitative changes in carotid plaque morphology may be measured non-invasively by ultrasound. MATERIAL AND METHODS This is a retrospective study on a cohort of 324 patients who received multifactorial cardiovascular risk reduction treatment at a community prevention clinic. All patients received lipid-lowering medications (statin, niacin, and/or ezetimibe) and lifestyle modification. All patients underwent at least one follow-up CIMT measurement after starting their regimen. Annual biomarker, CIMT, and plaque measurements were analyzed for associations with CVD risk reduction treatment. RESULTS Median time to last CIMT was 3.0 years. Compared to baseline, follow-up analysis of all treatment groups at 2 years showed a 52.7% decrease in max CIMT, a 3.0% decrease in mean CIMT, and an 87.0% decrease in the difference between max and mean CIMT (p < 0.001). Plaque composition changes occurred, including a decrease in lipid-rich plaques of 78.4% within the first 2 years (p < 0.001). After the first 2 years, CIMT and lipid-rich plaques continued to decline at reduced rates. CONCLUSION In a cohort of patients receiving comprehensive CVD risk reduction therapy, delipidation of subclinical carotid plaque and reductions in CIMT predominantly occurred within 2 years, and correlated with changes in traditional biomarkers. These observations, generated from existing clinical data, provide unique insight into the longitudinal on-treatment changes in carotid plaque.
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Affiliation(s)
- Henry G. Cheng
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Birju S. Patel
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Seth S. Martin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Michael Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Amy Doneen
- Heart Attack and Stroke Prevention Center, Spokane, USA
| | - Brad Bale
- Heart Attack and Stroke Prevention Center, Spokane, USA
| | - Steven R. Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
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Abstract
Obesity has reached epidemic proportions in the United States and is disproportionately concentrated in poor populations. This paper explores the role that poverty may play in driving the present obesity epidemic. Current literature supports a food choice constraint model in which one's ability to purchase healthy foods falls with income in a standard budget constraint shift fashion because healthy foods (nonenergydense foods) are relatively costly. This model is reinforced by a biological preference for energy-dense foods. Theoretically, a tax on energy-dense food would reduce the prevalence of obesity, along with obesity-related disease, and therefore should be carefully considered by the American people.
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