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Rahman M, Wang X, Bundy JD, Charleston J, Cohen D, Cohen J, Drawz PE, Ghazi L, Horowitz E, Lash JP, Schrauben S, Weir MR, Xie D, Townsend RR. Prognostic Significance of Ambulatory BP Monitoring in CKD: A Report from the Chronic Renal Insufficiency Cohort (CRIC) Study. J Am Soc Nephrol 2020; 31:2609-2621. [PMID: 32973085 DOI: 10.1681/asn.2020030236] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/22/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Whether ambulatory BP monitoring is of value in evaluating risk for outcomes in patients with CKD is not clear. METHODS We followed 1502 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study for a mean of 6.72 years. We evaluated, as exposures, ambulatory BP monitoring profiles (masked uncontrolled hypertension, white-coat effect, sustained hypertension, and controlled BP), mean ambulatory BP monitoring and clinic BPs, and diurnal variation in BP-reverse dipper (higher at nighttime), nondipper, and dipper (lower at nighttime). Outcomes included cardiovascular disease (a composite of myocardial infarction, cerebrovascular accident, heart failure, and peripheral arterial disease), kidney disease (a composite of ESKD or halving of the eGFR), and mortality. RESULTS Compared with having controlled BP, the presence of masked uncontrolled hypertension independently associated with higher risk of the cardiovascular outcome and the kidney outcome, but not with all-cause mortality. Higher mean 24-hour systolic BP associated with higher risk of cardiovascular outcome, kidney outcome, and mortality, independent of clinic BP. Participants with the reverse-dipper profile of diurnal BP variation were at higher risk of the kidney outcome. CONCLUSIONS In this cohort of participants with CKD, BP metrics derived from ambulatory BP monitoring are associated with cardiovascular outcomes, kidney outcomes, and mortality, independent of clinic BP. Masked uncontrolled hypertension and mean 24-hour BP associated with high risk of cardiovascular disease and progression of kidney disease. Alterations of diurnal variation in BP are associated with high risk of progression of kidney disease, stroke, and peripheral arterial disease. These data support the wider use of ambulatory BP monitoring in the evaluation of hypertension in patients with CKD. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2020_09_24_JASN2020030236.mp3.
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Affiliation(s)
- Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Xue Wang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua D Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jeanne Charleston
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Debbie Cohen
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordana Cohen
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul E Drawz
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Lama Ghazi
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Edward Horowitz
- Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - James P Lash
- Division of Nephrology, University of Illinois, Chicago, Illinois
| | - Sarah Schrauben
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew R Weir
- Division of Nephrology, University of Maryland, Baltimore, Maryland
| | - Dawei Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond R Townsend
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Shi M, Chen LY, Bekwelem W, Norby FL, Soliman EZ, Alam AB, Alonso A. Association of Atrial Fibrillation With Incidence of Extracranial Systemic Embolic Events: The ARIC Study. J Am Heart Assoc 2020; 9:e016724. [PMID: 32865122 PMCID: PMC7727011 DOI: 10.1161/jaha.120.016724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. Methods and Results This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA2DS2‐VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA2DS2‐VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA2DS2‐VASc score was associated with increased SEE risk (HR per 1‐point increase, 1.24; 95% CI, 1.05–1.47). Conclusions AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA2DS2‐VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.
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Affiliation(s)
- Mengyuan Shi
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Lin Y Chen
- Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | | | - Faye L Norby
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center Department of Epidemiology and Prevention Wake Forest School of Medicine Winston-Salem NC
| | - Aniqa B Alam
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Alvaro Alonso
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
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Rooney MR, Lutsey PL, Alonso A, Selvin E, Pankow JS, Rudser KD, Dudley SC, Chen LY. Serum magnesium and burden of atrial and ventricular arrhythmias: The Atherosclerosis Risk in Communities (ARIC) Study. J Electrocardiol 2020; 62:20-25. [PMID: 32745731 PMCID: PMC7665977 DOI: 10.1016/j.jelectrocard.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Low serum magnesium (Mg) is associated with an increased incidence of atrial and ventricular arrhythmias. A richer phenotyping of arrhythmia indices, such as burden or frequency, may provide etiologic insights. OBJECTIVES To evaluate cross-sectional associations of serum Mg with burden of atrial arrhythmias [atrial fibrillation (AF), premature atrial contractions (PAC), supraventricular tachycardia (SVT)], and ventricular arrhythmias [premature ventricular contractions (PVC), non-sustained ventricular tachycardia (NSVT)] over 2-weeks of ECG monitoring. METHODS We included 2513 ARIC Study visit 6 (2016-2017) participants who wore the Zio XT Patch-a leadless, ambulatory ECG-monitor-for up to 2-weeks. Serum Mg was modeled categorically and continuously. AF burden was categorized as intermittent or continuous based on the percent of analyzable time spent in AF. Other arrhythmia burdens were defined by the average number of abnormal beats per day. Linear regression was used for continuous outcomes; logistic and multinomial regression were used for categorical outcomes. RESULTS Participants were mean ± SD age 79 ± 5 years, 58% were women and 25% black. Mean serum Mg was 0.82 ± 0.08 mmol/L and 19% had hypomagnesemia (<0.75 mmol/L). Serum Mg was inversely associated with PVC burden and continuous AF. The AF association was no longer statistically significant with further adjustment for traditional lifestyle risk factors, only the association with PVC burden remained significant. There were no associations between serum Mg and other arrhythmias examined. CONCLUSIONS In this community-based cohort of older adults, we found little evidence of independent cross-sectional associations between serum Mg and arrhythmia burden.
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Affiliation(s)
- Mary R Rooney
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Selvin
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - James S Pankow
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kyle D Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Samuel C Dudley
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lin Yee Chen
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Ruban A, Daya N, Schneider AL, Gottesman R, Selvin E, Coresh J, Lazo M, Koton S. Liver Enzymes and Risk of Stroke: The Atherosclerosis Risk in Communities (ARIC) Study. J Stroke 2020; 22:357-368. [PMID: 33053951 PMCID: PMC7568972 DOI: 10.5853/jos.2020.00290] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/26/2020] [Accepted: 08/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma-glutamyl transpeptidase [GGT]) are glutamate-regulatory enzymes, and higher glutamate levels correlated with worse prognosis of patients with neurotrauma. However, less is known about the association between liver enzymes and incidence of stroke. We evaluated the association between serum levels of AST, ALT, and GGT and incidence of stroke in the Atherosclerosis Risk in Communities (ARIC) study cohort from 1990 to 1992 through December 31, 2016. METHODS We included 12,588 ARIC participants without prevalent stroke and with data on liver enzymes ALT, AST, and GGT at baseline. We used multivariable Cox regression models to examine the associations between liver enzymes levels at baseline and stroke risk (overall, ischemic stroke, and intracerebral hemorrhage [ICH]) through December 31, 2016, adjusting for potential confounders. RESULTS During a median follow-up time of 24.2 years, we observed 1,012 incident strokes (922ischemic strokes and 90 ICH). In age, sex, and race-center adjusted models, the hazard ratios (HRs; 95% confidence intervals [CIs]) for the highest compared to lowest GGT quartile were 1.94 (95% CI, 1.64 to 2.30) for all incident stroke and 2.01 (95% CI, 1.68 to 2.41) for ischemic stroke, with the results supporting a dose-response association (P for linear trend <0.001). Levels of AST were associated with increased risk of ICH, but the association was significant only when comparing the third quartile with the lowest quartile (adjusted HR, 1.82; 95% CI, 1.06 to 3.13). CONCLUSIONS Elevated levels of GGT (within normal levels), independent of liver disease, are associated with higher risk of incident stroke overall and ischemic stroke, but not ICH.
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Affiliation(s)
- Angela Ruban
- Department of Nursing, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea L.C. Schneider
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Gottesman
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariana Lazo
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Silvia Koton
- Department of Nursing, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Inhibition of cyclooxygenase-1 does not reduce mortality in post-ischemic stroke rats. Neurosci Lett 2020; 737:135296. [PMID: 32777346 DOI: 10.1016/j.neulet.2020.135296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ischemic stroke is one of the leading causes of mortality and morbidity. The currently available non-invasive therapeutic options are not sufficiently efficacious. Post-ischemic brain is characterized by a prominent inflammatory response. Little is known about the involvement of cyclooxygenase (COX)-1 in the pathophysiology of ischemic stroke. OBJECTIVE This study was undertaken to examine the effects of a highly selective COX-1 inhibitor - mofezolac - on clinical outcomes and brain inflammatory markers in post-stroke rats. METHODS Stroke was induced by subjecting rats to permanent middle cerebral artery occlusion (MCAO). Control rats underwent a sham surgery. Rats were treated with mofezolac (50 mg/kg, intraperitoneally [ip]) once daily for 14 days. Control animals were treated with vehicle. Body temperature (BT), neurological score (NS) and cumulative mortality were monitored at different time points. At the end of the experiment, rats were euthanized and three brain regions (hypothalamus, hippocampus and frontal cortex) were extracted. Levels of interleukin (IL)-6, prostaglandin (PG)E2 and tumor necrosis factor (TNF)-α in these brain regions were determined by ELISA kits. RESULTS BT, NS and cumulative mortality were all significantly higher in post-MCAO rats than in sham-operated rats, irrespective of the treatment given. BT, NS and mortality rate did not differ significantly between mofezolac-treated and vehicle-treated sham-operated animals. BT was significantly lower in mofezolac-treated as compared to vehicle-treated post-MCAO rats. Mofezolac did not significantly alter NS in post-MCAO rats at any time-point. Cumulative 14-day mortality was non-significantly higher in mofezolac-treated as compared to vehicle-treated post-MCAO rats (48 % vs. 21 %, respectively; P = 0.184). Mostly, IL-6 and TNF-α levels did not differ between post-MCAO and sham-operated rats and were not affected by mofezolac treatment. In contrast, mofezolac significantly decreased PGE2 levels in post-MCAO rats' brains. CONCLUSION Overall, these results suggest that chronic treatment with the selective COX-1 inhibitor mofezolac did not reduce morbidity or mortality in post-stroke rats.
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Demmer RT, Norby FL, Lakshminarayan K, Walker KA, Pankow JS, Folsom AR, Mosley T, Beck J, Lutsey PL. Periodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC). Neurology 2020; 95:e1660-e1671. [PMID: 32727837 DOI: 10.1212/wnl.0000000000010312] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination. METHODS Participants enrolled in the Atherosclerosis Risk in Communities study with a clinical periodontal examination (or edentulous participants) at visit 4 (1996-1998; mean ± SD age 63 ± 6 years, 55% female, 21% black) and adjudicated dementia outcomes through 2016 were included (n = 8,275). A subgroup of 4,559 participants had adjudicated dementia and MCI assessments at visit 5 (2011-2013). Participants received a full-mouth periodontal examination and were classified into periodontal profile classes (PPCs) based on the severity and extent of gingival inflammation and attachment loss. MCI and dementia were determined via neurocognitive testing, neurological examination and history, informant interviews, and brain MRI in a subset. Cox proportional hazards models regressed incident dementia on PPCs. Relative risk regression models were used for the composite of MCI/dementia. RESULTS The cumulative incidence and incidence density of dementia during follow-up (average 18.4 years) were 19% (n = 1,569) and 11.8 cases per 1,000 person-years. Multivariable adjusted hazard ratios for incident dementia among participants with severe PPC or edentulism (vs periodontal healthy) were 1.22 (95% confidence interval [CI] 1.01-1.47) and 1.21 (95% CI 0.99-1.48), respectively. For the combined dementia/MCI outcome, adjusted risk ratios among participants with mild/intermediate PPC, severe PPC, or edentulism (vs periodontal healthy) were 1.22 (95% CI 1.00-1.48), 1.15 (95% CI 0.88-1.51), and 1.90 (95% CI 1.40-2.58). Results were stronger among younger (≤62 years) participants (p for interaction = 0.02). CONCLUSION Periodontal disease was modestly associated with incident MCI and dementia in a community-based cohort of black and white participants.
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Affiliation(s)
- Ryan T Demmer
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill.
| | - Faye L Norby
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Kamakshi Lakshminarayan
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Keenan A Walker
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - James S Pankow
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Aaron R Folsom
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Thomas Mosley
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Jim Beck
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Pamela L Lutsey
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
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Reshetnyak E, Ntamatungiro M, Pinheiro LC, Howard VJ, Carson AP, Martin KD, Safford MM. Impact of Multiple Social Determinants of Health on Incident Stroke. Stroke 2020; 51:2445-2453. [PMID: 32673521 PMCID: PMC9264323 DOI: 10.1161/strokeaha.120.028530] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Social determinants of health (SDOH) have been previously associated with incident stroke. Although SDOH often cluster within individuals, few studies have examined associations between incident stroke and multiple SDOH within the same individual. The objective was to determine the individual and cumulative effects of SDOH on incident stroke. METHODS This study included 27 813 participants from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study, a national, representative, prospective cohort of black and white adults aged ≥45 years. SDOH was the primary exposure. The main outcome was expert adjudicated incident stroke. Cox proportional hazards models examined associations between incident stroke and SDOH, individually and as a count of SDOH, adjusting for potential confounders. RESULTS The mean age was 64.7 years (SD 9.4) at baseline; 55.4% were women and 40.4% were blacks. Over a median follow-up of 9.5 years (IQR, 6.0-11.5), we observed 1470 incident stroke events. Of 10 candidate SDOH, 7 were associated with stroke (P<0.10): race, education, income, zip code poverty, health insurance, social isolation, and residence in one of the 10 lowest ranked states for public health infrastructure. A significant age interaction resulted in stratification at 75 years. In fully adjusted models, among individuals <75 years, risk of stroke rose as the number of SDOH increased (hazard ratio for one SDOH, 1.26 [95% CI, 1.02-1.55]; 2 SDOH hazard ratio, 1.38 [95% CI, 1.12-1.71]; and ≥3 SDOH hazard ratio, 1.51 [95% CI, 1.21-1.89]) compared with those without any SDOH. Among those ≥75 years, none of the observed effects reached statistical significance. CONCLUSIONS Incremental increases in the number of SDOH were independently associated with higher incident stroke risk in adults aged <75 years, with no statistically significant effects observed in individuals ≥75 years. Targeting individuals with multiple SDOH may help reduce risk of stroke among vulnerable populations.
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Affiliation(s)
- Evgeniya Reshetnyak
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY (E.R., L.C.P., M.M.S.)
| | - Mariella Ntamatungiro
- Department of Internal Medicine, Columbia University College of Physicians and Surgeons, New York, NY (M.N.)
| | - Laura C Pinheiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY (E.R., L.C.P., M.M.S.)
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H., A.P.C., K.D.M.)
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H., A.P.C., K.D.M.)
| | - Kimberly D Martin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H., A.P.C., K.D.M.)
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY (E.R., L.C.P., M.M.S.)
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Wang SY, Tan ASL, Claggett B, Chandra A, Khatana SAM, Lutsey PL, Kucharska-Newton A, Koton S, Solomon SD, Kawachi I. Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities Study. JAMA Cardiol 2020; 4:1203-1212. [PMID: 31596441 DOI: 10.1001/jamacardio.2019.3788] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Higher income is associated with lower incident cardiovascular disease (CVD). However, there is limited research on the association between changes in income and incident CVD. Objective To examine the association between change in household income and subsequent risk of CVD. Design, Setting, and Participants The Atherosclerosis Risk In Communities (ARIC) study is an ongoing, prospective cohort of 15 792 community-dwelling men and women, of mostly black or white race, from 4 centers in the United States (Jackson, Mississippi; Washington County, Maryland; suburbs of Minneapolis, Minnesota; and Forsyth County, North Carolina), beginning in 1987. For our analysis, participants were followed up until December 31, 2016. Exposures Participants were categorized based on whether their household income dropped by more than 50% (income drop), remained unchanged/changed less than 50% (income unchanged), or increased by more than 50% (income rise) over a mean (SD) period of approximately 6 (0.3) years between ARIC visit 1 (1987-1989) and visit 3 (1993-1995). Main Outcomes and Measures Our primary outcome was incidence of CVD after ARIC visit 3, including myocardial infarction (MI), fatal coronary heart disease, heart failure (HF), or stroke during a mean (SD) of 17 (7) years. Analyses were adjusted for sociodemographic variables, health behaviors, and CVD biomarkers. Results Of the 8989 included participants (mean [SD] age at enrollment was 53 [6] years, 1820 participants were black [20%], and 3835 participants were men [43%]), 900 participants (10%) experienced an income drop, 6284 participants (70%) had incomes that remained relatively unchanged, and 1805 participants (20%) experienced an income rise. After full adjustment, those with an income drop experienced significantly higher risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 1.17; 95% CI, 1.03-1.32). Those with an income rise experienced significantly lower risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 0.86; 95% CI, 0.77-0.96). Conclusions and Relevance Income drop over 6 years was associated with higher risk of subsequent incident CVD over 17 years, while income rise over 6 years was associated with lower risk of subsequent incident CVD over 17 years. Health professionals should have greater awareness of the influence of income change on the health of their patients.
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Affiliation(s)
- Stephen Y Wang
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Andy S L Tan
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alvin Chandra
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sameed Ahmed M Khatana
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pamela L Lutsey
- University of Minnesota School of Public Health, Minneapolis
| | - Anna Kucharska-Newton
- University of North Carolina Gillings School of Global Public Health, Chapel Hill.,University of Kentucky College of Public Health, Lexington
| | - Silvia Koton
- School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ichiro Kawachi
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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109
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English SW, Saigle V, McIntyre L, Chassé M, Fergusson D, Turgeon AF, Lauzier F, Griesdale D, Garland A, Zarychanski R, Algird A, Wiens EJ, Hu V, Dutta P, Boun V, van Walraven C. External validation demonstrated the Ottawa SAH prediction models can identify pSAH using health administrative data. J Clin Epidemiol 2020; 126:122-130. [PMID: 32619751 DOI: 10.1016/j.jclinepi.2020.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/22/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of the study is to externally validate three primary subarachnoid hemorrhage (pSAH) identification models. STUDY DESIGN AND SETTING We evaluated three models that identify pSAH using recursive partitioning (A), logistic regression (B), and a prevalence-adjusted logistic regression(C), respectively. Blinded chart review and/or linkage to existing registries determined pSAH status. We included all patients aged ≥18 in four participating center registries or whose discharge abstracts contained ≥1 administrative codes of interest between January 1, 2012 and December 31, 2013. RESULTS A total of 3,262 of 193,190 admissions underwent chart review (n = 2,493) or registry linkage (n = 769). A total of 657 had pSAH confirmed (20·1% sample, 0·34% admissions). The sensitivity, specificity, and positive predictive value (PPV) were as follows: i) model A: 98·3% (97·0-99·2), 53·5% (51·5-55·4), and 34·8% (32·6-37·0); ii) model B (score ≥6): 98·0% (96·6-98·9), 47·4% (45·5-49·4), and 32·0% (30·0-34·1); and iii) model C (score ≥2): 95·7% (93·9-97·2), 85·5% (84·0-86·8), and 62·3 (59·3-65·3), respectively. Model C scores of 0, 1, 2, 3, or 4 had probabilities of 0·5% (0·2-1·5), 1·5% (1·0-2·2), 24·8% (21·0-29·0), 90·0% (86·8-92·0), and 97·8% (88·7-99·6), without significant difference between centers (P = 0·86). The PPV of the International Classification of Diseases code (I60) was 63·0% (95% confidence interval: 60·0-66·0). CONCLUSIONS All three models were highly sensitive for pSAH. Model C could be used to adjust for misclassification bias.
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Affiliation(s)
- Shane W English
- Department of Medicine (Critical Care), uOttawa, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute (OHRI), Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.
| | - Victoria Saigle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), uOttawa, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Michaël Chassé
- Division of Critical Care, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montreal, Quebec H2X 0A9, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Department of Medicine (Clinical Epidemiology), uOttawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Alexis F Turgeon
- Centre de recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), 1050 Chemin Sainte-Foy, Local K0-03, Québec, Québec G1S 4L8, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, 2325 Rue de l'Université, Québec, Québec G1V 0A6, Canada
| | - François Lauzier
- Centre de recherche du Centre Hospitalier de l'Université de Québec, Université Laval, Québec City, Québec, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, and Department of Medicine, Université Laval, 2325 Rue de l'Université, Québec, Québec G1V 0A6, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Allan Garland
- Sections of Critical Care and Respirology, Department of Internal Medicine, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg Manitoba R3A 1R9, Canada
| | - Almunder Algird
- Department of Neurosurgery, McMaster University, Hamilton Health Sciences, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada
| | - Evan J Wiens
- Department of Internal Medicine, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg Manitoba R3A 1R9, Canada
| | - Vivien Hu
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Pallavi Dutta
- Faculty of Health Sciences, McMaster University, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada
| | - Vincent Boun
- Centre de recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), 1050 Chemin Sainte-Foy, Local K0-03, Québec, Québec G1S 4L8, Canada
| | - Carl van Walraven
- Department of Medicine (Clinical Epidemiology), uOttawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue Building, 1st Floor, Ottawa, Ontario K1Y 4E9, Canada; ICES-uOttawa, Administrative Services, 1053 Carling Avenue Building, 1st Floor, Ottawa, Ontario K1Y 4E9, Canada
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110
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Sen S, Mascari R. Exploring the periodontal disease-ischemic stroke link. J Periodontol 2020; 91 Suppl 1:S35-S39. [PMID: 32592499 DOI: 10.1002/jper.20-0138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022]
Abstract
Multiple risk factors are associated with ischemic stroke. Here, we highlight studies indicating that periodontal disease significantly increases the risk of both primary ischemic stroke and subsequent cardiovascular events. Additionally, studies have shown an association between periodontal disease and multiple causes of ischemic stroke. Finally, we describe an ongoing clinical trial testing the benefit of periodontal disease treatment as a strategy to reduce risk for recurrent cardiovascular events in patients who have had recent ischemic stroke or transient ischemic attack. This article is mostly based on a presentation given in honor of Steven Offenbacher (1950 to 2018).
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Affiliation(s)
- Souvik Sen
- Department of Neurology, School of Medicine, University of South Carolina, Columbia, SC
| | - Rachel Mascari
- Department of Neurology, School of Medicine, University of South Carolina, Columbia, SC
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111
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Jones EM, Okpala M, Zhang X, Parsha K, Keser Z, Kim CY, Wang A, Okpala N, Jagolino A, Savitz SI, Sharrief AZ. Racial disparities in post-stroke functional outcomes in young patients with ischemic stroke. J Stroke Cerebrovasc Dis 2020; 29:104987. [PMID: 32689593 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain racial and ethnic groups. We assessed racial differences in risk factors, stroke etiology, and outcomes among young stroke patients. METHODS Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18-50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS). For univariate comparisons Chi-square and Kruskal-Wallis tests were performed as appropriate. Multivariable logistic regression was used to assess impact of race on day seven modified Rankin score (mRS). RESULTS Among 810 patients with race and outcome data who were admitted in the study period, median age was 43, 57.1% were male, and 36.5% NHW, 43.2% NHB, 20.2% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, and end-stage renal disease varied significantly by race. Compared to NHW, NHB had higher odds of HTN (OR 2.28, 1.65-3.15), CHF (OR 2.17, 1.06-4.46), and DM II 1.92 (1.25-2.94) while HIS had higher odds of DM II (OR 2.52, 1.55-4.10) and lower odds of smoking (OR 0.56, 0.35-0.90). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.50 CI (0.31-0.78)) and HIS (OR 0.37 CI (0.21-0.67)) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses. CONCLUSIONS In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. Our study suggests a need for targeted prevention efforts for younger populations at highest risk for stroke.
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Affiliation(s)
- Erica M Jones
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States.
| | - Munachi Okpala
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States
| | - Xu Zhang
- Division of Clinical and Translational Sciences, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Kaushik Parsha
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States
| | - Zafer Keser
- McGovern School of Medicine, University of Texas Health Sciences Center at Houston, Houston. TX, United States
| | - Christina Y Kim
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States
| | - Austin Wang
- McGovern School of Medicine, University of Texas Health Sciences Center at Houston, Houston. TX, United States
| | - Nnedinma Okpala
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States
| | - Amanda Jagolino
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States
| | - Anjail Z Sharrief
- Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States
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112
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Lutsey PL, Windham BG, Misialek JR, Cushman M, Kucharska-Newton A, Basu S, Folsom AR. Long-Term Association of Venous Thromboembolism With Frailty, Physical Functioning, and Quality of Life: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2020; 9:e015656. [PMID: 32476561 PMCID: PMC7429054 DOI: 10.1161/jaha.119.015656] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Relatively little is known about the long‐term consequences of venous thromboembolism (VTE) on physical functioning. We compared long‐term frailty status, physical function, and quality of life among survivors of VTE with survivors of coronary heart disease (CHD) and stroke, and with those without these diseases. Methods and Results Cases of VTE, CHD, and stroke were continuously identified since ARIC (Atherosclerosis Risk in Communities Study) recruitment during 1987 to 1989. Functional measures were objectively captured at ARIC clinic visits 5 (2011–2013) and 6 (2016–2017); quality of life was self‐reported. The 6161 participants at visit 5 were, on average, 75.7 (range, 66–90) years of age. By visit 5, 3.2% had had a VTE, 6.9% CHD, and 3.4% stroke. Compared with those without any of these conditions, VTE survivors were more likely to be frail (odds ratio [OR], 3.11; 95% CI, 1.80–5.36) and have low (<10) versus good scores on the Short Physical Performance Battery (OR, 3.59; 95% CI, 2.36–5.47). They also had slower gait speed, less endurance, and lower physical quality of life. VTE survivors were similar to coronary heart disease and stroke survivors on categorical frailty and outcomes on Short Physical Performance Battery assessment. When score on the Short Physical Performance Battery instrument was modeled continuously, VTE survivors performed better than stroke survivors but worse than CHD survivors. Conclusions VTE survivors had triple the odds of frailty and poorer physical function than those without the vascular diseases considered. Their function was somewhat worse than that of CHD survivors, but better than stroke survivors. These findings suggest that VTE patients may benefit from additional efforts to improve postevent physical functioning.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - B Gwen Windham
- Division of Geriatrics Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Mary Cushman
- Division of Hematology and Oncology Department of Medicine University of Vermont Colchester VT
| | - Anna Kucharska-Newton
- Division of Epidemiology College of Public Health University of Kentucky Lexington KY.,Department of Epidemiology Gillings School of Public Health University of North Carolina, Chapel Hill NC
| | - Saonli Basu
- Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN
| | - Aaron R Folsom
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
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113
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Li D, Misialek JR, Jing M, Tsai MY, Eckfeldt JH, Steffen LM, Knopman D, Wruck L, Gottesman R, Mosley TH, Sharrett AR, Alonso A. Plasma phospholipid very-long-chain SFAs in midlife and 20-year cognitive change in the Atherosclerosis Risk in Communities (ARIC): a cohort study. Am J Clin Nutr 2020; 111:1252-1258. [PMID: 32320012 PMCID: PMC7266687 DOI: 10.1093/ajcn/nqaa048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/24/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Very-long-chain SFAs (VLSFAs) have recently gained considerable attention as having beneficial effects on health and aging. OBJECTIVES The objective of this study was to assess the associations of plasma phospholipid VLSFAs [arachidic acid (20:0), behenic acid (22:0), tricosanoic acid (23:0), and lignoceric acid (24:0)] with 20-y cognitive decline in the Atherosclerosis Risk in Communities (ARIC) participants. Furthermore, this study compared the associations of plasma phospholipid VLSFAs with 5 common groups of fatty acids [i.e., total SFAs, total MUFAs, total ω-3 (n-3) PUFAs, total marine-derived ω-3 PUFAs, total ω-6 PUFAs]. METHODS This study used a cohort study design of 3229 ARIC participants enrolled at the Minnesota field center. Fatty acids were measured at visit 1 (1987-1989); and cognition was assessed at visits 2 (1990-1992), 4 (1996-1998), and 5 (2011-2013) using 3 tests: the Delayed Word Recall Test (DWRT), the Digit-Symbol Substitution Test (DSST), and the Word Fluency Test (WFT). RESULTS Higher proportions of plasma phospholipid total VLSFAs and each individual VLSFA were associated with less decline in WFT, a test of verbal fluency. For example, 1 SD higher in total VLSFAs at baseline was associated with 0.057 SD (95% CI: 0.018, 0.096, P = 0.004) less cognitive decline over 20 y as measured by WFT score. None of the 5 common fatty acid groups were associated with change in WFT, but a higher proportion of plasma phospholipid total MUFAs was associated with greater decline in DWRT; higher total ω-6 PUFAs with less decline in DWRT; and higher total ω-3 and total marine-derived ω-3 PUFAs with less decline in DSST. CONCLUSIONS This study suggests that higher proportions of plasma phospholipid VLSFAs in midlife may be associated with less 20-y cognitive decline.
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Affiliation(s)
- Danni Li
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ma Jing
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lisa Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Tom H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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114
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Leavitt C, Zakai NA, Auer P, Cushman M, Lange EM, Levitan EB, Olson N, Thornton TA, Tracy RP, Wilson JG, Lange LA, Reiner AP, Raffield LM. Interferon gamma-induced protein 10 (IP-10) and cardiovascular disease in African Americans. PLoS One 2020; 15:e0231013. [PMID: 32240245 PMCID: PMC7117698 DOI: 10.1371/journal.pone.0231013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/15/2020] [Indexed: 12/25/2022] Open
Abstract
Biomarkers of chronic inflammation (such as C-reactive protein) have long been associated with cardiovascular disease and mortality; however, biomarkers involved in antiviral cytokine induction and adaptive immune system activation remain largely unexamined. We hypothesized the cytokine interferon gamma inducible protein 10 (IP-10) would be associated with clinical and subclinical cardiovascular disease and all-cause mortality in African Americans. We assessed these associations in the Jackson Heart Study (JHS) cohort and the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. There was a modest association of IP-10 with higher odds of left ventricular hypertrophy (OR = 1.20 (95% confidence interval (CI) 1.03, 1.41) per standard deviation (SD) higher natural log-transformed IP-10 in JHS). We did not observe associations with ankle brachial index, intima-media thickness, or arterial calcification. Each SD higher increment of ln-transformed IP-10 concentration was associated with incident heart failure (hazard ratio (HR) 1.26; 95% CI 1.11, 1.42, p = 4x10-4) in JHS, and with overall mortality in both JHS (HR 1.12 per SD, 95% CI 1.03, 1.21, p = 7.5x10-3) and REGARDS (HR 1.31 per SD, 95% CI 1.10, 1.55, p = 2.0 x 10-3), adjusting for cardiovascular risk factors and C-reactive protein. However, we found no association between IP-10 and stroke or coronary heart disease. These results suggest a role of IP-10 in heart failure and mortality risk independent of C-reactive protein. Further research is needed to investigate how the body's response to chronic viral infection may mediate heart failure and overall mortality risk in African Americans.
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Affiliation(s)
- Colton Leavitt
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
| | - Paul Auer
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
| | - Ethan M. Lange
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, United States of America
| | - Nels Olson
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
| | - Timothy A. Thornton
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Russell P. Tracy
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
- Department of Biochemistry, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Leslie A. Lange
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Alex P. Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Laura M. Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, United States of America
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115
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Mathews L, Ishigami J, Ding N, Hoogeveen RC, Kucharska-Newton A, Ballantyne CM, Gottesman R, Selvin E, Matsushita K. Cardiac Biomarkers and Subsequent Risk of Hospitalization With Bleeding in the Community: Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2020; 9:e013560. [PMID: 32114886 PMCID: PMC7335570 DOI: 10.1161/jaha.119.013560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background hs‐cTnT (high‐sensitivity cardiac troponin T), but not NT‐proBNP (N‐terminal pro–B natriuretic peptide), has been shown to predict bleeding in patients with atrial fibrillation. Whether these biomarkers are independently associated with bleeding in the general population is unknown. Methods and Results We used Cox proportional hazards models to examine the association of hs‐cTnT and NT‐proBNP with incident bleeding (defined by International Classification of Diseases, Ninth Revision [ICD‐9] codes) among 9550 middle‐aged men and women without a history of cardiovascular disease or bleeding. There were 847 hospitalizations with bleeding (92% from gastrointestinal bleeding) during a median follow‐up of 9.0 years. Serum levels of hs‐cTnT were associated with bleeding in a graded fashion, with a hazard ratio of 1.28 (95% CI, 1.06–1.59) for 6 to <9 ng/L, 1.52 (1.21–1.91) for 9 to <14, and 2.05 (1.56–2.69) for ≥14 versus <3 ng/L. For NT‐proBNP, the highest category (≥264 versus <42 pg/mL) showed a hazard ratio of 2.00 (1.59–2.61), and the remaining 3 categories had hazard ratios ranging from 1.2 to 1.3. Individuals in the highest category of both hs‐cTnT and NT‐proBNP had a hazard ratio of 3.03 (1.97–4.68) compared with those in the lowest categories. Conclusions In a community‐based population, elevated hs‐cTnT and NT‐proBNP were associated with bleeding‐related hospitalizations. These biomarkers may have a high utility in identifying people at high risk for bleeding. There is a need for research on the underlying mechanisms linking subclinical cardiac abnormalities and bleeding.
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Affiliation(s)
- Lena Mathews
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Division of Cardiology Johns Hopkins School of Medicine Baltimore MD
| | - Junichi Ishigami
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ning Ding
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ron C Hoogeveen
- Department of Medicine Baylor College of Medicine Houston TX
| | - Anna Kucharska-Newton
- Gillings School of Global Public Health University of North Carolina at Chapel Hill NC.,College of Public Health University of Kentucky Lexington KY
| | | | - Rebecca Gottesman
- Department of Neurology Johns Hopkins School of Medicine Baltimore MD
| | - Elizabeth Selvin
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Kunihiro Matsushita
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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116
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Cognitive Correlates of MRI-defined Cerebral Vascular Injury and Atrophy in Elderly American Indians: The Strong Heart Study. J Int Neuropsychol Soc 2020; 26:263-275. [PMID: 31791442 PMCID: PMC7083690 DOI: 10.1017/s1355617719001073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE American Indians experience substantial health disparities relative to the US population, including vascular brain aging. Poorer cognitive test performance has been associated with cranial magnetic resonance imaging findings in aging community populations, but no study has investigated these associations in elderly American Indians. METHODS We examined 786 American Indians aged 64 years and older from the Cerebrovascular Disease and its Consequences in American Indians study (2010-2013). Cranial magnetic resonance images were scored for cortical and subcortical infarcts, hemorrhages, severity of white matter disease, sulcal widening, ventricle enlargement, and volumetric estimates for white matter hyperintensities (WMHs), hippocampus, and brain. Participants completed demographic, medical history, and neuropsychological assessments including testing for general cognitive functioning, verbal learning and memory, processing speed, phonemic fluency, and executive function. RESULTS Processing speed was independently associated with the presence of any infarcts, white matter disease, and hippocampal and brain volumes, independent of socioeconomic, language, education, and clinical factors. Other significant associations included general cognitive functioning with hippocampal volume. Nonsignificant, marginal associations included general cognition with WMH and brain volume; verbal memory with hippocampal volume; verbal fluency and executive function with brain volume; and processing speed with ventricle enlargement. CONCLUSIONS Brain-cognition associations found in this study of elderly American Indians are similar to those found in other racial/ethnic populations, with processing speed comprising an especially strong correlate of cerebrovascular disease. These findings may assist future efforts to define opportunities for disease prevention, to conduct research on diagnostic and normative standards, and to guide clinical evaluation of this underserved and overburdened population.
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117
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Gardener H, Sacco RL, Rundek T, Battistella V, Cheung YK, Elkind MSV. Race and Ethnic Disparities in Stroke Incidence in the Northern Manhattan Study. Stroke 2020; 51:1064-1069. [PMID: 32078475 DOI: 10.1161/strokeaha.119.028806] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose- An excess incidence of strokes among blacks versus whites has been shown, but data on disparities related to Hispanic ethnicity remain limited. This study examines race/ethnic differences in stroke incidence in the multiethnic, largely Caribbean Hispanic, NOMAS (Northern Manhattan Study), and whether disparities vary by age. Methods- The study population included participants in the prospective population-based NOMAS, followed for a mean of 14±7 years. Multivariable-adjusted Cox proportional hazards models were constructed to estimate the association between race/ethnicity and incident stroke of any subtype and ischemic stroke, stratified by age. Results- Among 3298 participants (mean baseline age 69±10 years, 37% men, 24% black, 21% white, 52% Hispanic), 460 incident strokes accrued (400 ischemic, 43 intracerebral hemorrhage, 9 subarachnoid hemorrhage). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years), followed by Hispanics (10/1000 person-years), and lowest in whites (9/1000 person-years), and this order was observed for crude incidence rates until age 75. By age 85, the greatest incidence rate was in Hispanics. Blacks had an increased risk of stroke versus whites overall in multivariable models that included sociodemographics (hazard ratio, 1.51 [95% CI, 1.13-2.02]), and stratified analyses showed that this disparity was driven by women of age ≥70. The increased rate of stroke among Hispanics (age/sex-adjusted hazard ratio, 1.48 [95% CI, 1.13-1.93]) was largely explained by education and insurance status (a proxy for socieoeconomic status; hazard ratio after further adjusting for these variables, 1.17 [95% CI, 0.85-1.62]) but remained significant for women age ≥70. Conclusions- This study provides novel data regarding the increased stroke risk among Caribbean Hispanics in this elderly population. Results highlight the need to create culturally tailored campaigns to reach black and Hispanic populations to reduce race/ethnic stroke disparities and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.
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Affiliation(s)
- Hannah Gardener
- From the Department of Neurology, University of Miami, Miller School of Medicine, FL (H.G., R.L.S., T.R.)
| | - Ralph L Sacco
- From the Department of Neurology, University of Miami, Miller School of Medicine, FL (H.G., R.L.S., T.R.)
| | - Tatjana Rundek
- From the Department of Neurology, University of Miami, Miller School of Medicine, FL (H.G., R.L.S., T.R.)
| | | | - Ying Kuen Cheung
- Department of Biostatistics, Mailman Public School of Health (Y.K.C.), Columbia University, New York
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Columbia University, New York
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118
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Jensen K, Howell SJ, Phan F, Khayyat‐Kholghi M, Wang L, Haq KT, Johnson J, Tereshchenko LG. Bringing Critical Race Praxis Into the Study of Electrophysiological Substrate of Sudden Cardiac Death: The ARIC Study. J Am Heart Assoc 2020; 9:e015012. [PMID: 32013706 PMCID: PMC7033892 DOI: 10.1161/jaha.119.015012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/08/2020] [Indexed: 12/24/2022]
Abstract
Background Race is an established risk factor for sudden cardiac death (SCD). We sought to determine whether the association of electrophysiological substrate with SCD varies between black and white individuals. Methods and Results Participants from the ARIC (Atherosclerosis Risk in Communities) study with analyzable ECGs (n=14 408; age, 54±6 years; 74% white) were included. Electrophysiological substrate was characterized by ECG metrics. Two competing outcomes were adjudicated: SCD and non-SCD. Interaction of ECG metrics with race was studied in Cox proportional hazards and Fine-Gray competing risk models, adjusted for prevalent cardiovascular disease, risk factors, and incident nonfatal cardiovascular disease. At the baseline visit, adjusted for age, sex, and study center, blacks had larger spatial ventricular gradient magnitude (0.30 mV; 95% CI, 0.25-0.34 mV), sum absolute QRST integral (18.4 mV*ms; 95% CI, 13.7-23.0 mV*ms), and Cornell voltage (0.30 mV; 95% CI, 0.25-0.35 mV) than whites. Over a median follow-up of 24.4 years, SCD incidence was higher in blacks (2.86 per 1000 person-years; 95% CI, 2.50-3.28 per 1000 person-years) than whites (1.37 per 1000 person-years; 95% CI, 1.22-1.53 per 1000 person-years). Blacks with hypertension had the highest rate of SCD: 4.26 (95% CI, 3.66-4.96) per 1000 person-years. Race did not modify an association of ECG variables with SCD, except QRS-T angle. Spatial QRS-T angle was associated with SCD in whites (hazard ratio, 1.38; 95% CI, 1.25-1.53) and hypertension-free blacks (hazard ratio, 1.52; 95% CI, 1.09-2.12), but not in blacks with hypertension (hazard ratio, 1.15; 95% CI, 0.99-1.32) (P-interaction=0.004). Conclusions Race did not modify associations of electrophysiological substrate with SCD and non-SCD. Electrophysiological substrate does not explain racial disparities in SCD rate.
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Affiliation(s)
- Kelly Jensen
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Stacey J. Howell
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Francis Phan
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | | | - Linda Wang
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Kazi T. Haq
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - John Johnson
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Larisa G. Tereshchenko
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
- Division of CardiologyDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMD
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119
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Quispe R, Michos ED, Martin SS, Puri R, Toth PP, Al Suwaidi J, Banach M, Virani SS, Blumenthal RS, Jones SR, Elshazly MB. High-Sensitivity C-Reactive Protein Discordance With Atherogenic Lipid Measures and Incidence of Atherosclerotic Cardiovascular Disease in Primary Prevention: The ARIC Study. J Am Heart Assoc 2020; 9:e013600. [PMID: 32013698 PMCID: PMC7033866 DOI: 10.1161/jaha.119.013600] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Inflammation is an independent causal risk factor for atherosclerotic cardiovascular diseases (ASCVDs). However, whether hsCRP (high-sensitivity C-reactive protein) is prognostic across various levels of atherogenic lipid measures such as low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B and total cholesterol/high-density lipoprotein cholesterol in primary prevention is unknown. Methods and Results We studied 9748 ARIC (Atherosclerosis Risk in Communities) study participants who were free of ASCVD at baseline (visit 4, 1996-1998) and had measurements of lipids, apolipoprotein B, and hsCRP. We used multivariable adjusted Cox models to estimate the risk of incident ASCVD events associated with hsCRP levels (less than/greater than or equal to median) in individuals where triple lipid measures combined (low-density lipoprotein cholesterol + non-high-density lipoprotein cholesterol + apolipoprotein B) or quadruple measures combined [triple + total cholesterol/high-density lipoprotein cholesterol] were less than versus greater than or equal to median cut points. Mean age of participants was 62.6±5.6 years; 59% women, 22% black. There were 1574 ASCVD events over median (interquartile range) follow-up of 18.4 (12.8-19.5) years, and discordance between hsCRP and lipid measures was prevalent in 50% of the population. hsCRP greater than or equal to median (2.4 mg/L), compared with less than median, was associated with an increased risk of ASCVD in individuals with less than median levels of the triple (adjusted hazard ratio, 1.33; 95% CI, 1.09-1.60) and quadruple (adjusted hazard ratio,1.47; 95% CI, 1.18-1.85) lipid measures. Such increased risk was consistent among individuals with low (<7.5%) or high (≥7.5%) estimated risk by the pooled cohort equation. There were no interactions by sex, diabetes mellitus, or statin use. Conclusions Our findings suggest that inflammation is independently associated with ASCVD regardless of atherogenic lipid levels and pooled cohort equation risk score in individuals without known ASCVD.
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Affiliation(s)
- Renato Quispe
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Peter P Toth
- Department of Preventive Cardiology CGH Medical Center Sterling IL.,University of Illinois College of Medicine Peoria IL
| | - Jassim Al Suwaidi
- Division of Cardiology Department of Medicine Weill Cornell Medical College-Qatar Doha Qatar.,Department of Cardiology Heart Hospital HMC Doha Qatar
| | - Maciej Banach
- Department of Hypertension Medical University of Lodz Lodz Poland
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Mohamed B Elshazly
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD.,Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland OH.,Department of Cardiology Heart Hospital HMC Doha Qatar
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120
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McEvoy JW, Daya N, Rahman F, Hoogeveen RC, Blumenthal RS, Shah AM, Ballantyne CM, Coresh J, Selvin E. Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes. JAMA 2020; 323:329-338. [PMID: 31990314 PMCID: PMC6990938 DOI: 10.1001/jama.2019.21402] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE In the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, the definition of hypertension was lowered from a blood pressure (BP) of greater than or equal to 140/90 to greater than or equal to 130/80 mm Hg. The new diastolic BP threshold of 80 mm Hg was recommended based on expert opinion and changes the definition of isolated diastolic hypertension (IDH). OBJECTIVE To compare the prevalence of IDH in the United States, by 2017 ACC/AHA and 2003 Joint National Committee (JNC7) definitions, and to characterize cross-sectional and longitudinal associations of IDH with outcomes. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analyses of the National Health and Nutrition Examination Survey (NHANES 2013-2016) and longitudinal analyses of the Atherosclerosis Risk in Communities (ARIC) Study (baseline 1990-1992, with follow-up through December 31, 2017). Longitudinal results were validated in 2 external cohorts: (1) the NHANES III (1988-1994) and NHANES 1999-2014 and (2) the Give Us a Clue to Cancer and Heart Disease (CLUE) II cohort (baseline 1989). EXPOSURES IDH, by 2017 ACC/AHA (systolic BP <130 mm Hg, diastolic BP ≥80 mm Hg) and by JNC7 (systolic BP <140 mm Hg, diastolic BP ≥90 mm Hg) definitions. MAIN OUTCOMES AND MEASURES Weighted estimates for prevalence of IDH in US adults and prevalence of US adults recommended BP pharmacotherapy by the 2017 ACC/AHA guideline based solely on the presence of IDH. Risk of incident atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD) in the ARIC Study. RESULTS The study population included 9590 adults from the NHANES (mean [SD] baseline age, 49.6 [17.6] years; 5016 women [52.3%]) and 8703 adults from the ARIC Study (mean [SD] baseline age, 56.0 [5.6] years; 4977 women [57.2%]). The estimated prevalence of IDH in the NHANES was 6.5% by the 2017 ACC/AHA definition and 1.3% by the JNC7 definition (absolute difference, 5.2% [95% CI, 4.7%-5.7%]). Among those newly classified as having IDH, an estimated 0.6% (95% CI, 0.5%-0.6%) also met the guideline threshold for antihypertensive therapy. Compared with normotensive ARIC participants, IDH by the 2017 ACC/AHA definition was not significantly associated with incident ASCVD (n = 1386 events; median follow-up, 25.2 years; hazard ratio [HR], 1.06 [95% CI, 0.89-1.26]), HF (n = 1396 events; HR, 0.91 [95% CI, 0.76-1.09]), or CKD (n = 2433 events; HR, 0.98 [95% CI, 0.65-1.11]). Results were also null for cardiovascular mortality in the 2 external cohorts (eg, HRs of IDH by the 2017 ACC/AHA definition were 1.17 [95% CI, 0.87-1.56] in the NHANES [n = 1012 events] and 1.02 [95% CI, 0.92-1.14] in CLUE II [n = 1497 events]). CONCLUSIONS AND RELEVANCE In this analysis of US adults, the estimated prevalence of IDH was more common when defined by the 2017 ACC/AHA BP guideline compared with the JNC7 guideline. However, IDH was not significantly associated with increased risk for cardiovascular outcomes.
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Affiliation(s)
- John W. McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Natalie Daya
- Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Faisal Rahman
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ron C. Hoogeveen
- Houston Methodist DeBakey Heart and Vascular Center, Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christie M. Ballantyne
- Houston Methodist DeBakey Heart and Vascular Center, Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Cowan LT, Lakshminarayan K, Lutsey PL, Beck J, Offenbacher S, Pankow JS. Endodontic therapy and incident cardiovascular disease: The Atherosclerosis Risk in Communities (ARIC) study. J Public Health Dent 2020; 80:79-91. [DOI: 10.1111/jphd.12353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/17/2019] [Accepted: 11/13/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Logan T. Cowan
- Department of Biostatistics, Epidemiology and Environmental Health SciencesGeorgia Southern University Statesboro GA USA
| | | | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota Minneapolis MN USA
| | - James Beck
- Department of Dental Ecology, School of DentistryUniversity of North Carolina Chapel Hill NC USA
| | - Steven Offenbacher
- Department of Periodontology, School of DentistryUniversity of North Carolina Chapel Hill NC USA
| | - James S. Pankow
- Division of Epidemiology and Community HealthUniversity of Minnesota Minneapolis MN USA
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122
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Moazzami K, Shao IY, Chen LY, Lutsey PL, Jack CR, Mosley T, Joyner DA, Gottesman R, Alonso A. Atrial Fibrillation, Brain Volumes, and Subclinical Cerebrovascular Disease (from the Atherosclerosis Risk in Communities Neurocognitive Study [ARIC-NCS]). Am J Cardiol 2020; 125:222-228. [PMID: 31771759 PMCID: PMC6942172 DOI: 10.1016/j.amjcard.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 01/24/2023]
Abstract
The aim of the present study was to investigate the association between atrial fibrillation (AF) and total and regional brain volumes among participants in the community-based Atherosclerosis Risk in Communities Neurocognitive study (ARIC-NCS). A total of 1,930 participants (130 with AF) with a mean age of 76.3 ± 5.2, who underwent 3T brain MRI scans in 2011 to 2013 were included. Prevalent AF was ascertained from study ECGs and hospital discharge codes. Brain volumes were measured using FreeSurfer image analysis software. Markers of subclinical cerebrovascular disease included lobar microhemorrhages, subcortical microhemorrhages, cortical infarcts, subcortical infarcts, lacunar infarcts, and volume of white matter hyperintensities. Linear regression models were used to assess the associations between AF status and brain volumes. In adjusted analyses, AF was not associated with markers of subclinical cerebrovascular disease. However, AF was associated with smaller regional brain volumes (including temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all p <0.05]) after controlling for demographics, cardiovascular risk factors, prevalent cardiovascular disease, and markers of subclinical cerebrovascular disease. Subgroup analysis revealed a significant interaction between AF and total brain volume with respect to age (p = 0.02), with associations between AF and smaller brain volumes being stronger for older individuals. In conclusion, AF was associated with smaller brain volumes, and the association was stronger among older individuals. This finding may be related to the longer exposure period of the older population to AF or the possibility that older people are more susceptible to the effects of AF on brain volume.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Iris Yuefan Shao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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123
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Malaeb D, Cherri S, Hallit S, Saade S, Hosseini H, Salameh P. Assessment of post discharge medication prescription among Lebanese patients with cerebral infarction: Results of a cross-sectional study. Clin Neurol Neurosurg 2020; 191:105674. [PMID: 31954365 DOI: 10.1016/j.clineuro.2020.105674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The study objective was to investigate the degree of physician adherence with the international guidelines for post-stroke discharge medications among Lebanese hospitals. PATIENT AND METHODS This retrospective observational study was conducted in three Lebanese hospitals between January 2016 and December 2017. RESULTS Out of 200 patients with stroke, 64.7 % were males. The difference of systolic blood pressure from baseline, 2 h, and after 24 h showed significant decrease by mean value 25.18 ± 33.45 (P < 0.001), and 6.44 ± 22.11 (P = 0.019) respectively. Also diastolic blood pressure showed significant decrease between baseline and after 24 h by a mean value 12.17 ± 13.63 (P value <0.001). Concerning post discharge medications adherence, antithrombotic drugs showed the highest percentage (73 %) followed by antihypertensive and lipid lowering agents by comparable results (47.5 % and 40.7 % respectively). The physician adherence for the three medications together showed (30.4 %). CONCLUSION Secondary prevention for critical diseases such as stroke appears to be inadequate in the study area.
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Affiliation(s)
- Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon; Life Sciences and Health Department, Paris-Est University, Paris, France.
| | - Sarah Cherri
- School of Pharmacy, Lebanese International University, Beirut, Lebanon.
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Sylvia Saade
- School of Pharmacy, Lebanese International University, Beirut, Lebanon.
| | - Hassan Hosseini
- Life Sciences and Health Department, Paris-Est University, Paris, France.
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon; Faculty of Pharmacy, Lebanese University, Hadat, Lebanon; Faculty of Medicine, Lebanese University, Hadat, Lebanon.
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Elfassy T, Grasset L, Glymour MM, Swift S, Zhang L, Howard G, Howard VJ, Flaherty M, Rundek T, Osypuk TL, Zeki Al Hazzouri A. Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States. Stroke 2020; 50:805-812. [PMID: 30852967 DOI: 10.1161/strokeaha.118.023782] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose- It is unclear whether disparities in mortality among stroke survivors exist long term. Therefore, the purpose of the current study is to describe rates of longer term mortality among stroke survivors (ie, beyond 30 days) and to determine whether socioeconomic disparities exist. Methods- This analysis included 1329 black and white participants, aged ≥45 years, enrolled between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) who suffered a first stroke and survived at least 30 days after the event. Long-term mortality among stroke survivors was defined in person-years as time from 30 days after a first stroke to date of death or censoring. Mortality rate ratios (MRRs) were used to compare rates of poststroke mortality by demographic and socioeconomic characteristics. Results- Among adults who survived ≥30 days poststroke, the age-adjusted rate of mortality was 82.3 per 1000 person-years (95% CI, 75.4-89.2). Long-term mortality among stroke survivors was higher in older individuals (MRR for 75+ versus <65, 3.2; 95% CI, 2.6-4.1) and among men than women (MRR, 1.3; 95% CI, 1.1-1.6). It was also higher among those with less educational attainment (MRR for less than high-school versus college graduate, 1.5; 95% CI, 1.1-1.9), lower income (MRR for <$20k versus >50k, 1.4; 95% CI, 1.1-1.9), and lower neighborhood socioeconomic status (SES; MRR for low versus high neighborhood SES, 1.4; 95% CI, 1.1-1.7). There were no differences in age-adjusted rates of long-term poststroke mortality by race, rurality, or US region. Conclusions- Rates of long-term mortality among stroke survivors were higher among individuals with lower SES and among those residing in neighborhoods of lower SES. These results emphasize the need for improvements in long-term care poststroke, especially among individuals of lower SES.
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Affiliation(s)
- Tali Elfassy
- From the Division of Epidemiology, Department of Public Health Sciences (T.E., L.G., S.S., L.Z.), University of Miami, FL
| | - Leslie Grasset
- From the Division of Epidemiology, Department of Public Health Sciences (T.E., L.G., S.S., L.Z.), University of Miami, FL
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco (M.M.G.)
| | - Samuel Swift
- From the Division of Epidemiology, Department of Public Health Sciences (T.E., L.G., S.S., L.Z.), University of Miami, FL
| | - Lanyu Zhang
- From the Division of Epidemiology, Department of Public Health Sciences (T.E., L.G., S.S., L.Z.), University of Miami, FL
| | - George Howard
- Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health
| | - Virginia J Howard
- Department of Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health
| | - Matthew Flaherty
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (M.F.)
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine (T.R.), University of Miami, FL
| | - Theresa L Osypuk
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (T.L.O.)
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (A.Z.A.H.)
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125
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Cowan LT, Lutsey PL, Pankow JS, Matsushita K, Ishigami J, Lakshminarayan K. Inpatient and Outpatient Infection as a Trigger of Cardiovascular Disease: The ARIC Study. J Am Heart Assoc 2019; 7:e009683. [PMID: 30571501 PMCID: PMC6404437 DOI: 10.1161/jaha.118.009683] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acute infections are known cardiovascular disease (CVD) triggers, but little is known regarding how CVD risk varies following inpatient versus outpatient infections. We hypothesized that in‐ and outpatient infections are associated with CVD risk and that the association is stronger for inpatient infections. Methods and Results Coronary heart disease (CHD) and ischemic stroke cases were identified and adjudicated in the ARIC (Atherosclerosis Risk in Communities Study). Hospital discharge diagnosis codes and Medicare claims data were used to identify infections diagnosed in in‐ and outpatient settings. A case‐crossover design and conditional logistic regression were used to compare in‐ and outpatient infections among CHD and ischemic stroke cases (14, 30, 42, and 90 days before the event) with corresponding control periods 1 and 2 years previously. A total of 1312 incident CHD cases and 727 incident stroke cases were analyzed. Inpatient infections (14‐day odds ratio [OR]=12.83 [5.74, 28.68], 30‐day OR=8.39 [4.92, 14.31], 42‐day OR=6.24 [4.02, 9.67], and 90‐day OR=4.48 [3.18, 6.33]) and outpatient infections (14‐day OR=3.29 [2.50, 4.32], 30‐day OR=2.69 [2.14, 3.37], 42‐day OR=2.45 [1.97, 3.05], and 90‐day OR=1.99 [1.64, 2.42]) were more common in all CHD case periods compared with control periods and inpatient infection was a stronger CHD trigger for all time periods (P<0.05). Inpatient infection was also a stronger stroke trigger with the difference borderline statistically significant (P<0.10) for the 42‐ and 90‐day time periods. Conclusions In‐ and outpatient infections are associated with CVD risk. Patients with an inpatient infection may be at particularly elevated CVD risk and should be considered potential candidates for CVD prophylaxis. See Editorial by https://doi.org/10.1161/JAHA.118.011175
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Affiliation(s)
- Logan T Cowan
- 1 Department of Epidemiology and Environmental Health Sciences Georgia Southern University Statesboro GA
| | - Pamela L Lutsey
- 2 Division of Epidemiology and Community Health University of Minnesota Minneapolis MN
| | - James S Pankow
- 2 Division of Epidemiology and Community Health University of Minnesota Minneapolis MN
| | | | - Junichi Ishigami
- 3 Department of Epidemiology Johns Hopkins University Baltimore MD
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Gutierrez A, Norby FL, Maheshwari A, Rooney MR, Gottesman RF, Mosley TH, Lutsey PL, Oldenburg N, Soliman EZ, Alonso A, Chen LY. Association of Abnormal P-Wave Indices With Dementia and Cognitive Decline Over 25 Years: ARIC-NCS (The Atherosclerosis Risk in Communities Neurocognitive Study). J Am Heart Assoc 2019; 8:e014553. [PMID: 31830872 PMCID: PMC6951047 DOI: 10.1161/jaha.119.014553] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/12/2019] [Indexed: 12/30/2022]
Abstract
Background Abnormal P-wave indices (PWIs)-reflecting underlying left atrial abnormality-are associated with increased risk of stroke independent of atrial fibrillation. We assessed whether abnormal PWIs are associated with incident dementia and greater cognitive decline, independent of atrial fibrillation and ischemic stroke. Methods and Results We included 13 714 participants (mean age, 57±6 years; 56% women; 23% black) who were followed for dementia through the end of 2015. (Abnormal P-wave terminal force in lead V1, ≥4000 μV×ms), abnormal P-wave axis (>75° or <0°), prolonged P-wave duration (>120 ms), and advanced interatrial block were determined from ECGs at visits 2 to 4. Dementia was adjudicated by an expert panel using data from cognitive tests and hospitalization International Classification of Diseases codes. Cognitive function was measured longitudinally using 3 neuropsychological tests. Cox proportional hazards models were used to assess the association between time-dependent abnormal PWIs with incident dementia. Linear regression models were used to evaluate PWIs with cognitive function over time. At the conclusion of the study, 19%, 16%, 28%, and 1.9% of participants had abnormal P-wave terminal force in lead V1, abnormal P-wave axis, prolonged P-wave duration, and advanced interatrial block, respectively. During mean follow-up of 18 years, there were 1390 (10%) dementia cases. All abnormal PWIs except advanced interatrial block were associated with an increased risk of dementia even after adjustment for incident atrial fibrillation and stroke: multivariable hazard ratio of abnormal P wave terminal force in lead V1=1.60, 95% CI, 1.41 to 2.83; abnormal P-wave axis, hazard ratio =1.36, 95% CI, 1.17 to 2.57; prolonged P-wave duration, hazard ratio=1.60, 95% CI, 1.42 to 1.80. Only abnormal P-wave terminal force in lead V1 was associated with greater decline in global cognition. Conclusions Abnormal PWIs are independently associated with an increased risk of dementia. This novel finding should be replicated in other cohorts and the underlying mechanisms should be evaluated.
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Affiliation(s)
- Alejandra Gutierrez
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Faye L. Norby
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Ankit Maheshwari
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Mary R. Rooney
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Rebecca F. Gottesman
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Thomas H. Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Niki Oldenburg
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE)Wake Forest University School of MedicineWinston‐SalemNC
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Lin Y. Chen
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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Mansoor H, Jo A, Beau De Rochars VM, Pepine CJ, Mainous AG. Novel Self-Report Tool for Cardiovascular Risk Assessment. J Am Heart Assoc 2019; 8:e014123. [PMID: 31818214 PMCID: PMC6951080 DOI: 10.1161/jaha.119.014123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The currently used atherosclerotic cardiovascular disease risk calculator relies on several measured variables and does not incorporate some well‐established risk factors such as family history of premature myocardial infarction and other nontraditional risk factors. Our study aimed to develop and validate a simple risk score to predict 10‐year risk of incident cardiovascular events using patient‐reported information. Methods and Results Using data from the Atherosclerosis Risk in Communities cohort, we identified adults with no previous history of cardiovascular disease and randomly divided the cohort into “development” (70%) and “validation” (30%) subgroups. Adjusted Cox regression modeling was used to develop a prediction model. The predictive performance of the new risk score was compared with the score derived from the atherosclerotic cardiovascular disease risk calculator. A total of 9285 individuals met the inclusion criteria. During follow‐up (median 8.93 years), a total of 694 (7.47%) incident cardiovascular events occurred. The following 6 factors were included: male sex, age, current smoking, diabetes mellitus, hypertension, and family history of premature myocardial infarction. The C‐statistic was 0.72 in the validation cohort with good calibration. The area under the curve for the simple risk score was comparable to the atherosclerotic cardiovascular disease risk score. Conclusions The novel simple risk score is an easy‐to‐use tool to predict cardiovascular events in adults from self‐reported information without need for laboratory or physical examination data. This risk score included 6‐items and had comparable predictive performance to the guideline recommended atherosclerotic cardiovascular disease risk score but relies solely on self‐reported information.
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Affiliation(s)
- Hend Mansoor
- Department of Health Services Research, Management, and Policy University of Florida Gainesville FL
| | - Ara Jo
- Department of Health Services Research, Management, and Policy University of Florida Gainesville FL
| | - V Madsen Beau De Rochars
- Department of Health Services Research, Management, and Policy University of Florida Gainesville FL
| | - Carl J Pepine
- Division of Cardiovascular Medicine Department of Medicine University of Florida Gainesville FL
| | - Arch G Mainous
- Department of Health Services Research, Management, and Policy University of Florida Gainesville FL
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128
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Caughey MC, Derebail VK, Key NS, Reiner AP, Gottesman RF, Kshirsagar AV, Heiss G. Thirty-year risk of ischemic stroke in individuals with sickle cell trait and modification by chronic kidney disease: The atherosclerosis risk in communities (ARIC) study. Am J Hematol 2019; 94:1306-1313. [PMID: 31429114 PMCID: PMC6858511 DOI: 10.1002/ajh.25615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Abstract
Sickle cell trait (SCT) has been associated with hypercoagulability, chronic kidney disease (CKD), and ischemic stroke. Whether concomitant CKD modifies long-term ischemic stroke risk in individuals with SCT is uncertain. We analyzed data from 3602 genotyped black adults (female = 62%, mean baseline age = 54 years) who were followed for a median 26 years by the Atherosclerosis Risk in Communities Study. Ischemic stroke was verified by physician review. Associations between SCT and ischemic stroke were analyzed using repeat-events Cox regression, adjusted for potential confounders. SCT was identified in 236 (7%) participants, who more often had CKD at baseline than noncarriers (18% vs 13%, P = .02). Among those with CKD, elevated factor VII activity was more prevalent with SCT genotype (36% vs 22%; P = .05). From 1987-2017, 555 ischemic strokes occurred in 436 individuals. The overall hazard ratio of ischemic stroke associated with SCT was 1.31 (95% CI: 0.95-1.80) and was stronger in participants with concomitant CKD (HR = 2.18; 95% CI: 1.16-4.12) than those without CKD (HR = 1.09; 95% CI: 0.74-1.61); P for interaction = .04. The hazard ratio of composite ischemic stroke and/or death associated with SCT was 1.20 (95% CI: 1.01-1.42) overall, 1.44 (95% CI: 1.002-2.07) among those with CKD, and 1.15 (95% CI: 0.94-1.39) among those without CKD; P for interaction = .18. The long-term risk of ischemic stroke associated with SCT relative to noncarrier genotype appears to be modified by concomitant CKD.
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Affiliation(s)
- Melissa C. Caughey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vimal K. Derebail
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nigel S. Key
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Abhijit V. Kshirsagar
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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129
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Howard VJ, Madsen TE, Kleindorfer DO, Judd SE, Rhodes JD, Soliman EZ, Kissela BM, Safford MM, Moy CS, McClure LA, Howard G, Cushman M. Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors. JAMA Neurol 2019; 76:179-186. [PMID: 30535250 DOI: 10.1001/jamaneurol.2018.3862] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Race-specific and sex-specific stroke risk varies across the lifespan, yet few reports describe sex differences in stroke risk separately in black individuals and white individuals. Objective To examine incidence and risk factors for ischemic stroke by sex for black and white individuals. Design, Setting, and Participants This prospective cohort study included participants 45 years and older who were stroke-free from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, enrolled from the continental United States 2003 through 2007 with follow-up through October 2016. Data were analyzed from March 2018 to September 2018. Exposures Sex and race. Main Outcomes and Measures Physician-adjudicated incident ischemic stroke, self-reported race/ethnicity, and measured and self-reported risk factors. Results A total of 25 789 participants (14 170 women [54.9%]; 10 301 black individuals [39.9%]) were included. Over 222 120 person-years of follow-up, 939 ischemic strokes occurred: 159 (16.9%) in black men, 326 in white men (34.7%), 217 in black women (23.1%), and 237 in white women (25.2%). Between 45 and 64 years of age, white women had 32% lower stroke risk than white men (incidence rate ratio [IRR], 0.68 [95% CI, 0.49-0.94]), and black women had a 28% lower risk than black men (IRR, 0.72 [95% CI, 0.52-0.99]). Lower stroke risk in women than men persisted at age 65 through 74 years in white individuals (IRR, 0.71 [95% CI, 0.55-0.94]) but not in black individuals (IRR, 0.94 [95% CI, 0.68-1.30]); however, the race-sex interaction was not significant. At 75 years and older, there was no sex difference in stroke risk for either race. For white individuals, associations of systolic blood pressure (women: hazard ratio [HR], 1.13 [95% CI, 1.05-1.22]; men: 1.04 [95% CI, 0.97-1.11]; P = .099), diabetes (women: HR, 1.84 [95% CI, 1.35-2.52]; men: 1.13 [95% CI, 0.86-1.49]; P = .02), and heart disease (women: HR, 1.76 [95% CI, 1.30-2.39]; men, 1.26 [95% CI, 0.99-1.60]; P = .09) with stroke risk were larger for women than men, while antihypertensive medication use had a smaller association in women than men (women: HR, 1.17 [95% CI, 0.89-1.54]; men: 1.61 [95% CI, 1.29-2.03]; P = .08). In black individuals, there was no evidence of a sex difference for any risk factors. Conclusions and Relevance For both races, at age 45 through 64 years, women were at lower stroke risk than men, and there was no sex difference at 75 years or older; however, the sex difference pattern may differ by race from age 65 through 74 years. The association of risk factors on stroke risk differed by race-sex groups. While the need for primordial prevention, optimal management, and control of risk factors is universal across all age, racial/ethnic, and sex groups, some demographic subgroups may require earlier and more aggressive strategies.
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Affiliation(s)
- Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dawn O Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - J David Rhodes
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, North Carolina.,Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Monika M Safford
- Department of Medicine, Weill-Cornell Medicine, New York, New York
| | - Claudia S Moy
- Department of Health and Human Services, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, Colchester, Vermont
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130
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GeographicalDifference, Rural-urban Transition and Trend in Stroke Prevalence in China: Findings from a National Epidemiological Survey of Stroke in China. Sci Rep 2019; 9:17330. [PMID: 31758035 PMCID: PMC6874659 DOI: 10.1038/s41598-019-53848-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
Accurate and up-to-date provincial and regional-level stroke prevalence estimates are important for research planning and targeted strategies for stroke prevention and management. However, recent and comprehensive evaluation is lacking over the past 30 years in China. This study aimed to examine the geographical variations in stroke prevalence based on data from the National Epidemiological Survey of Stroke in China (NESS-China) and demonstrate urban-rural transition and trend over three decades. The stroke prevalence (prevalence day, August 31, 2013) was estimated using the world standard population. The stroke prevalence was 873.4 per 100,000 population, and varied from 218.0 in Sichuan to 1768.9 in Heilongjiang. Stroke prevalence exhibited a noticeable north-south gradient (1097.1, 917.7, and 619.4 in the north, middle, and the south, respectively; P < 0.001) and showed a 2.0-fold, 1.5-fold, and 1.2-fold increase in rural areas in the north, the middle, and the south, respectively, from 1985 to 2013. Overall, stroke prevalence was higher in the rural regions than in the urban (945.4 versus 797.5, P < 0.001) regions. However, the converse was depicted in 12 provinces. A noticeable geographical variation in stroke prevalence was observed and was evolving overtime in China. It is imperative that effective public health policies and interventions be implemented, especially in those regions with higher prevalence.
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131
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Lansky AJ, Messé SR, Brickman AM, Dwyer M, Bart van der Worp H, Lazar RM, Pietras CG, Abrams KJ, McFadden E, Petersen NH, Browndyke J, Prendergast B, Ng VG, Cutlip DE, Kapadia S, Krucoff MW, Linke A, Scala Moy C, Schofer J, van Es GA, Virmani R, Popma J, Parides MK, Kodali S, Bilello M, Zivadinov R, Akar J, Furie KL, Gress D, Voros S, Moses J, Greer D, Forrest JK, Holmes D, Kappetein AP, Mack M, Baumbach A. Proposed Standardized Neurological Endpoints for Cardiovascular Clinical Trials: An Academic Research Consortium Initiative. Eur Heart J 2019; 39:1687-1697. [PMID: 28171522 DOI: 10.1093/eurheartj/ehx037] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Surgical and catheter-based cardiovascular procedures and adjunctive pharmacology have an inherent risk of neurological complications. The current diversity of neurological endpoint definitions and ascertainment methods in clinical trials has led to uncertainties in the neurological risk attributable to cardiovascular procedures and inconsistent evaluation of therapies intended to prevent or mitigate neurological injury. Benefit-risk assessment of such procedures should be on the basis of an evaluation of well-defined neurological outcomes that are ascertained with consistent methods and capture the full spectrum of neurovascular injury and its clinical effect. The Neurologic Academic Research Consortium is an international collaboration intended to establish consensus on the definition, classification, and assessment of neurological endpoints applicable to clinical trials of a broad range of cardiovascular interventions. Systematic application of the proposed definitions and assessments will improve our ability to evaluate the risks of cardiovascular procedures and the safety and effectiveness of preventive therapies.
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Affiliation(s)
- Alexandra J Lansky
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cardiovascular Research Group, New Haven, Connecticut.,Department of Cardiology, St Bartholomew's Hospital, William Harvey Research Institute, and Queen Mary University of London, London, United Kingdom
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam M Brickman
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Michael Dwyer
- Buffalo Neuroimaging Analysis, University of Buffalo, Buffalo, New York
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald M Lazar
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cody G Pietras
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cardiovascular Research Group, New Haven, Connecticut
| | - Kevin J Abrams
- Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida
| | - Eugene McFadden
- Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Nils H Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey Browndyke
- Division of Geriatric Behavioral Health, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | | | - Vivian G Ng
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cardiovascular Research Group, New Haven, Connecticut
| | - Donald E Cutlip
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mitchell W Krucoff
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Axel Linke
- Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
| | - Claudia Scala Moy
- Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Joachim Schofer
- Medicare Center and Department for Percutaneous Interventions of Structural Heart Disease, Albertine Heart Center, Hamburg, Germany
| | | | | | - Jeffrey Popma
- Icahn School of Medicine at Mount Sinai Group, New York, New York
| | | | - Susheel Kodali
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - Michel Bilello
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis, University of Buffalo, Buffalo, New York
| | - Joseph Akar
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, Providence, Rhode Island
| | - Daryl Gress
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Szilard Voros
- Global Institute for Research and Global Genomics Group, Richmond, Virginia
| | - Jeffrey Moses
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - David Greer
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Arie P Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; and the
| | - Michael Mack
- Department of Cardiovascular Surgery, The Heart Hospital Baylor Plano Research Center, Plano Texas. Grants to support travel costs, meeting rooms, and lodging for academic attendees at the San Francisco and New York meetings were provided by Boston Scientific, Edwards Lifesciences, Medtronic Corporation, St. Jude Medical, NeuroSave Inc., and Keystone Heart Ltd
| | - Andreas Baumbach
- Department of Cardiology, St Bartholomew's Hospital, William Harvey Research Institute, and Queen Mary University of London, London, United Kingdom
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132
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Decker JJ, Norby FL, Rooney MR, Soliman EZ, Lutsey PL, Pankow JS, Alonso A, Chen LY. Metabolic Syndrome and Risk of Ischemic Stroke in Atrial Fibrillation: ARIC Study. Stroke 2019; 50:3045-3050. [PMID: 31623543 PMCID: PMC6817422 DOI: 10.1161/strokeaha.119.025376] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/12/2019] [Indexed: 01/05/2023]
Abstract
Background and Purpose- Metabolic syndrome (MetS), a prothrombotic state, is associated with an increased risk of atrial fibrillation (AF) and stroke. The CHA2DS2-VASc score does not account for the MetS components of prehypertension, prediabetes mellitus, abdominal obesity, elevated triglycerides, and low HDL (high-density lipoprotein). Data are limited on the association of MetS with stroke in AF, independent of CHA2DS2-VASc variables. Our aim was to identify MetS components associated with ischemic stroke in participants with AF in the ARIC study (Atherosclerosis Risk in Communities). Methods- We included 1172 participants with incident AF within 5 years of measurement of MetS components. MetS was defined by ATP criteria and International Diabetes Federation criteria. Incident ischemic stroke was physician adjudicated. Multivariable Cox proportional hazards regression was used to assess the association of MetS components with stroke. Results- After a median follow-up of 14.8 years, there were 113 ischemic stroke cases. Of the individual MetS components, low HDL was borderline associated with increased stroke risk (hazard ratio, 1.48 [95% CI, 0.99-2.21]) after adjustment for CHA2DS2-VASc variables while the remaining MetS variables were not associated with stroke risk. The presence of ≥3 components of MetS was not significantly associated with ischemic stroke after adjustment for CHA2DS2-VASc variables (hazard ratio, 1.38 [95% CI, 0.91-2.11]). The risk of stroke increased by 13% for each additional component of MetS; however, this association was borderline significant (hazard ratio, 1.13 [95% CI, 0.99-1.28]). Conclusions- The presence of MetS was not significantly associated with ischemic stroke after adjustment for CHA2DS2-VASc variables. Consideration of MetS is unlikely to improve stroke prediction in AF.
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Affiliation(s)
- Joseph J. Decker
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary R. Rooney
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elsayed Z. Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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133
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Verney SP, Suchy-Dicey AM, Cholerton B, Calhoun D, Nelson L, Montine TJ, Ali T, Longstreth WT, Buchwald D. The associations among sociocultural factors and neuropsychological functioning in older American Indians: The Strong Heart Study. Neuropsychology 2019; 33:1078-1088. [PMID: 31343235 PMCID: PMC8048411 DOI: 10.1037/neu0000574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Valid neuropsychological assessment is critical to the accurate diagnosis and effective treatment of diverse populations. American Indians and Alaska Natives experience substantial health disparities relative to the general U.S. POPULATION Given the dearth of studies on neuropsychological health in this population, we aimed to characterize neuropsychological performance among older American Indians with respect to age, sex, education, income, and language use. METHOD From 2010 to 2014, we recruited 818 American Indians aged 60 and older from the Cerebrovascular Disease and Its Consequences in American Indians Study, who comprised all of the surviving members of a cardiovascular study (Strong Heart Study). This cohort from 11 tribes resided on or near their home reservations in three geographic regions (Northern Plains, Southern Plains, and Southwest). Using a cross-sectional design investigating potential vascular brain injury, we administered a brief, targeted neuropsychological and motor function assessments. RESULTS Higher scores on neuropsychological tests were associated with younger age, female sex, more education, higher income, and less Native American language use. Similar associations were found for the motor tests, although men had higher scores on both motor function tests. After accounting for other sociocultural and health factors, age, sex, education, income, and Native American language use all had significant associations to the test scores. CONCLUSIONS Our findings may be used to guide research and inform clinical practice. The development of future normative studies for older American Indians will be more culturally appropriate when sociocultural factors are included. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Steven P Verney
- Department of Psychology and Psychology Clinical Neuroscience Center
| | | | | | | | - Lonnie Nelson
- Institute for Education and Research to Advance Community Health
| | | | | | | | - Dedra Buchwald
- Institute for Education and Research to Advance Community Health
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Yang C, Kwak L, Ballew SH, Jaar BG, Deal JA, Folsom AR, Heiss G, Sharrett AR, Selvin E, Sabanayagam C, Coresh J, Matsushita K. Retinal microvascular findings and risk of incident peripheral artery disease: An analysis from the Atherosclerosis Risk in Communities (ARIC) Study. Atherosclerosis 2019; 294:62-71. [PMID: 31812251 DOI: 10.1016/j.atherosclerosis.2019.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/23/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Lower-extremity peripheral artery disease (PAD) is usually considered large artery disease. Interestingly, retinal microvascular findings were shown to predict PAD progression in diabetes. However, it is unknown whether retinal microvascular parameters are associated with incident PAD and its severe form, critical limb ischemia (CLI), in a community-based cohort. METHODS Among 9371 ARIC participants (aged 49-72 years) free of a history of PAD, we quantified the associations of several retinal measures by retinal photography during the period 1993-1995 with PAD risk using Cox models. Incident PAD was defined as the first hospitalization with PAD diagnosis or leg revascularization (considered CLI if an additional diagnosis of ulcer, gangrene, or amputation). RESULTS During a median follow-up of 18.8 years, 303 participants developed PAD (including 91 CLI cases). Although generalized retinal arteriolar narrowing was not associated with PAD, most measures of retinopathy demonstrated strong associations with PAD beyond potential confounders including diabetes, with adjusted hazard ratios (HR) of 3.26 (95% CI 2.18-4.90) for blot-shaped hemorrhages, 3.11 (1.83-5.29) for hard exudates, and 2.18 (1.62-2.95) for any retinopathy. Adjusted HRs were significantly greater for CLI (ranging from 3.2 to 5.9) than for PAD (all p-values <0.05). Retinopathy measures showed particularly strong associations in participants with diabetes (p-value for interaction [vs. those without diabetes] <0.001). CONCLUSIONS Several retinopathy measures were strongly associated with PAD, especially with CLI and in diabetes. Our results support the contribution of microvascular abnormalities to the development and progression of PAD and would have implications on its preventive and therapeutic approaches.
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Affiliation(s)
- Chao Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lucia Kwak
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Bernard G Jaar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; Nephrology Center of Maryland, Baltimore, MD, USA
| | - Jennifer A Deal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aaron R Folsom
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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135
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Parikh RR, Folsom AR, Misialek JR, Rosamond WD, Chang PP, Tang W, Cushman M. Prospective study of plasma high molecular weight kininogen and prekallikrein and incidence of coronary heart disease, ischemic stroke and heart failure. Thromb Res 2019; 182:89-94. [PMID: 31473403 PMCID: PMC6825898 DOI: 10.1016/j.thromres.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/10/2019] [Accepted: 08/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION High molecular weight kininogen (HK) and prekallikrein (PK) are proteins in the kallikrein/kinin system of the coagulation cascade. They play an important role in the contact activation system of the intrinsic coagulation pathway, renin-angiotensin activation, and inflammation. Hence these proteins have been posited to affect the occurrence of cardiovascular events and thus to be potential therapeutic targets. Previous case-control studies have provided inconsistent evidence for an association of HK and PK with cardiovascular disease. METHODS In the prospective population-based Atherosclerosis Risk in Communities(ARIC) Study, we used Cox proportional hazards regression models to investigate the association in 4195 middle-aged adults of plasma HK and PK concentrations in 1993-95 (linearly and in quartiles) with incident coronary heart disease, ischemic stroke, and heart failure through 2016. RESULTS Over a mean of 18 years follow-up, we identified incident cardiovascular events (coronary heart disease and ischemic stroke) in 618 participants and heart failure in 667. We observed no significant relation between HK or PK and cardiovascular disease or heart failure, before and after adjusting for several potential confounding variables. CONCLUSIONS We found no compelling evidence to support an association of plasma HK or PK concentrations with incident CHD, ischemic stroke, or heart failure.
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Affiliation(s)
- Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 3nd Street, Suite 300, Minneapolis, MN 55454, United States.
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 3nd Street, Suite 300, Minneapolis, MN 55454, United States.
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 3nd Street, Suite 300, Minneapolis, MN 55454, United States.
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina, 137 East Franklin Street, Suite 306, CB# 7435, Chapel Hill, NC 27514, United States.
| | - Patricia P Chang
- Division of Cardiology, Department of Medicine, University of North Carolina, 300 Meadowmont Village Cir #104, Chapel Hill, NC 27517, United States.
| | - Weihong Tang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 3nd Street, Suite 300, Minneapolis, MN 55454, United States.
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Main Pavilion, 111 Colchester Ave, Burlington, VT 05401, United States; Department of Medicine, University of Vermont College of Medicine, Main Pavilion, 111 Colchester Ave, Burlington, VT 05401, United States.
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136
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Windham BG, Griswold ME, Wilkening SR, Su D, Tingle J, Coker LH, Knopman D, Gottesman RF, Shibata D, Mosley TH. Midlife Smaller and Larger Infarctions, White Matter Hyperintensities, and 20-Year Cognitive Decline: A Cohort Study. Ann Intern Med 2019; 171:389-396. [PMID: 31450238 PMCID: PMC7413210 DOI: 10.7326/m18-0295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Smaller (<3-mm) infarctions are associated with stroke and stroke mortality, but relationships with cognitive decline are unknown. OBJECTIVE To characterize the relationships of smaller, larger, and both smaller and larger infarctions in middle age with 20-year cognitive decline. DESIGN Longitudinal cohort study. SETTING Two ARIC (Atherosclerosis Risk in Communities) study sites with magnetic resonance imaging data (1993 to 1995) and up to 5 cognitive assessments over 20 years. PARTICIPANTS Stroke-free participants aged 50 years or older. MEASUREMENTS Infarctions were categorized as none, smaller only, larger only (3 to 20 mm), or both smaller and larger. Global cognitive Z scores were derived from 3 cognitive tests administered up to 5 times. Mixed-effects models estimated adjusted associations between infarctions and cognitive decline. Results are the average difference in standardized cognitive decline associated with infarctions versus no infarctions. RESULTS Among 1884 participants (mean age, 62 years; 60% women; 50% black), 1611 (86%) had no infarctions, 50 (3%) had smaller infarctions only, 185 (10%) had larger infarctions only, and 35 (2%) had both. Participants with both smaller and larger infarctions had steeper cognitive decline by more than half an SD (difference, -0.57 SD [95% CI, -0.89 to -0.26 SD]) compared with those who had no infarctions. Amounts of cognitive decline associated with only smaller infarctions and only larger infarctions were similar and were not statistically different from that associated with no infarctions. LIMITATION Few participants had only smaller infarctions or both smaller and larger infarctions, and the data lacked counts of smaller infarctions and volumes of white matter hyperintensities. CONCLUSION The substantial cognitive decline from middle age associated with having both smaller and larger infarctions, but not larger infarctions alone, suggests that the combination of smaller and larger infarctions may escalate risk for cognitive decline later in life in stroke-free persons. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- B Gwen Windham
- University of Mississippi Medical Center, Jackson, Mississippi (B.G.W., T.H.M.)
| | - Michael E Griswold
- University of Mississippi Medical Center School of Population Health, Jackson, Mississippi (M.E.G., D.S., J.T.)
| | - Steven R Wilkening
- University of Mississippi Medical Center School of Medicine, Jackson, Mississippi (S.R.W.)
| | - Dan Su
- University of Mississippi Medical Center School of Population Health, Jackson, Mississippi (M.E.G., D.S., J.T.)
| | - Jonathan Tingle
- University of Mississippi Medical Center School of Population Health, Jackson, Mississippi (M.E.G., D.S., J.T.)
| | - Laura H Coker
- Wake Forest School of Medicine, Winston-Salem, North Carolina (L.H.C.)
| | | | | | - Dean Shibata
- University of Washington, Seattle, Washington (D.S.)
| | - Thomas H Mosley
- University of Mississippi Medical Center, Jackson, Mississippi (B.G.W., T.H.M.)
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137
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Cuthbertson CC, Tan X, Heiss G, Kucharska‐Newton A, Nichols HB, Kubota Y, Evenson KR. Associations of Leisure-Time Physical Activity and Television Viewing With Life Expectancy Free of Nonfatal Cardiovascular Disease: The ARIC Study. J Am Heart Assoc 2019; 8:e012657. [PMID: 31495291 PMCID: PMC6818021 DOI: 10.1161/jaha.119.012657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Background High levels of physical activity have been associated with longer life expectancy free of cardiovascular disease (CVD), but specific types of CVD and sedentary behavior have not been examined. We examined associations of leisure-time moderate-to-vigorous physical activity (LTPA) and television viewing with life expectancy free of 3 types of CVD. Methods and Results We included 13 534 participants from the ARIC (Atherosclerosis Risk in Communities) cohort. We used multistate survival models to estimate associations of LTPA in the past year (no LTPA, less than the median, equal to or greater than the median) and television viewing (often or very often, sometimes, seldom or rarely) with life expectancy at age 50 free of nonfatal coronary heart disease (CHD), stroke, and heart failure (HF). Over 27 years of follow-up, 4519 participants developed one of the 3 nonfatal CVDs and 5475 deaths occurred. Compared with participants who engaged in no LTPA, participants who engaged in LTPA equal to or greater than the median had longer life expectancy free of nonfatal CHD (men: 1.5 years [95% CI, 1.0-2.0]; women: 1.6 years [95% CI, 1.1-2.2]), stroke (men: 1.8 years [95% CI, 1.2-2.3]; women: 1.8 years [95% CI, 1.3-2.3]), and HF (men: 1.6 years [95% CI, 1.1-2.1]; women: 1.7 years [95% CI, 1.2-2.2]). Compared with viewing more television, watching less television was associated with longer life expectancy free of CHD, stroke, and HF (≈0.8 year). Conclusions Higher levels of LTPA and less television viewing were associated with longer life expectancy free of CHD, stroke, and HF. Engaging in LTPA and watching less television may increase the number of years lived free of CHD, stroke, and HF.
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Affiliation(s)
| | - Xianming Tan
- Department of BiostatisticsUniversity of North Carolina at Chapel HillNC
| | - Gerardo Heiss
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
| | | | - Hazel B. Nichols
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Disease PreventionOsakaJapan
| | - Kelly R. Evenson
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
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Li D, Misialek JR, Huang F, Windham GB, Yu F, Alonso A. Independent Association of Plasma Hydroxysphingomyelins With Physical Function in the Atherosclerosis Risk in Communities (ARIC) Study. J Gerontol A Biol Sci Med Sci 2019; 73:1103-1110. [PMID: 29053806 DOI: 10.1093/gerona/glx201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Background Plasma metabolites such as phosphatidylcholines and sphingomyelins (SMs) are associated with an age-related cognitive decline. However, their relations to age-related physical function decline remain largely unknown. Methods We examined the cross-sectional relations of 12 plasma metabolites (including four phosphatidylcholines and four SMs) with physical function in 383 older adults in the At herosclerosis Risk in Communities Study at the fifth exam (2011-2013, mean age [standard deviation (SD)]: 78.0 [5.5], 54.4% women, 28.3% African Americans). Physical function was assessed using grip strength, Short Physical Performance Battery, and 4-m walking speed. Individual metabolites were log-transformed and standardized. Multivariable linear regression was performed to account for demographics, APOE genotype, cardiovascular risk factors, comorbidities, use of antihypertensive and lipid-lowering medications, depressive symptoms, and cognition. Results Lower concentrations of asymmetric dimethylarginine and higher concentrations of SM (OH) C22:1, SM (OH) C22:2, and SM (OH) C24:1 were associated with physical function measures. In particular, SM (OH) C22:1 and SM (OH) C24:1 were associated with all three measures of physical function: β-coefficients (95% confidence interval) with grip strength were 0.89 kg (0.00, 1.78) and 0.86 kg (0.10, 1.61) per 1 SD higher concentration, respectively; with Short Physical Performance Battery score, were 0.61 (0.34, 0.88) and 0.41 (0.19, 0.63) per 1 SD difference, respectively; with 4-m walking speed were 0.035 m/s (0.013, 0.056) and 0.035 m/s (0.028, 0.047), respectively. Conclusions Plasma SM (OH)s may be independently associated with physical function in older adults.
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Affiliation(s)
- Danni Li
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Fangying Huang
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis
| | - Gwen B Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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139
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Porter AK, Schilsky S, Evenson KR, Florido R, Palta P, Holliday KM, Folsom AR. The Association of Sport and Exercise Activities With Cardiovascular Disease Risk: The Atherosclerosis Risk in Communities (ARIC) Study. J Phys Act Health 2019; 16:698-705. [PMID: 31369998 PMCID: PMC6994359 DOI: 10.1123/jpah.2018-0671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/25/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study assessed the independent associations between participation in self-reported sport and exercise activities and incident cardiovascular disease (CVD). METHODS Data were from 13,204 participants in the Atherosclerosis Risk in Communities Study cohort (1987-2015). Baseline sport and exercise activities were assessed via the modified Baecke questionnaire. Incident CVD included coronary heart disease, heart failure, or stroke. Multivariable-adjusted Cox proportional hazard models assessed the association of participation in specific sport and exercise activities at enrollment with risk of CVD. RESULTS During a median follow-up time of 25.2 years, 30% of the analytic sample (n = 3966) was diagnosed with incident CVD. In fully adjusted models, participation in racquet sports (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.61-0.93), aerobics (HR 0.75; 95% CI, 0.63-0.88), running (HR 0.68; 95% CI, 0.54-0.85), and walking (HR 0.89; 95% CI, 0.83-0.95) was significantly associated with a lower risk of CVD. There were no significant associations for bicycling, softball/baseball, gymnastics, swimming, basketball, calisthenics exercises, golfing with cart, golfing with walking, bowling, or weight training. CONCLUSIONS Participation in specific sport and exercises may substantially reduce the risk for CVD.
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140
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Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc 2019; 8:e012865. [PMID: 31387433 PMCID: PMC6759882 DOI: 10.1161/jaha.119.012865] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population.
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Affiliation(s)
- Hyunju Kim
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Laura E Caulfield
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Vanessa Garcia-Larsen
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Lyn M Steffen
- Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis MN
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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141
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George KM, Lutsey PL, Selvin E, Palta P, Windham BG, Folsom AR. Association Between Thyroid Dysfunction and Incident Dementia in the Atherosclerosis Risk in Communities Neurocognitive Study. JOURNAL OF ENDOCRINOLOGY AND METABOLISM 2019; 9:82-89. [PMID: 32411312 PMCID: PMC7223793 DOI: 10.14740/jem588] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Abnormal thyroid hormone levels (high or low) and autoimmunity from autoimmune thyroid disease (AITD) may increase dementia risk. METHODS We examined the associations of thyroid dysfunction or possible AITD in 1990 - 1992 with dementia through 2017 in the Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study. Thyroid dysfunction (subclinical and overt hypo- or hyperthyroidism and euthyroidism) was categorized from serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) cut-points and AITD from anti-thyroid peroxidase (anti-TPO) antibody positivity. Dementia was identified primarily based on cognitive test performance, neuropsychological examinations and clinician review of suspected cases. Additional cases of dementia were ascertained through telephone interviews or relevant hospital and death certificate codes. Cox regression with multivariable adjustment was used for analysis. RESULTS After exclusions for missing data, 12,481 participants were included in the analysis (mean index exam age 57 ± 5.7 (44% male, 25% black)), and 2,235 incident dementia cases were identified. AITD was not significantly associated with dementia. Subclinical hypothyroidism was associated with a lower risk of dementia (hazard ratio (HR) (95% confidence interval (CI)): 0.74 (0.60 - 0.92)), while overt hyperthyroidism was associated with a higher risk of dementia (HR (95% CI): 1.40 (1.02 - 1.92)) compared to euthyroid participants. Participants with serum FT4 concentrations above the 95th percentile were at an increased risk of dementia compared to those in the middle 90% of FT4 (HR (95% CI): 1.23 (1.02 - 1.48)). CONCLUSIONS Subclinical hypothyroidism was associated with reduced risk of dementia, whereas overt hyperthyroidism, particularly very elevated FT4, was associated with increased risk of dementia. The association between subclinical hypothyroidism and reduced risk of dementia cannot be explained, but may have been an artifact due to change. By extrapolation, effective treatment of overt hyperthyroidism may modestly reduce dementia risk in older adults.
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Affiliation(s)
- Kristen M. George
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Pamela L. Lutsey
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Elizabeth Selvin
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Priya Palta
- Columbia University Department of Medicine, Division of General Medicine, New York, NY, USA
| | - Beverly Gwen Windham
- University of Mississippi Medical Center, Department of Medicine, Jackson, MS, USA
| | - Aaron R. Folsom
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
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142
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Folsom AR, Basu S, Hong CP, Heckbert SR, Lutsey PL, Rosamond WD, Cushman M. Reasons for Differences in the Incidence of Venous Thromboembolism in Black Versus White Americans. Am J Med 2019; 132:970-976. [PMID: 30953632 PMCID: PMC6744355 DOI: 10.1016/j.amjmed.2019.03.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Venous thromboembolism incidence rates are 30%-100% higher in US blacks than whites. We examined the degree to which differences in the frequencies of socioeconomic, lifestyle, medical risk factors, and genetic variants explain the excess venous thromboembolism risk in blacks and whether some risk factors are more strongly associated with venous thromboembolism in blacks compared with whites. METHODS We measured venous thromboembolism risk factors in black and white participants of the Atherosclerosis Risk in Communities study in 1987-1989 and followed them prospectively through 2015 for venous thromboembolism incidence. RESULTS Over a mean of 22 years, we identified 332 venous thromboembolisms in blacks and 578 in whites, yielding 65% higher crude incidence rates per 1000 person-years in blacks. The age and sex-adjusted hazard ratio (95% confidence interval) of venous thromboembolism for blacks compared with whites was 2.04 (1.76, 2.37) for follow-up >10 years and was attenuated to 1.14 (0.89, 1.46) when adjusted for baseline confounders or mediators of the race association, which tended to be more common in blacks. For example, adjustment for just baseline weight, family income, and concentration of plasma factor VIII reduced the regression coefficient for race by 75%. There were no significant (P <0.05) 2-way multiplicative interactions of race with any risk factor, except with a 5-single nucleotide polymorphism (5-SNP) genetic risk score (a weaker venous thromboembolism risk factor in blacks) and with hospitalization for heart failure (a stronger venous thromboembolism risk factor in blacks). CONCLUSION The higher incidence rate of venous thromboembolism in blacks than whites was mostly explained by blacks having higher frequencies of venous thromboembolism risk factors.
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Affiliation(s)
- Aaron R Folsom
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis.
| | - Saonli Basu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Ching-Ping Hong
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Susan R Heckbert
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Wayne D Rosamond
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill
| | - Mary Cushman
- Department of Medicine, University of Vermont, Colchester Research Facility, Colchester; Department of Pathology, University of Vermont, Main Campus, Burlington
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Ding N, Sang Y, Chen J, Ballew SH, Kalbaugh CA, Salameh MJ, Blaha MJ, Allison M, Heiss G, Selvin E, Coresh J, Matsushita K. Cigarette Smoking, Smoking Cessation, and Long-Term Risk of 3 Major Atherosclerotic Diseases. J Am Coll Cardiol 2019; 74:498-507. [PMID: 31345423 PMCID: PMC6662625 DOI: 10.1016/j.jacc.2019.05.049] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/09/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Public statements about the effect of smoking on cardiovascular disease are predominantly based on investigations of coronary heart disease (CHD) and stroke, although smoking is recognized as a strong risk factor for peripheral artery disease (PAD). No study has comprehensively compared the long-term association of cigarette smoking and its cessation with the incidence of 3 major atherosclerotic diseases (PAD, CHD, and stroke). OBJECTIVES The aim of this study was to quantify the long-term association of cigarette smoking and its cessation with the incidence of the 3 outcomes. METHODS A total of 13,355 participants aged 45 to 64 years in the ARIC (Atherosclerosis Risk In Communities) study without PAD, CHD, or stroke at baseline (1987 to 1989) were included. The associations of smoking parameters (pack-years, duration, intensity, and cessation) with incident PAD were quantified and contrasted with CHD and stroke using Cox models. RESULTS Over a median follow-up of 26 years, there were 492 PAD cases, 1,798 CHD cases, and 1,106 stroke cases. A dose-response relationship was identified between pack-years of smoking and 3 outcomes, with the strongest results for PAD. The pattern was consistent when investigating duration and intensity separately. A longer period of smoking cessation was consistently related to lower risk of PAD, CHD, and stroke, but a significantly elevated risk persisted up to 30 years following smoking cessation for PAD and up to 20 years for CHD. CONCLUSIONS All smoking measures showed significant associations with 3 major atherosclerotic diseases, with the strongest effect size for incident PAD. The risk due to smoking lasted up to 30 years for PAD and 20 years for CHD. Our results further highlight the importance of smoking prevention and early smoking cessation, and indicate the need for public statements to take PAD into account when acknowledging the impact of smoking on overall cardiovascular health.
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Affiliation(s)
- Ning Ding
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yingying Sang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jingsha Chen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana H Ballew
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Corey A Kalbaugh
- University of North Carolina at Chapel Hill Department of Surgery, Chapel Hill, North Carolina
| | - Maya J Salameh
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Allison
- University of California San Diego School of Medicine, La Jolla, California
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland.
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144
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Abstract
PURPOSE OF REVIEW Stroke prevention is the cornerstone of atrial fibrillation (AF) management and the anticoagulation decision is currently based on CHA2DS2-VASc risk score. We discuss several novel risk factors besides those included in CHA2DS2-VASc score and alternative models for stroke prediction. RECENT FINDINGS Several clinical markers including obstructive sleep apnea and renal failure, laboratory markers like brain natriuretic peptide, imaging criteria including left atrial appendage morphology, spontaneous echo contrast, and coronary artery calcium score may predict stroke in AF patients. Addition of African American ethnicity to CHA2DS2-VASc score also improves stroke prediction in AF. Finally, novel models including TIMI-AF score, ATRIA score, and GARFIELD-AF scores have potential roles in risk stratification for stroke. While CHA2DS2-VASc score is the currently recommended risk stratification model for stroke prediction in AF, use of additional clinical, laboratory, imaging markers, ethnicity, and novel stroke prediction models may further assist in decision to anticoagulate the AF patient for stroke prevention.
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Affiliation(s)
- Pooja S Jagadish
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rajesh Kabra
- Division of Cardiology, Department of Internal Medicine, Division of Cardiology, University of Tennessee Health Science Center, 1211 Union Avenue, Suite 965, Memphis, TN, 38163, USA.
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145
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Muller CJ, Alonso A, Forster J, Vock DM, Zhang Y, Gottesman RF, Rosamond W, Longstreth WT, MacLehose RF. Stroke Incidence and Survival in American Indians, Blacks, and Whites: The Strong Heart Study and Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2019; 8:e010229. [PMID: 31189396 PMCID: PMC6645631 DOI: 10.1161/jaha.118.010229] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background American Indians (AIs) have high stroke morbidity and mortality. We compared stroke incidence and mortality in AIs, blacks, and whites. Methods and Results Pooled data from 2 cardiovascular disease cohort studies included 3182 AIs from the SHS (Strong Heart Study), aged 45 to 74 years at baseline (1988–1990) and 3765 blacks and 10 413 whites from the ARIC (Atherosclerosis Risk in Communities) Study, aged 45 to 64 years at baseline (1987–1989). Stroke surveillance was based on self‐report, hospital records, and death certificates. We estimated hazard ratios for incident stroke (ischemic and hemorrhagic combined) through 2008, stratified by sex and birth‐year tertile, and relative risk for poststroke mortality. Incident strokes numbered 282 for AIs, 416 for blacks, and 613 for whites. For women and men, stroke incidence among AIs was similar to or lower than blacks and higher than whites. Covariate adjustment resulted in lower hazard ratios for most comparisons, but results for these models were not always statistically significant. After covariate adjustment, AI women and men had higher 30‐day poststroke mortality than blacks (relative risk=2.1 [95% CI=1.0, 3.2] and 2.2 [95% CI=1.3, 3.1], respectively), and whites (relative risk=1.6 [95% CI=0.8, 2.5] and 1.7 [95% CI=1.1, 2.4]), and higher 1‐year mortality (relative risk range=1.3–1.5 for all comparisons). Conclusions Stroke incidence in AIs was lower than for blacks and higher than for whites; differences were larger for blacks and smaller for whites after covariate adjustment. Poststroke mortality was higher in AIs than blacks and whites.
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Affiliation(s)
- Clemma J Muller
- 1 Elson S. Floyd College of Medicine Washington State University Seattle WA
| | - Alvaro Alonso
- 2 Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
| | - Jean Forster
- 3 Division of Epidemiology University of Minnesota Minneapolis MN
| | - David M Vock
- 4 Division of Biostatistics University of Minnesota Minneapolis MN
| | - Ying Zhang
- 5 Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Rebecca F Gottesman
- 6 Departments of Neurology and Epidemiology Johns Hopkins University Baltimore MD
| | - Wayne Rosamond
- 7 Department of Epidemiology Gillings School of Public Health University of North Carolina at Chapel Hill NC
| | - W T Longstreth
- 8 Departments of Neurology and Epidemiology University of Washington Seattle WA
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146
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Ramalho SHR, Santos M, Claggett B, Matsushita K, Kitzman DW, Loehr L, Solomon SD, Skali H, Shah AM. Association of Undifferentiated Dyspnea in Late Life With Cardiovascular and Noncardiovascular Dysfunction: A Cross-sectional Analysis From the ARIC Study. JAMA Netw Open 2019; 2:e195321. [PMID: 31199443 PMCID: PMC6575149 DOI: 10.1001/jamanetworkopen.2019.5321] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022] Open
Abstract
Importance Undifferentiated dyspnea is common in late life, but the relative contribution of subclinical cardiac dysfunction is unknown. Impairments in cardiac structure and function may be characteristics of undifferentiated dyspnea in elderly people, providing potential insights into occult heart failure (HF). Objective To quantify the association of undifferentiated dyspnea with cardiac dysfunction after accounting for other potential contributors. Design, Setting, and Participants This cross-sectional study used data from Atherosclerosis Risk in Communities study participants 65 years and older who attended the fifth study visit (from 2011 to 2013) and had not been diagnosed with HF, chronic obstructive pulmonary disease, morbid obesity, or severe kidney disease. Analyses were conducted from October 2017 to June 2018. Exposures Dyspnea measured using the modified Medical Research Council scale, with a score less than 2 classified as none to mild and a score of 2 or more classified as moderate to severe. Main Outcomes and Measures Using multivariable logistic regression, the association of undifferentiated dyspnea was defined using cardiac structure, systolic and diastolic function, pulmonary pressure (echocardiography), pulmonary function (spirometry), glomerular filtration rate, hemoglobin, body mass index, depression, and physical performance. The population-attributable risk was calculated for each dysfunction metric. Results Among 4342 participants (mean [SD] age, 75.9 [5.0] years; 2533 [58.3%] women), 1173 (27.0%) had undifferentiated dyspnea. Moderate to severe dyspnea was present in 574 participants (13.2%) and was associated with left ventricular (LV) hypertrophy (odds ratio [OR], 1.53; 95% CI, 1.25-1.87; P < .001) and LV diastolic (OR, 1.46; 95% CI, 1.20-1.78; P < .001) and systolic (OR, 1.28; 95% CI, 1.05-1.56; P = .02) dysfunction. Moderate to severe dyspnea was also associated with obstructive (OR, 1.59; 95% CI, 1.28-1.99; P < .001) and restrictive (OR, 2.56; 95% CI, 1.99-3.27; P < .001) findings on spirometry, renal impairment (OR, 1.32; 95% CI, 1.08-1.61; P = .01), anemia (OR, 1.72; 95% CI, 1.39-2.12; P < .001), lower (OR, 2.77; 95% CI, 2.18-3.51; P < .001) and upper (OR, 1.82; 95% CI, 1.49-2.23; P < .001) extremity weakness, depression (OR, 3.01; 95% CI, 2.24-4.25; P < .001), and obesity (OR, 2.35; 95% CI, 1.95-2.83; P < .001). After accounting for these, moderate to severe dyspnea was associated with LV hypertrophy (OR, 1.30; 95% CI, 1.01-1.67; P = .04) and was not associated with systolic or diastolic function. In contrast, in the fully adjusted model, other organ system measures were associated with dyspnea, except for glomerular filtration rate and grip strength. The population-attributable risk of dyspnea associated with obesity alone was 22.6% compared with 5.8% for LV hypertrophy. Conclusions and Relevance Undifferentiated dyspnea is multifactorial in older adults, and this study showed an association with obesity. When accounting for other relevant organ systems, cardiovascular function poorly discriminated those with vs those without dyspnea. Therefore, dyspnea should not be assumed to represent occult HF in this population.
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Affiliation(s)
- Sergio H. R. Ramalho
- Health Sciences and Technologies Post-Graduation Program, University of Brasília, Brasília, Brazil
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mario Santos
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Laura Loehr
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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147
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Koton S, Wruck L, Quibrera PM, Gottesman RF, Agarwal SK, Jones SA, Wright JD, Shahar E, Coresh J, Rosamond WD. Temporal trends in validated ischaemic stroke hospitalizations in the USA. Int J Epidemiol 2019; 48:994-1003. [PMID: 30879069 DOI: 10.1093/ije/dyz025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate assessment of the burden of stroke, a major cause of disability and death, is crucial. We aimed to estimate rates of validated ischaemic stroke hospitalizations in the USA during 1998-2011. METHODS We used the Atherosclerosis Risk in Communities (ARIC) study cohort's adjudicated stroke data for participants aged ≥55 years, to construct validation models for each International Classification of Diseases (ICD)-code group and patient covariates. These models were applied to the Nationwide Inpatient Sample (NIS) data to estimate the probability of validated ischaemic stroke for each eligible hospitalization. Rates and trends in NIS using ICD codes vs estimates of validated ischaemic stroke were compared. RESULTS After applying validation models, the estimated annual average rate of validated ischaemic stroke hospitalizations in the USA during 1998-2011 was 3.37 [95% confidence interval (CI): 3.31, 3.43) per 1000 person-years. Validated rates declined during 1998-2011 from 4.7/1000 to 2.9/1000; however, the decline was limited to 1998-2007, with no further decline subsequently through 2011. Validation models showed that the false-positive (∼23% of strokes) and false-negative rates of ICD-9-CM codes in primary position for ischaemic stroke approximately cancel. Therefore, estimates of ischaemic stroke hospitalizations did not substantially change after applying validation models. CONCLUSIONS Overall, ischaemic stroke hospitalization rates in the USA have declined during 1998-2007, but no further decline was observed from 2007 to 2011. Validated ischaemic stroke hospitalizations estimates were similar to published estimates of hospitalizations with ischaemic stroke ICD codes in primary position. Validation of national discharge data using prospective chart review data is important to estimate the accuracy of reported burden of stroke.
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Affiliation(s)
- Silvia Koton
- Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Pedro Miguel Quibrera
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil K Agarwal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sydney A Jones
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Eyal Shahar
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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148
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Almuwaqqat Z, Jokhadar M, Norby FL, Lutsey PL, O'Neal WT, Seyerle A, Soliman EZ, Chen LY, Bremner JD, Vaccarino V, Shah AJ, Alonso A. Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the ARIC Study. J Am Heart Assoc 2019; 8:e012503. [PMID: 31140335 PMCID: PMC6585369 DOI: 10.1161/jaha.119.012503] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The association of antidepressant medication type with the risk of cardiovascular disease (CVD) is unclear. We hypothesized that selective serotonin reuptake inhibitors (SSRIs) are associated with lower risks of CVD events relative to tricyclics and other non‐SSRI antidepressants. Methods and Results We studied 2027 participants from the ARIC (Atherosclerosis Risk in Communities) study (mean age 63±10 years; 29% men; 78% white) treated with antidepressants at some time between 1987 and 2013. Antidepressant usage was confirmed by participants bringing pill bottles to study visits. CVD events in the study sample were identified, including atrial fibrillation, heart failure, myocardial infarction, and ischemic stroke. Hazard ratios were used to compare CVD events adjusted for sociodemographic and clinical risk factors in SSRIs users (47%) versus non‐SSRI users. Participants were followed from antidepressant initiation up to 2016 for a median of 13.5 years. We identified 332 atrial fibrillation, 365 heart failure, 174 myocardial infarction and 119 ischemic stroke events. CVD risk was similar for SSRIs and non‐SSRI antidepressant users (hazard ratio, 1.10; 95% CI, 0.86–1.41 for atrial fibrillation; hazard ratio, 0.98; 95% CI, 0.77–1.25 for heart failure; hazard ratio, 0.91; 95% CI, 0.64–1.29 for myocardial infarction; and hazard ratio, 1.07; 95% CI, 0.70–1.63 for ischemic stroke). Conclusions SSRI use was not associated with reduced risk of incident CVD compared with non‐SSRI antidepressant use. These results do not provide evidence supporting the use of SSRIs compared with tricyclics and other non‐SSRI antidepressants in relation to CVD risk.
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Affiliation(s)
- Zakaria Almuwaqqat
- 1 Department of Medicine Emory University School of Medicine Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Maan Jokhadar
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Faye L Norby
- 3 Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Pamela L Lutsey
- 3 Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Wesley T O'Neal
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Amanda Seyerle
- 8 Eshelman School of Pharmacy University of North Carolina Chapel Hill NC
| | - Elsayed Z Soliman
- 4 Department of Epidemiology and Prevention Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston-Salem NC
| | - Lin Y Chen
- 5 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - J Douglas Bremner
- 7 Department of Psychiatry & Behavioral Sciences Emory University School of Medicine Atlanta GA.,9 Atlanta VA Medical Center Decatur GA
| | - Viola Vaccarino
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,6 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Amit J Shah
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,6 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,9 Atlanta VA Medical Center Decatur GA
| | - Alvaro Alonso
- 6 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
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149
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Oliver-Williams C, Vladutiu CJ, Loehr LR, Rosamond WD, Stuebe AM. The Association Between Parity and Subsequent Cardiovascular Disease in Women: The Atherosclerosis Risk in Communities Study. J Womens Health (Larchmt) 2019; 28:721-727. [PMID: 30481103 PMCID: PMC6537113 DOI: 10.1089/jwh.2018.7161] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Previous studies are inconclusive on the relationship between parity and cardiovascular disease (CVD), with few evaluating multiple cardiovascular outcomes. It is also unclear if any relationship between parity and CVD is independent of breastfeeding. We examined the associations between parity and cardiovascular outcomes, including breastfeeding adjustment. Materials and Methods: Data were from 8,583 White and African American women, 45-64 years of age, in the Atherosclerosis Risk in Communities Study. Coronary heart disease (CHD), myocardial infarction (MI), heart failure, and strokes were ascertained from 1987 to 2016 by annual interviews and hospital surveillance. Parity and breastfeeding were self-reported. Cox proportional hazards regression estimated hazard ratios (HR) for the association between parity and cardiovascular outcomes, adjusting for baseline sociodemographic, clinical and lifestyle factors, and breastfeeding. Results: Women reported no pregnancies (6.0%), or having 0 (1.6%), 1-2 (36.2%), 3-4 (36.4%), or 5+ (19.7%) live births. During 30 years follow-up, there were 1,352 CHDs, 843 MIs, 750 strokes, and 1,618 heart failure events. Compared with women with 1-2 prior births, those with prior pregnancies and no live births had greater incident CHD (HR = 1.64, 95% confidence interval 1.14-2.42) and heart failure risk (1.46, 1.04-2.05), after adjustment for baseline characteristics. Women with 5+ births had greater risk of CHD (1.29, 1.10-1.52) and hospitalized MI (1.38, 1.13-1.69), after adjustment for baseline characteristics and breastfeeding. Conclusions: In a diverse U.S. cohort, a history of 5+ live births is associated with CHD risk, specifically, MI, independent of breastfeeding. Having a prior pregnancy and no live birth is associated with greater CHD and heart failure risk.
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Affiliation(s)
- Clare Oliver-Williams
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Homerton College, Hills Road, University of Cambridge, Cambridge, United Kingdom
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Laura R. Loehr
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Alison M. Stuebe
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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150
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Li D, Misialek JR, Jack CR, Mielke MM, Knopman D, Gottesman R, Mosley T, Alonso A. Plasma Metabolites Associated with Brain MRI Measures of Neurodegeneration in Older Adults in the Atherosclerosis Risk in Communities⁻Neurocognitive Study (ARIC-NCS). Int J Mol Sci 2019; 20:ijms20071744. [PMID: 30970556 PMCID: PMC6479561 DOI: 10.3390/ijms20071744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Plasma metabolites are associated with cognitive and physical function in the elderly. Because cerebral small vessel disease (SVD) and neurodegeneration are common causes of cognitive and physical function decline, the primary objective of this study was to investigate the associations of six plasma metabolites (two plasma phosphatidylcholines [PCs]: PC aa C36:5 and PC aa 36:6 and four sphingomyelins [SMs]: SM C26:0, SM [OH] C22:1, SM [OH] C22:2, SM [OH] C24:1) with magnetic resonance imaging (MRI) features of cerebral SVD and neurodegeneration in older adults. Methods: This study included 238 older adults in the Atherosclerosis Risk in Communities study at the fifth exam. Multiple linear regression was used to assess the association of each metabolite (log-transformed) in separate models with MRI measures except lacunar infarcts, for which binary logistic regression was used. Results: Higher concentrations of plasma PC aa C36:5 had adverse associations with MRI features of cerebral SVD (odds ratio of 1.69 [95% confidence interval: 1.01, 2.83] with lacunar infarct, and beta of 0.16 log [cm3] [0.02, 0.30] with log [White Matter Hyperintensities (WMH) volume]) while higher concentrations of 3 plasma SM (OH)s were associated with higher total brain volume (beta of 12.0 cm3 [5.5, 18.6], 11.8 cm3 [5.0, 18.6], and 7.3 cm3 [1.2, 13.5] for SM [OH] C22:1, SM [OH] C22:2, and SM [OH] C24:1, respectively). Conclusions: This study identified associations between certain plasma metabolites and brain MRI measures of SVD and neurodegeneration in older adults, particularly higher SM (OH) concentrations with higher total brain volume.
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Affiliation(s)
- Danni Li
- Department of Lab Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, MMC 609, Minneapolis, MN 55455, USA.
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55906, USA.
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - David Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
| | - Tom Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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