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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Mulvagh SL, Mullen KA, Nerenberg KA, Kirkham AA, Green CR, Dhukai AR, Grewal J, Hardy M, Harvey PJ, Ahmed SB, Hart D, Levinsson AL, Parry M, Foulds HJ, Pacheco C, Dumanski SM, Smith G, Norris CM. The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman. CJC Open 2021; 4:115-132. [PMID: 35198930 PMCID: PMC8843896 DOI: 10.1016/j.cjco.2021.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/13/2021] [Indexed: 02/09/2023] Open
Abstract
Women have unique sex- and gender-related risk factors for cardiovascular disease (CVD) that can present or evolve over their lifespan. Pregnancy-associated conditions, polycystic ovarian syndrome, and menopause can increase a woman’s risk of CVD. Women are at greater risk for autoimmune rheumatic disorders, which play a role in the predisposition and pathogenesis of CVD. The influence of traditional CVD risk factors (eg, smoking, hypertension, diabetes, obesity, physical inactivity, depression, anxiety, and family history) is greater in women than men. Finally, there are sex differences in the response to treatments for CVD risk and comorbid disease processes. In this Atlas chapter we review sex- and gender-unique CVD risk factors that can occur across a woman’s lifespan, with the aim to reduce knowledge gaps and guide the development of optimal strategies for awareness and treatment.
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Applicability and implementation of the collagen-induced arthritis mouse model, including protocols (Review). Exp Ther Med 2021; 22:939. [PMID: 34335888 PMCID: PMC8290431 DOI: 10.3892/etm.2021.10371] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/30/2021] [Indexed: 12/16/2022] Open
Abstract
Animal models of rheumatoid arthritis (RA) are essential for studying the pathogenesis of RA in vivo and determining the efficacy of anti-RA drugs. During the past decades, numerous rodent models of arthritis have been evaluated as potential models and the modeling methods are relatively well-developed. Among these models, the collagen-induced arthritis (CIA) mouse model is the first choice and the most widely used because it may be generated rapidly and inexpensively and is relatively similar in pathogenesis to human RA. To date, there have been numerous classic studies and reviews discussing related pathogeneses and modeling methods. Based on this knowledge, combined with the latest convenient and effective methods for CIA model construction, the present review aims to introduce the model to beginners and clarify important details regarding its use. Information on the origin and pathogenesis of the CIA model, the protocol for establishing it, the rate of successful arthritis induction and the methods used to evaluate the severity of arthritis are briefly summarized. With this information, it is expected that researchers who have recently entered the field or are not familiar with this information will be able to start quickly, avoid unnecessary errors and obtain reliable results.
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Do individuals with autoimmune disease have increased risk of subclinical carotid atherosclerosis and stiffness? Hypertens Res 2021; 44:978-987. [PMID: 33833420 DOI: 10.1038/s41440-021-00655-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/02/2021] [Accepted: 03/14/2021] [Indexed: 12/13/2022]
Abstract
To explore the role of chronic inflammation inherent to autoimmune diseases in the development of subclinical atherosclerosis and arterial stiffness, this study recruited two population-based samples of individuals with and without autoimmune disease (ratio 1:5) matched by age, sex, and education level and with a longstanding (≥6 years) diagnosis of autoimmune disease. Common carotid intima-media thickness (IMT) and arterial distensibility and compliance were assessed with carotid ultrasound. Multivariable linear and logistic regression models were adjusted for 10-year cardiovascular risk. In total, 546 individuals with and without autoimmune diseases (91 and 455, respectively) were included. The mean age was 66 years (standard deviation 12), and 240 (43.9%) were women. Arterial stiffness did not differ according to the presence of autoimmune diseases. In men, the diagnosis of autoimmune diseases significantly increased common carotid IMT [beta-coefficient (95% confidence interval): 0.058 (0.009; 0.108); p value = 0.022] and the percentage with IMT ≥ 75th percentile [1.012 (0.145; 1.880); p value = 0.022]. Women without autoimmune disease were more likely to have IMT ≥ the 75th percentile [-2.181 (-4.214; -0.149); p value = 0.035], but the analysis of IMT as a continuous variable did not yield significant results. In conclusion, subclinical carotid atherosclerosis, but not arterial stiffness, was more common in men with autoimmune diseases. Women did not show significant differences in any of these carotid features. Sex was an effect modifier in the association between common carotid IMT values and the diagnosis of autoimmune diseases.
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Shabbir A, Rathod KS, Khambata RS, Ahluwalia A. Sex Differences in the Inflammatory Response: Pharmacological Opportunities for Therapeutics for Coronary Artery Disease. Annu Rev Pharmacol Toxicol 2020; 61:333-359. [PMID: 33035428 DOI: 10.1146/annurev-pharmtox-010919-023229] [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] [Indexed: 12/15/2022]
Abstract
Coordinated molecular responses are key to effective initiation and resolution of both acute and chronic inflammation. Vascular inflammation plays an important role in initiating and perpetuating atherosclerotic disease, specifically at the site of plaque and subsequent fibrous cap rupture. Both men and women succumb to this disease process, and although management strategies have focused on revascularization and pharmacological therapies in the acute situation to reverse vessel closure and prevent thrombogenesis, data now suggest that regulation of host inflammation may improve both morbidity and mortality, thus supporting the notion that prevention is better than cure. There is a clear sex difference in the incidence of vascular disease, and data confirm biological differences in inflammatory initiation and resolution between men and women. This article reviews contemporary opinions describing the sex difference in the initiation and resolution of inflammatory responses, with a view to explore potential targets for pharmacological intervention.
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Affiliation(s)
- Asad Shabbir
- The William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom;
| | - Krishnaraj Sinhji Rathod
- The William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom;
| | - Rayomand Syrus Khambata
- The William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom;
| | - Amrita Ahluwalia
- The William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom;
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Dent EL, Broome HJ, Sasser JM, Ryan MJ. Blood pressure and albuminuria in a female mouse model of systemic lupus erythematosus: impact of long-term high salt consumption. Am J Physiol Regul Integr Comp Physiol 2020; 319:R448-R454. [PMID: 32813539 DOI: 10.1152/ajpregu.00070.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hypertension and kidney involvement are common in patients with autoimmune disease. Sodium intake is linked to hypertension in both human and animal studies. Evidence suggests that dietary salt may be an important environmental factor that promotes autoimmune activity. Therefore, we hypothesized that a long-term high-salt diet would accelerate the progression of autoimmunity, hypertension, and albuminuria during systemic lupus erythematosus (SLE), an autoimmune disease that predominantly affects young women and has a high prevalence of hypertension and renal disease. To test this hypothesis, an established experimental model of SLE (female NZBWF1 mice) that develops hypertension and renal disease was used. SLE mice were fed a high-salt (4% NaCl) or normal (0.4% NaCl) diet for 24 wk beginning at 10 wk of age and ending at 34 wk of age, a time by which female NZBWF1 mice typically have hypertension and exhibit signs of renal disease. Plasma anti-dsDNA autoantibodies were measured as an indicator of active SLE disease, and urinary albumin was monitored longitudinally as a marker of renal disease. Arterial pressure was measured in conscious, freely moving mice at 34 wk of age. Urinary endothelin-1 (ET-1) excretion, renal endothelin A and B receptor protein expression, and renal mRNA expression of NOS1, NOS2, NOX2, MCP-1, TNF-α, serum- and glucocorticoid-regulated kinase 1, and interleukin-2 (IL-2) were assessed to determine the impact on gene products commonly altered by a high-salt diet. SLE mice fed a high-salt diet had increased circulating autoantibodies, but the high-salt diet did not significantly affect albuminuria or arterial pressure. Urinary ET-1 excretion was increased, whereas renal endothelin A receptor and IL-2 expression were decreased in response to a high-salt diet. These data suggest that a chronic high-salt diet may not accelerate cardiovascular and renal consequences commonly associated with SLE.
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Affiliation(s)
- Elena L Dent
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Hanna J Broome
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennifer M Sasser
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael J Ryan
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi.,G.V (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi
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Affiliation(s)
- Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, and Division of Molecular Cell Biology, Washington University School of Medicine, St. Louis, MO. Department of Biomedical Engineering, Washington University, McKelvey School of Engineering, St. Louis, MO. Veterans Affairs St. Louis Health Care System, St. Louis, MO
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Du BB, Wang XT, Tong YL, Liu K, Li PP, Li XD, Yang P, Wang Y. Optical coherence tomography guided treatment avoids stenting in an antiphospholipid syndrome patient: A case report. World J Clin Cases 2020; 8:2399-2405. [PMID: 32548174 PMCID: PMC7281051 DOI: 10.12998/wjcc.v8.i11.2399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing attention has been paid to acute myocardial infarction (AMI) in young female patients for whom secondary factors should be considered during the diagnostic process. Anti-phospholipid syndrome (APS), a rare autoimmune disease that is most common in young female patients, is reportedly related to AMI. To date, coronary interventions, particularly stenting, remains controversial in this special clinical scenario.
CASE SUMMARY A 26-year-old female patient was admitted to hospital for acute chest pain, palpitations, and dyspnea. She had a past medical history of APS and pulmonary embolism. Coronary angiography showed acute occlusion of the proximal left anterior descending artery. After repeated thrombus aspirations, residual thrombus and mild stenosis were found in the proximal left anterior descending artery. Optical coherence tomography (OCT) was done, which confirmed the non-atherosclerosis coronary thrombosis and an intact intima in this patient. Deferring or avoiding stenting based on follow-up intracoronary findings with intensified antithrombotic treatment was chosen. One week later, coronary angiography and OCT confirmed an intact intima with no injury and no residual thrombus. The 3-mo telephone follow-up reported a good prognosis.
CONCLUSION APS can cause acute non-atherosclerosis coronary thrombosis which presents as an AMI in young female patients. Intracoronary OCT findings can guide interventional strategies in this special clinical scenario.
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Affiliation(s)
- Bei-Bei Du
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Xing-Tong Wang
- Department of Hematology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ya-Liang Tong
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Kun Liu
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Pei-Pei Li
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Xiang-Dong Li
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ping Yang
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ying Wang
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
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Fiechter M, Haider A, Bengs S, Marędziak M, Burger IA, Roggo A, Portmann A, Schade K, Warnock GI, Treyer V, Messerli M, Fuchs TA, Pazhenkottil AP, Buechel RR, Kaufmann PA, Gebhard C. Sex-dependent association between inflammation, neural stress responses, and impaired myocardial function. Eur J Nucl Med Mol Imaging 2019; 47:2010-2015. [PMID: 31701187 DOI: 10.1007/s00259-019-04537-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Evidence to date has failed to reveal unique female determinants of cardiovascular disease. However, a strong association was recently observed between increased metabolic activity in the amygdala, a neural centre involved in the processing of emotions, and impaired myocardial function in women, but not in men. Given the stronger immune responses in females, we sought to retrospectively investigate the interaction between inflammation, perceived stress, and myocardial injury. METHODS Overall, 294 patients (mean age 66.9 ± 10.0 years, 28.6% women) underwent both, 99mTc-tetrofosmin single-photon emission computed tomography myocardial perfusion imaging and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography for the assessment of cardiac function, bone marrow metabolism (surrogate marker of inflammation), and resting amygdalar activity. RESULTS A positive association was found between amygdalar metabolism and 18F-FDG bone marrow uptake in women (r = 0.238, p = 0.029), but not in men (r = 0.060, p = 0.385). Linear regression models selected both, abnormal left ventricular ejection fraction (LVEF) and abnormal myocardial perfusion, as significant indicators of an increased amygdalar activity in women (B-coefficient LVEF, - 0.096; p = 0.021; abnormal myocardial perfusion, 3.227; p = 0.043), but not in men (bone marrow p = 0.076; abnormal myocardial perfusion p = 0.420). Accordingly, an interaction term consisting of sex and LVEF/abnormal myocardial perfusion was significant (p = 0.043 and p = 0.015, respectively). CONCLUSIONS Upregulated amygdalar metabolism is associated with an enhanced inflammatory state in female patients with impaired cardiac function. Given that enhanced activity of the limbic system is associated with worse cardiovascular outcomes, our study suggests that a focus on inflammatory markers and indicators of distress might help to tailor cardiovascular risk assessment and therapy towards the female cardiovascular phenotype.
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Affiliation(s)
- Michael Fiechter
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland. .,Swiss Paraplegic Center, Nottwil, Switzerland.
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Monika Marędziak
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Andrea Roggo
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Katharina Schade
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Geoffrey I Warnock
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
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Fiechter M, Roggo A, Haider A, Bengs S, Burger IA, Marędziak M, Portmann A, Treyer V, Becker AS, Messerli M, Mühlematter UJ, Kudura K, von Felten E, Benz DC, Fuchs TA, Gräni C, Pazhenkottil AP, Buechel RR, Kaufmann PA, Gebhard C. Metabolic Activity in Central Neural Structures of Patients With Myocardial Injury. J Am Heart Assoc 2019; 8:e013070. [PMID: 31566462 PMCID: PMC6806042 DOI: 10.1161/jaha.119.013070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Increasing evidence suggests a psychosomatic link between neural systems and the heart. In light of the growing burden of ischemic cardiovascular disease across the globe, a better understanding of heart‐brain interactions and their implications for cardiovascular treatment strategies is needed. Thus, we sought to investigate the interaction between myocardial injury and metabolic alterations in central neural areas in patients with suspected or known coronary artery disease. Methods and Results The association between resting metabolic activity in distinct neural structures and cardiac function was analyzed in 302 patients (aged 66.8±10.2 years; 70.9% men) undergoing fluor‐18‐deoxyglucose positron emission tomography and 99mTc‐tetrofosmin single‐photon emission computed tomography myocardial perfusion imaging. There was evidence for reduction of callosal, caudate, and brainstem fluor‐18‐deoxyglucose uptake in patients with impaired left ventricular ejection fraction (<55% versus ≥55%: P=0.047, P=0.022, and P=0.013, respectively) and/or in the presence of myocardial ischemia (versus normal perfusion: P=0.010, P=0.013, and P=0.016, respectively). In a sex‐stratified analysis, these differences were observed in men, but not in women. A first‐order interaction term consisting of sex and impaired left ventricular ejection fraction or myocardial ischemia was identified as predictor of metabolic activity in these neural regions (left ventricular ejection fraction: P=0.015 for brainstem; myocardial ischemia: P=0.004, P=0.018, and P=0.003 for callosal, caudate, or brainstem metabolism, respectively). Conclusions Myocardial dysfunction and injury are associated with reduced resting metabolic activity of central neural structures, including the corpus callosum, the caudate nucleus, and the brainstem. These associations differ in women and men, suggesting sex differences in the pathophysiological interplay of the nervous and cardiovascular systems.
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Affiliation(s)
- Michael Fiechter
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland.,Swiss Paraplegic Center Nottwil Switzerland
| | - Andrea Roggo
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Monika Marędziak
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Anton S Becker
- Department of Diagnostic and Interventional Radiology University Hospital Zurich Zurich Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Urs J Mühlematter
- Department of Diagnostic and Interventional Radiology University Hospital Zurich Zurich Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
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11
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McFarlane IM, Leon SYZ, Bhamra MS, Burza A, Waite SA, Rodriguez Alvarez M, Koci K, Taklalsingh N, Kaplan I, Pathiparampil J, Kabani N, Watler E, Sorrento CS, Frefer M, Vaitkus V, Green J, Matthew K, Arroyo-Mercado F, Lyo H, Soliman F, Sanchez RA, Reyes FM, Ozeri DJ, Dronamraju V, Trevisonno M, Grant C, Clerger G, Amin K, Freeman L, Dawkins M, Lenis Lopez D, Smerling J, Gondal I, Dellinger E, Paltoo K, Bhat H, Kolla S. Assessment of Cardiovascular Disease Risk and Therapeutic Patterns among Urban Black Rheumatoid Arthritis Patients. Med Sci (Basel) 2019; 7:E31. [PMID: 30791646 PMCID: PMC6410013 DOI: 10.3390/medsci7020031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) patients have nearly twice the risk of cardiovascular disease (CVD) compared to the general population. We aimed to assess, in a predominantly Black population, the prevalence of traditional and RA-specific CVD risk factors and therapeutic patterns. Utilizing ICD codes, we identified 503 RA patients ≥18 years old who were seen from 2010 to 2017. Of them, 88.5% were Black, 87.9% were women and 29.4% were smokers. CVD risk factors (obesity, diabetes, hypertension, dyslipidemia) were higher than in previously reported White RA cohorts. Eighty-seven percent of the patients had at least one traditional CVD risk factor, 37% had three or more traditional CVD risk factors and 58% had RA-specific risk factors (seropositive RA, >10 years of disease, joint erosions, elevated inflammatory markers, extra-articular disease, body mass index (BMI) < 20). CV outcomes (coronary artery disease/myocardial infarction, heart failure, atrial fibrillation and stroke) were comparable to published reports. Higher steroid use, which increases CVD risk, and lesser utilization of biologics (decrease CV risk) were also observed. Our Black RA cohort had higher rates of traditional CVD risk factors, in addition to chronic inflammation from aggressive RA, which places our patients at a higher risk for CVD outcomes, calling for revised risk stratification strategies and effective interventions to address comorbidities in this vulnerable population.
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Affiliation(s)
- Isabel M. McFarlane
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Su Yien Zhaz Leon
- Samaritan Medical Center Department of Rheumatology, Watertown, NY 13601, USA;
| | - Manjeet S. Bhamra
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Aaliya Burza
- Department of Medicine, Division of Pulmonary and Critical Care State, SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA;
| | - Stephen Anthony Waite
- Department of Radiology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (S.A.W.); (S.K.)
| | - Milena Rodriguez Alvarez
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Kristaq Koci
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Nicholas Taklalsingh
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Ian Kaplan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Joshy Pathiparampil
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Naureen Kabani
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Elsie Watler
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Cristina S. Sorrento
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Mosab Frefer
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Vytas Vaitkus
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Jason Green
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Keron Matthew
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Fray Arroyo-Mercado
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Helen Lyo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Faisal Soliman
- Department of Geriatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11201, USA;
| | - Randolph A. Sanchez
- Department of Rheumatology, Hahnemann Hospital, Philadelphia, PA 19019, USA;
| | - Felix M. Reyes
- Department of Family and Social Medicine, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY 10468, USA;
| | | | - Veena Dronamraju
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Michael Trevisonno
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Christon Grant
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Guerrier Clerger
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Khabbab Amin
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Latoya Freeman
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Makeda Dawkins
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Diana Lenis Lopez
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Jonathan Smerling
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Irfan Gondal
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Elaine Dellinger
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Karen Paltoo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Hina Bhat
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (M.S.B.); (M.R.A.); (K.K.); (N.T.); (I.K.); (J.P.); (N.K.); (E.W.); (C.S.S.); (M.F.); (V.V.); (J.G.); (K.M.); (F.A.-M.); (H.L.); (V.D.); (M.T.); (C.G.); (G.C.); (K.A.); (L.F.); (M.D.); (D.L.L.); (J.S.); (I.G.); (E.D.); (K.P.); (H.B.)
| | - Srinivas Kolla
- Department of Radiology SUNY Downstate Medical Center/Health + Hospitals Kings County, Brooklyn, NY 11201, USA; (S.A.W.); (S.K.)
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