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Renlund-Vikström M, Jääskeläinen TJ, Kivelä A, Heinonen S, Laivuori H, Sarkola T. Cardiac Structure and Function in 8- to 12-Year-Old Children Following In-Utero Exposure to Preeclampsia (FINNCARE Study). J Am Heart Assoc 2024; 13:e034494. [PMID: 39011963 DOI: 10.1161/jaha.124.034494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/20/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND We evaluated how elevated blood pressure in children exposed to preeclampsia (PE) impacted on their cardiac structure and function, as well as relations with maternal, gestational, and perinatal factors and child body size and composition. METHODS AND RESULTS A total of 182 PE (46 early-onset preeclampsia) and 85 unexposed (non-PE) children were examined in the FINNCARE study 8 to 12 years after the index pregnancy with echocardiography; office, central, and 24-hour ambulatory blood pressures; and body anthropometrics and composition. PE children had lower right ventricular basal sphericity index (mean difference, -0.26 95% CI, -0.39 to -0.12) and lower mitral lateral E'-wave peak velocity (-1.4 cm/s [95% CI, -2.1 to -0.6]), as well as higher E to E' ratio (0.40 [95% CI, 0.15-0.65]) and indexed tricuspid annular plane systolic excursion (0.03 [95% CI, 0.01-0.05]) compared with non-PE children. These differences were accentuated in early-onset PE children. Left ventricular mass (LVM) or left atrial volume were not different between PE and non-PE children. Lean body mass, body fat percentage, and 24-hour systolic blood pressure were independent predictors of LVM. Lean body mass and body fat percentage were independent predictors of left atrial volume. No significant associations between LVM or left atrial volume and maternal, gestational, or perinatal parameters were found. CONCLUSIONS Preadolescent PE children display a more globular-shaped right ventricle with higher longitudinal systolic displacement as well as mildly altered diastolic indices, with the alterations being pronounced in early-onset preeclampsia. Lean body mass and adiposity are independently related with LVM and left atrial volume, and systolic blood pressure with LVM in both PE and non-PE children. These unfavorable associations indicate remodeling of cardiac structure in young children also reflected in mild functional changes in PE children. REGISTRATION URL: https://www.clinicaltrials.gov; unique identifier: NCT04676295.
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Affiliation(s)
- Michelle Renlund-Vikström
- Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
- Minerva Foundation Institute for Medical Research Helsinki Finland
| | - Tiina J Jääskeläinen
- Medical and Clinical Genetics University of Helsinki and Helsinki University Hospital Helsinki Finland
- Department of Food and Nutrition University of Helsinki Helsinki Finland
| | - Anni Kivelä
- Medical and Clinical Genetics University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology Helsinki University Hospital Helsinki Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics University of Helsinki and Helsinki University Hospital Helsinki Finland
- Department of Obstetrics and Gynecology Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere Center for Child, Adolescent, and Maternal Health Research Tampere Finland
| | - Taisto Sarkola
- Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
- Minerva Foundation Institute for Medical Research Helsinki Finland
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Park HS, Park SH, Seong Y, Kim HJ, Choi HY, Park HC, Jhee JH. Cumulative Blood Pressure Load and Incident CKD. Am J Kidney Dis 2024:S0272-6386(24)00894-1. [PMID: 39084487 DOI: 10.1053/j.ajkd.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 08/02/2024]
Abstract
RATIONALE & OBJECTIVE The association of long-term cumulative blood pressure (BP) loads with the risk of incident chronic kidney disease (CKD) remains a matter of debate. This study aimed to investigate this association among healthy Korean adults with normal kidney function. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS We analyzed 5,221 participants without CKD in the Korean Genome and Epidemiology Study. Cumulative systolic and diastolic BP (SBP and DBP) loads were calculated as the ratios of the areas under the curve (AUC) for SBP ≥120 mmHg or ≥80 mmHg for DBP divided by the AUC for all SBP or DBP measurements during the exposure period. These AUCs were categorized into four groups: group 0 (reference), cumulative BP load of 0 and groups 1-3, tertiles of cumulative BP loads. OUTCOME Primary endpoint was incident CKD defined as a composite of an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2 or proteinuria greater than 1+ on dipstick examination for at least two consecutive measurements ≥90 days apart. ANALYTICAL APPROACH Multivariable Cox proportional hazards regression to estimate the independent association of cumulative BP loads with incident CKD. RESULTS Higher cumulative SBP and DBP loads were associated with an increased risk of incident CKD (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.12-1.35 for SBP and HR 1.14, 95% CI 1.04-1.26 for DBP loads for each 1.0 unit greater load). Compared to SBP group 0, groups 2 and 3 were associated with 1.94- and 1.89-fold greater risk of incident CKD. Compared to DBP group 0, groups 2 and 3 were associated with 1.42- and 1.54-fold greater risks. These associations of high cumulative BP loads with an increased risk of incident CKD remained consistent even in subgroups not taking antihypertensive agents or without prior hypertension diagnosis. LIMITATIONS The assessment of CKD outcomes relied on eGFR and spot urine tests. CONCLUSIONS These findings highlight the association between high cumulative SBP and DBP loads and the occurrence of CKD, even in individuals with normal BP levels.
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Affiliation(s)
- Hye-Sun Park
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Ho Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeseul Seong
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Jeong Kim
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon Young Choi
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Mun J, Lee J, Park SM. Real-time closed-loop brainstem stimulation modality for enhancing temporal blood pressure reduction. Brain Stimul 2024; 17:826-835. [PMID: 38997106 DOI: 10.1016/j.brs.2024.07.002] [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: 03/07/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Traditional pharmacological interventions are well tolerated in the management of elevated blood pressure (BP) for individuals with resistant hypertension. Although neuromodulation has been investigated as an alternative solution, its open-loop (OL) modality cannot follow the patient's physiological state. In fact, neuromodulation for controlling highly fluctuating BP necessitates a closed-loop (CL) stimulation modality based on biomarkers to monitor the patient's continuously varying physiological state. OBJECTIVE By leveraging its intuitive linkage with BP responses in ongoing efforts aimed at developing a CL system to enhance temporal BP reduction effect, this study proposes a CL neuromodulation modality that controls nucleus tractus solitarius (NTS) activity to effectively reduce BP, thus reflecting continuously varying physiological states. METHOD While performing neurostimulation targeting the NTS in the rat model, the arterial BP response and neural activity of the NTS were simultaneously measured. To evaluate the temporal BP response effect of CL neurostimulation, OL (constant parameter; 20 Hz, 200 μA) and CL (Initial parameter; 11 Hz, 112 μA) stimulation protocols were performed with stimulation 180 s and rest 600 s, respectively, and examined NTS activity and BP response to the protocols. RESULTS In-vivo experiments for OL versus CL protocol for direct NTS stimulation in rats demonstrated an enhancement in temporal BP reduction via the CL modulation of NTS activity. CONCLUSION This study proposes a CL stimulation modality that enhances the effectiveness of BP control using a feedback control algorithm based on neural signals, thereby suggesting a new approach to antihypertensive neuromodulation.
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Affiliation(s)
- Junseung Mun
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Jiho Lee
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea; Department of Electrical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea; Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea; Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea.
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Mukherjee T, Keshavarzian M, Fugate EM, Naeini V, Darwish A, Ohayon J, Myers KJ, Shah DJ, Lindquist D, Sadayappan S, Pettigrew RI, Avazmohammadi R. Complete spatiotemporal quantification of cardiac motion in mice through enhanced acquisition and super-resolution reconstruction. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.31.596322. [PMID: 38895261 PMCID: PMC11185553 DOI: 10.1101/2024.05.31.596322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
The quantification of cardiac motion using cardiac magnetic resonance imaging (CMR) has shown promise as an early-stage marker for cardiovascular diseases. Despite the growing popularity of CMR-based myocardial strain calculations, measures of complete spatiotemporal strains (i.e., three-dimensional strains over the cardiac cycle) remain elusive. Complete spatiotemporal strain calculations are primarily hampered by poor spatial resolution, with the rapid motion of the cardiac wall also challenging the reproducibility of such strains. We hypothesize that a super-resolution reconstruction (SRR) framework that leverages combined image acquisitions at multiple orientations will enhance the reproducibility of complete spatiotemporal strain estimation. Two sets of CMR acquisitions were obtained for five wild-type mice, combining short-axis scans with radial and orthogonal long-axis scans. Super-resolution reconstruction, integrated with tissue classification, was performed to generate full four-dimensional (4D) images. The resulting enhanced and full 4D images enabled complete quantification of the motion in terms of 4D myocardial strains. Additionally, the effects of SRR in improving accurate strain measurements were evaluated using an in-silico heart phantom. The SRR framework revealed near isotropic spatial resolution, high structural similarity, and minimal loss of contrast, which led to overall improvements in strain accuracy. In essence, a comprehensive methodology was generated to quantify complete and reproducible myocardial deformation, aiding in the much-needed standardization of complete spatiotemporal strain calculations.
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Affiliation(s)
- Tanmay Mukherjee
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Maziyar Keshavarzian
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Elizabeth M. Fugate
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Vahid Naeini
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Amr Darwish
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX 77030, USA
| | - Jacques Ohayon
- Savoie Mont-Blanc University, Polytech Annecy-Chambéry, Le Bourget du Lac, France
- Laboratory TIMC-CNRS, UMR 5525, Grenoble-Alpes University, Grenoble, France
| | - Kyle J. Myers
- Hagler Institute for Advanced Study, Texas A&M University, College Station, TX 77843, USA
| | - Dipan J. Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX 77030, USA
| | - Diana Lindquist
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Sakthivel Sadayappan
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Roderic I. Pettigrew
- School of Engineering Medicine, Texas AM University, Houston, TX 77030, USA
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX 77030, USA
| | - Reza Avazmohammadi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX 77030, USA
- J. Mike Walker ’66 Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843, USA
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An J, Fischer H, Ni L, Xia M, Choi SK, Morrissette KL, Wei R, Reynolds K, Muntner P, Safford MM, Moran AE, Bellows BK, Isasi CR, Allen NB, Xanthakis V, Colantonio LD, Zhang Y. Association Between Young Adult Characteristics and Blood Pressure Trajectories. J Am Heart Assoc 2024; 13:e033053. [PMID: 38563367 PMCID: PMC11262534 DOI: 10.1161/jaha.123.033053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Blood pressure (BP) trajectories from young adulthood through middle age are associated with cardiovascular risk. We examined the associations of hypertension risk factors with BP trajectories among a large diverse sample. METHODS AND RESULTS We analyzed data from young adults, aged 18 to 39 years, with untreated BP <140/90 mm Hg at baseline from Kaiser Permanente Southern California (N=355 324). We used latent growth curve models to identify 10-year BP trajectories and to assess the associations between characteristics in young adulthood and BP trajectories. We identified the following 5 distinct systolic BP trajectories, which appeared to be determined mainly by the baseline BP with progressively higher BP at each year: group 1 (lowest BP trajectory, 7.9%), group 2 (26.5%), group 3 (33.0%), group 4 (25.4%), and group 5 (highest BP trajectory, 7.3%). Older age (adjusted odds ratio for 30-39 versus 18-29 years, 1.23 [95% CI, 1.18-1.28]), male sex (13.38 [95% CI, 12.80-13.99]), obesity (body mass index ≥30 versus 18.5-24.9 kg/m2, 14.81 [95% CI, 14.03-15.64]), overweight (body mass index 25-29.9 versus 18.5-24.9 kg/m2, 3.16 [95% CI, 3.00-3.33]), current smoking (1.58 [95% CI, 1.48-1.67]), prediabetes (1.21 [95% CI, 1.13-1.29]), diabetes (1.60 [95% CI, 1.41-1.81]) and high low-density lipoprotein cholesterol (≥160 versus <100 mg/dL, 1.52 [95% CI, 1.37-1.68]) were associated with the highest BP trajectory (group 5) compared with the reference group (group 2). CONCLUSIONS Traditional hypertension risk factors including smoking, diabetes, and elevated lipids were associated with BP trajectories in young adults, with obesity having the strongest association with the highest BP trajectory group.
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Affiliation(s)
- Jaejin An
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCAUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCAUSA
| | - Heidi Fischer
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCAUSA
| | - Liang Ni
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCAUSA
| | - Mengying Xia
- Division of General MedicineColumbia University Irving Medical CenterNew YorkNYUSA
| | - Soon Kyu Choi
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCAUSA
| | | | - Rong Wei
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCAUSA
| | - Kristi Reynolds
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCAUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCAUSA
| | - Paul Muntner
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Monika M. Safford
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Andrew E. Moran
- Division of General MedicineColumbia University Irving Medical CenterNew YorkNYUSA
| | - Brandon K. Bellows
- Division of General MedicineColumbia University Irving Medical CenterNew YorkNYUSA
| | - Carmen R. Isasi
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
| | | | - Vanessa Xanthakis
- Department of MedicineBoston University Chobanian and Avedisian School of MedicineBostonMAUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
| | | | - Yiyi Zhang
- Division of General MedicineColumbia University Irving Medical CenterNew YorkNYUSA
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Komnenov D, Al-Hadidi M, Ali H, Al-Jamal M, Salami K, Shelbaya S, Tayeb K, Domin D, Elhamzawy R. Dietary Fructose and Sodium Consumed during Early Mid-Life Are Associated with Hypertensive End-Organ Damage by Late Mid-Life in the CARDIA Cohort. Nutrients 2024; 16:913. [PMID: 38612947 PMCID: PMC11013729 DOI: 10.3390/nu16070913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
We aimed to investigate how dietary fructose and sodium impact blood pressure and risk of hypertensive target organ damage 10 years later. Data from n = 3116 individuals were obtained from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Four groups were identified based on the four possible combinations of the lower and upper 50th percentile for sodium (in mg) and fructose (expressed as percent of total daily calories). Differences among groups were ascertained and logistic regression analyses were used to assess the risk of hypertensive target organ damage (diastolic dysfunction, coronary calcification and albuminuria). Individuals in the low-fructose + low-sodium group were found to have lower SBP compared to those in the low-fructose + high-sodium and high-fructose + high-sodium groups (p < 0.05). The highest risk for hypertensive target organ damage was found for albuminuria only in the high-fructose + high-sodium group (OR = 3.328, p = 0.006) while female sex was protective across all groups against coronary calcification. Our findings highlight that sodium alone may not be the culprit for hypertension and hypertensive target organ damage, but rather when combined with an increased intake of dietary fructose, especially in middle-aged individuals.
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Affiliation(s)
- Dragana Komnenov
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
- John D. Dingell VA Medical Center, Detroit, MI 48201, USA
| | - Mohammad Al-Hadidi
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Hamza Ali
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Malik Al-Jamal
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Kassim Salami
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Samy Shelbaya
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Kareem Tayeb
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Daniel Domin
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Rana Elhamzawy
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
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Wu Y, Chen C, Wei FF, Liang W, Dong Y, Liu C, Choy M, Dong B. Associations between long-term averages of metabolic parameters in adulthood and cardiac structure and function in later life. Hypertens Res 2024; 47:496-506. [PMID: 37857766 DOI: 10.1038/s41440-023-01475-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
The effects of long-term levels of body mass index (BMI), blood pressure (BP), plasma lipids and fasting blood glucose (FBG) on the cardiac structure and function in later life in general population are to evaluate. We included adult participants without heart failure from Framingham Heart Study. The respective averages over a span of 30-36 years of seven parameters were pooled into linear regression models simultaneously to evaluate their associations with subsequent left atrial internal dimension (LAID), left ventricular mass index (LVMi), internal dimension (LVID), ejection fraction (LVEF), global longitudinal strain (GLS) and mitral inflow velocity to early diastolic mitral annular velocity (E/é). In 1838 participants (56.0% female, mean age 66.1 years), per 1-standard deviation (SD) increment of mean BMI correlated with larger LAID and LVID (β 0.05~0.17, standard error [SE] 0.01 for all), greater LVMi (β [SE], 1.49 [0.46]), worse E/é (β [SE], 0.28 [0.05]). Per 1-SD increment of mean systolic BP correlated with greater LVMi (β [SE], 4.70 [0.69]), LVEF (β [SE], 0.73 [0.24]), E/é (β [SE], 0.52 [0.08]), whereas increase of mean diastolic BP correlated with smaller LVMi (β [SE], -1.61 [0.62]), LVEF (β [SE], -0.46 [0.22]), E/é (β [SE], -0.30 [0.07]). Per 1-SD increment of mean high density lipoprotein cholesterol (HDL-c) correlated with smaller LVID (β [SE], -0.03 [0.01]) and better systolic function (LVEF, β [SE], 0.63 [0.19]; GLS, β [SE], -0.20 [0.10]). The variabilities of BMI, BP and HDL-c also correlated with certain cardiac measurements. In long-term, BMI affected the size and mass of heart chambers, systolic and diastolic BP differently influenced left ventricular mass and function, higher HDL-c linked to better systolic function. Clinical trial registration: URL: https://clinicaltrials.gov . Identifier: NCT00005121.
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Affiliation(s)
- Yuzhong Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China
| | - Chen Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China
| | - Fang-Fei Wei
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China
| | - Weihao Liang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, P R China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, P R China
| | - Manting Choy
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China.
| | - Bin Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, P R China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, P R China.
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, P R China.
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8
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Liu K, Hung M, Huang C, Chen J. Cumulative blood pressure load and hypertensive nephropathy in Han Chinese hypertensive patients. J Clin Hypertens (Greenwich) 2024; 26:207-216. [PMID: 38291944 PMCID: PMC10857487 DOI: 10.1111/jch.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 02/01/2024]
Abstract
The study aims to assess the relationship between cumulative blood pressure load (cBPL) and the risk of renal function decline in hypertensive patients and determine the blood pressure (BP) threshold required to prevent hypertensive nephropathy. A single-center prospective cohort study was conducted on hypertensive patients. The cBPL was defined as the proportion of area beyond variable BP cutoffs under ambulatory BP monitoring. Renal events were defined as > 25% (minor) or > 50% (major) decline of baseline estimated glomerular filtration rate (eGFR). Cox regression analysis was conducted between cBPL, other ambulatory BP parameters, and renal events. The results revealed a total of 436 Han Chinese hypertensive patients were eligible for enrollment. During an average follow-up period of 5.1 ± 3.3 years, a decline of > 25% and > 50% in eGFR was observed in 77 and eight participants, respectively. Cox regression analysis revealed that cSBPL140 (hazard ratio [HR], 1.102; 95% confidence interval [CI], 1.017-1.193; p = .017), cSBPL130 (HR, 1.076; 95% CI, 1.019-1.137; p = .008), and cSBPL120 (HR, 1.054; 95% CI, 1.010-1.099; p = .015) were independently associated with minor renal events. Similarly, cSBPL140 (HR, 1.228; 95% CI, 1.037-1.455; p = .017), cSBPL130 (HR, 1.189; 95% CI, 1.045-1.354; p = .009), and cSBPL120 (HR, 1.155; 95% CI, 1.039-1.285; p = .008) were independently associated with major renal events. In conclusion, cBPL is associated with renal function decline in hypertensive patients. Minimizing cBPL120 may decrease the risk of hypertensive nephropathy.
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Affiliation(s)
- Kuan‐I Liu
- Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineCollege of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ming‐Hui Hung
- Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineCollege of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Medical EducationNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Chin‐Chou Huang
- School of MedicineCollege of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of PharmacologyNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jaw‐Wen Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of PharmacologyNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Medical Research and Division of CardiologyDepartment of Internal MedicineTaipei Medical University HospitalTaipeiTaiwan
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9
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Masrouri S, Afaghi S, Khalili D, Shapiro MD, Hadaegh F. Cumulative Blood Pressure in Early Adulthood and Coronary Artery Calcium and Carotid Intima-Media Thickness in Middle Age Among Adults With Maintained Blood Pressure of <130/80 mm Hg: A Post Hoc Analysis. J Am Heart Assoc 2023; 12:e032091. [PMID: 38063213 PMCID: PMC10863794 DOI: 10.1161/jaha.123.032091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND To examine the association of blood pressure (BP) levels with coronary artery calcium and carotid intima-media thickness (CIMT) in people with maintained BP below the hypertension range based on current definitions. METHODS AND RESULTS In this post hoc analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) prospective observational cohort study conducted in 4 US cities, we examined 1233 study participants (mean [SD] age at year 20 examination was 45.3 [3.5] years; 65.4% women). Participants with BP assessments across 20 years and untreated BP of <130/80 mm Hg were included. Multivariable logistic or linear regression models, adjusted for age, sex, race, education, diabetes, body mass index, serum creatinine, smoking, alcohol intake, physical activity, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides, were used to examine the associations between cumulative BP measures with coronary artery calcium and CIMT. Higher long-term cumulative systolic BP and pulse pressure across early adulthood were associated with higher CIMT (both P<0.001) but not coronary artery calcium in the multivariable-adjusted model. The associations remained significant even after adjustment for a single BP measurement at year 0 or year 20. The odds ratio (OR) of a maximal CIMT >1.01 mm was ≈50% higher per 1-SD increase in systolic BP (OR, 1.50 [95% CI, 1.19-1.88]) and pulse pressure (OR, 1.46 [95% CI, 1.19-1.79]). Similar findings for CIMT were observed among individuals with a coronary artery calcium score of 0 as well as those with maintained BP of <120/80 mm Hg throughout young adulthood. CONCLUSIONS Long-term cumulative systolic BP and pulse pressure across early adulthood within the nonhypertensive range were associated with adverse midlife alterations in CIMT.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Siamak Afaghi
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular MedicineWake Forest University School of MedicineWinston SalemNC
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
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10
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El-Dosouky II, Seddik EH, Wageeh S. The Use of Global Longitudinal Strain to Detect Subclinical Reduction in Left Ventricular Pump Function. Crit Pathw Cardiol 2023; 22:149-152. [PMID: 37782622 DOI: 10.1097/hpc.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Left ventricular (LV) ejection fraction (LVEF) is not a sensitive marker of LV systolic function in a subset of patients with preserved EF. The relation between LV pump function and global longitudinal strain (GLS) has not been elucidated well in patients with objectively preserved EF and no apparent heart failure (HF). We aimed to detect whether LV GLS can discover impaired LV pump function [presented as low stroke volume index (SVI) and low cardiac output (COP)] in patients with objectively preserved EF and no apparent clinical HF and its practice utility. METHODS In total, 100 participants with LVEF of ≥50% were studied for demographic and echocardiographic data, including LVEF, stroke volume, SVI, COP, LV longitudinal strain assessments, apical 4-, 3-, and 2-chamber views averaged for GLS, and were classified into 2 groups: group 1: normal GLS (more negative than -18%) and group 2: low GLS (less negative than -18%). RESULTS Reduced LV GLS was associated with lower SVI (35.6 ± 13.6 vs. 43.8 ± 12.7 mL/m 2 ; P = 0.01), lesser COP (5.4 ± 1.9 vs. 6.5 ± 2.1 l/min; P = 0.02), GLS had strong positive correlations with SVI ( r = 0.75; P < 0.001), and COP ( r = 0.66; P < 0.001). LV GLS at a cutoff value less negative than -15% is a strong predictor of SVI ≤35 mL/m 2 (76% sensitivity and 79% specificity) and at a cutoff value less negative than -13.5% it is a strong predictor of COP ≤4 L/min (76% sensitivity and 73% specificity). LV GLS was the best independent predictor of low SVI (<35 mL/m 2 ) and low COP (<4 L/min). CONCLUSION Impaired LV strain is associated with lower LV pump function, presented as lower COP and lower SVI in patients with preserved EF even in the absence of clinical HF. It is of great importance to incorporate GLS in the routine evaluation of LV function hand-by-hand with the noninvasive assessment of LV stroke volume and COP that can replace GLS on evaluation of LV pump function in old machines with no GLS modalities, for early pick-up of patients with impaired LV pump function before apparent HF.
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Affiliation(s)
- Ibtesam I El-Dosouky
- From the Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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11
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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12
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Niu Z, Mu L, Buka SL, Loucks EB, Wang M, Tian L, Wen X. Involuntary tobacco smoke exposures from conception to 18 years increase midlife cardiometabolic disease risk: a 40-year longitudinal study. J Dev Orig Health Dis 2023; 14:689-698. [PMID: 38186328 PMCID: PMC10984799 DOI: 10.1017/s2040174423000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Few population studies have sufficient follow-up period to examine early-life exposures with later life diseases. A critical question is whether involuntary exposure to tobacco smoke from conception to adulthood increases the risk of cardiometabolic diseases (CMD) in midlife. In the Collaborative Perinatal Project, serum-validated maternal smoking during pregnancy (MSP) was assessed in the 1960s. At a mean age of 39 years, 1623 offspring were followed-up for the age at first physician-diagnoses of any CMDs, including diabetes, heart disease, hypertension, or hyperlipidemia. Detailed information on their exposure to environmental tobacco smoke (ETS) in childhood and adolescence was collected with a validated questionnaire. Cox regression was used to examine associations of in utero exposure to MSP and exposure to ETS from birth to 18 years with lifetime incidence of CMD, adjusting for potential confounders. We calculated midlife cumulative incidences of hyperlipidemia (25.2%), hypertension (14.9%), diabetes (3.9%), and heart disease (1.5%). Lifetime risk of hypertension increased by the 2nd -trimester exposure to MSP (adjusted hazard ratio: 1.29, 95% confidence interval: 1.01-1.65), ETS in childhood (1.11, 0.99-1.23) and adolescence (1.22, 1.04-1.44). Lifetime risk of diabetes increased by joint exposures to MSP and ETS in childhood (1.23, 1.01-1.50) or adolescence (1.47, 1.02-2.10). These associations were stronger in males than females, in never-daily smokers than lifetime ever smokers. In conclusion, early-life involuntary exposure to tobacco smoke increases midlife risk of hypertension and diabetes in midlife.
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Affiliation(s)
- Zhongzheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
| | - Stephen L. Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Eric B. Loucks
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
- RENEW Institute, The State University of New York at Buffalo, Buffalo, NY
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
| | - Lili Tian
- Department of Biostatistics, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY
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13
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Schreiner PJ, Bae S, Allen N, Liu K, Reis JP, Wu C, Ingram KH, Lloyd-Jones D, Lewis CE, Rana JS. Cumulative BMI and incident prediabetes over 30 years of follow-up: The CARDIA study. Obesity (Silver Spring) 2023; 31:2845-2852. [PMID: 37712179 PMCID: PMC10662945 DOI: 10.1002/oby.23866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study examined how cumulative BMI (cBMI) is associated with incident prediabetes in a biracial observational cohort study followed from young adulthood to middle age. METHODS Black and White men and women (n = 4190) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, ages 18 to 30 years in 1985 to 1986 and free of prediabetes or diabetes at baseline, were followed for 30 years. Cox regression was used to determine how cBMI was associated with incident prediabetes after controlling for traditional cardiovascular risk factors. RESULTS Over 30 years of follow-up, 46.2% of the sample developed prediabetes. Mean cBMI was 801.4 BMI-years for those with prediabetes and 658.3 BMI-years for those without (p < 0.0001). After multivariable adjustment, the hazard rate ratio for the highest cBMI quartile was 2.064 (95% CI: 1.793-2.377) relative to the lowest quartile. The second and third quartiles did not differ from the first quartile, consistent with a nonlinear trend. CONCLUSIONS The cumulative burden of higher weight and longer duration was associated with incident prediabetes, but this association was statistically significant only after a higher threshold was reached. Strategies for prevention of prediabetes in middle age may focus on avoiding overweight in young adulthood to limit duration.
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Affiliation(s)
- Pamela J. Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sejong Bae
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Norrina Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jared P. Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Colin Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Katherine H. Ingram
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamal S. Rana
- Department of Cardiology, Kaiser Permanente Northern California, Oakland, CA, USA
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14
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Kim H, Alvin Ang TF, Thomas RJ, Lyons MJ, Au R. Long-term blood pressure patterns in midlife and dementia in later life: Findings from the Framingham Heart Study. Alzheimers Dement 2023; 19:4357-4366. [PMID: 37394941 PMCID: PMC10597747 DOI: 10.1002/alz.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Long-term blood pressure (BP) measures, such as visit-to-visit BP variability (BPV) and cumulative BP, are strong indicators of cardiovascular risks. This study modeled up to 20 years of BP patterns representative of midlife by using BPV and cumulative BP, then examined their associations with development of dementia in later life. METHODS For 3201 individuals from the Framingham Heart Study, multivariate logistic regression analyses were performed to examine the association between long-term BP patterns during midlife and the development of dementia (ages ≥ 65). RESULTS After adjusting for covariates, every quartile increase in midlife cumulative BP was associated with a sequential increase in the risk of developing dementia (e.g., highest quartile of cumulative systolic blood pressure had approximately 2.5-fold increased risk of all-cause dementia). BPV was not significantly associated with dementia. DISCUSSION Findings suggest that cumulative BP over the course of midlife predicts risk of dementia in later life. HIGHLIGHTS Long-term blood pressure (BP) patterns are strong indicators of vascular risks. Cumulative BP and BP variability (BPV) were used to reflect BP patterns across midlife. High cumulative BP in midlife is associated with increased dementia risk. Visit-to-visit BPV was not associated with the onset of dementia.
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Affiliation(s)
- Hyun Kim
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Ting Fang Alvin Ang
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Robert J. Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue Shapiro 7 Boston, MA 02215
| | - Michael J. Lyons
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Dept. of Neurology, Medicine and Alzheimer’s Disease Research Center, Boston University School of Medicine, 72 E. Concord St, Boston MA 02118
- Dept. of Epidemiology, Boston University School of Public Health, 715 Albany St.Boston, MA 02118
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15
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Yi J, Wang L, Guo X, Ren X. Association between 5-year change in cardiovascular risk and the incidence of atherosclerotic cardiovascular diseases: a multi-cohort study. J Transl Med 2023; 21:589. [PMID: 37660053 PMCID: PMC10475181 DOI: 10.1186/s12967-023-04488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The influence of the historical cardiovascular risk status on future risk of atherosclerotic cardiovascular disease (ASCVD) is poorly understood. We aimed to investigate the association between 5-year changes in cardiovascular risk and ASCVD incidence. METHODS We analyzed pooled data from seven community-based prospective cohort studies with up to 20 years of follow-up data. The study populations included White or Black participants aged 40-75 years without prevalent ASCVD. Cardiovascular risk was assessed using the pooled cohort equation and was categorized into non-high (< 20%) or high risk (≥ 20%). Changes in cardiovascular disease (CVD) risk over a 5-year interval were recorded. The main outcome was incident ASCVD. RESULTS Among 11,026 participants (mean [SD] age, 60.0 [8.1] years), 4272 (38.7%) were female and 3127 (28.4%) were Black. During a median follow-up period of 9.9 years, 2560 (23.2%) ASCVD events occurred. In comparison with individuals showing a consistently high CVD risk, participants whose CVD risk changed from non-high to high (hazard ratio [HR], 0.67; 95% confidence interval [CI] 0.59-0.77) or high to non-high (HR, 0.57; 95% CI 0.41-0.80) and those with a consistently non-high risk (HR, 0.33; 95% CI 0.29-0.37) had a lower risk of incident ASCVD. In comparison with individuals showing a consistently non-high CVD risk, participants whose CVD risk changed from high to non-high (HR, 1.74; 95% CI 1.26-2.41) or from non-high to high risk (HR, 2.04; 95% CI 1.84-2.27) and those with a consistently high risk (HR 3.03; 95% CI 2.69-3.42) also showed an increased risk of incident ASCVD. CONCLUSIONS Individuals with the same current CVD risk status but different historical CVD risks exhibited varying risks of future ASCVD incidents. Dynamic risk evaluation may enable more accurate cardiovascular risk stratification, and decision-making regarding preventive interventions should take the historical risk status into account.
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Affiliation(s)
- Jiayi Yi
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lili Wang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xinli Guo
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xiangpeng Ren
- Department of Biochemistry, Medical College, Jiaxing University, No.899 Guangqiong Road, Jiaxing, 314001, Zhejiang, China.
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Varadarajan V, Gidding S, Wu C, Carr J, Lima JA. Imaging Early Life Cardiovascular Phenotype. Circ Res 2023; 132:1607-1627. [PMID: 37289903 PMCID: PMC10501740 DOI: 10.1161/circresaha.123.322054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/30/2023] [Indexed: 06/10/2023]
Abstract
The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.
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Affiliation(s)
- Vinithra Varadarajan
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
| | | | - Colin Wu
- Department of Medicine, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Jeffrey Carr
- Department Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
| | - Joao A.C. Lima
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
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Wang D, Kou PQ, Liao YY, Wang KK, Yan Y, Chen C, Chu C, Wang Y, Niu ZJ, Ma Q, Sun Y, Mu JJ. Sex differences in impact of cumulative systolic blood pressure from childhood to adulthood on albuminuria in midlife: a 30-year prospective cohort study. BMC Public Health 2023; 23:666. [PMID: 37041564 PMCID: PMC10088136 DOI: 10.1186/s12889-023-15613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/05/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Albuminuria is recognized as being a predictor of cardiovascular and renal disease. We aimed to identify the impact of the long-term burden and trends of systolic blood pressure on albuminuria in midlife, as well as to explore sex differences concerning this relationship. METHODS This longitudinal study consisted of 1,683 adults who had been examined 4 or more times for blood pressure starting in childhood, with a follow-up time period of 30 years. The cumulative effect and longitudinal trend of blood pressure were identified by using the area under the curve (AUC) of individual systolic blood pressure measurement with a growth curve random effects model. RESULTS Over 30 years of follow-up, 190 people developed albuminuria, including 53.2% males and 46.8% females (aged 43.39 ± 3.13 years in the latest follow-up). The urine albumin-to-creatinine ratio (uACR) values increased as the total and incremental AUC values increased. Additionally, women had a higher albuminuria incidence in the higher SBP AUC groups than men do (13.3% for men vs. 33.7% for women). Logistic regression showed that the ORs of albuminuria for males and females in the high total AUC group were 1.34 (0.70-2.60) and 2.94 (1.50-5.74), respectively. Similar associations were found in the incremental AUC groups. CONCLUSIONS Higher cumulative SBP was correlated with higher uACR levels and a risk of albuminuria in middle age, especially in women. The identification and control of cumulative SBP levels from an early age may assist in reducing the incidences of renal and cardiovascular disease for individuals in later life.
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Affiliation(s)
- Dan Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Pu-Qing Kou
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Yue-Yuan Liao
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Ke-Ke Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Yu Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Chen Chen
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Chao Chu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Ze-Jiaxin Niu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Qiong Ma
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Yue Sun
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China
| | - Jian-Jun Mu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China.
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, 710061, China.
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Clinical information from repeated blood pressure measurements in the management of heart failure with preserved ejection fraction. Hypertens Res 2023; 46:475-484. [PMID: 36380201 DOI: 10.1038/s41440-022-01079-9] [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: 07/08/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022]
Abstract
It remains unclear whether cumulative blood pressure (BP) exposure is associated with adverse outcomes in heart failure with preserved ejection fraction (HFpEF). The aim was to investigate the associations of adverse health outcomes with cumulative BP exposure as captured by weighted BP, cumulative BP and trends in BP over a 1-year timespan from baseline to a 12-month visit among 1303 patients with HFpEF (49.5% women; mean age, 71.5 years) enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. The primary endpoints consisted of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for the management of heart failure.We computed hazard ratios with a 1-SD increase in weighted BP and cumulative BP. In the spironolactone group, compared with patients with a downward trend in BP, those with an upward trend had higher event rates. However, there were no differences in event rates between those with upward and downward trends in BP in the placebo group. In multivariable-adjusted analyses that additionally accounted for baseline BP, weighted systolic BP and cumulative systolic BP predicted (P ≤ 0.037) the primary composite endpoint (hazard ratio [HR], 1.21; 95% CI, 1.05-1.39/1.15; 1.01-1.31) and hospitalization for HF (1.29; 1.09-1.52/1.18; 1.02-1.37), respectively. Among patients aged ≤72 years, cumulative systolic BP increased (P ≤ 0.016) the risk of the primary endpoint and hospitalization for HF. Higher cumulative systolic BP exposure conferred a higher risk of the primary endpoint and hospitalization for HF, independent of baseline BP. Our findings underscore that longitudinal BP measurements may refine risk stratification for patients with HFpEF.
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Evaluation of Arterial Stiffness and Carotid Intima-Media Thickness in Children with Primary and Renal Hypertension. Pediatr Cardiol 2023; 44:54-66. [PMID: 36169696 DOI: 10.1007/s00246-022-03012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
Abstract
Hypertension is an increasing disease in children and the risk of endothelial damage and target organ damage increases in the presence of additional risk factors such as obesity. In our study, the effect of hypertension on early atherosclerotic changes and target organ damage in children was investigated. Twenty four-hour ambulatory pulse wave analysis was performed by oscillometric method in 71 children aged 8-18 years, 17 of whom were diagnosed with primary hypertension without obesity, 18 had both primary hypertension and obesity, and 16 had renal hypertension. Twenty healthy normotensive children were included as the control group. Carotid intima-media thickness (CIMT) and Left Ventricular Mass Index were measured. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in the primary hypertension group compared to controls (p = 0.001, p = 0.005, p = 0.001, p = 0.009, respectively), cSBP was higher in the renal hypertension group than the control group (p = 0.018). There was no difference between the groups in terms of pulse wave analysis parameters, CIMT, or left ventricular mass index (p > 0.05). Pulse wave velocity was positively correlated with SBP, DBP, cSBP, cDBP (p < 0.001). Augmentation index was positively correlated with DBP and cDBP (p = 0.01, p = 0.002, respectively). Our findings show that high blood pressure is associated with arterial stiffness and target organ damage beginning in childhood. The detection of early atherosclerotic vascular changes using pulse wave analysis allows to take necessary precautions such as lifestyle changes to prevent target organ damage in hypertensive children.
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Shabani M, Ostovaneh MR, Ma X, Ambale Venkatesh B, Wu CO, Chahal H, Bakhshi H, McClelland RL, Liu K, Shea SJ, Burke G, Post WS, Watson KE, Folsom AR, Bluemke DA, Lima JAC. Pre-diagnostic predictors of mortality in patients with heart failure: The multi-ethnic study of atherosclerosis. Front Cardiovasc Med 2022; 9:1024031. [PMID: 36620619 PMCID: PMC9812565 DOI: 10.3389/fcvm.2022.1024031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background There are multiple predictive factors for cardiovascular (CV) mortality measured at, or after heart failure (HF) diagnosis. However, the predictive role of long-term exposure to these predictors prior to HF diagnosis is unknown. Objectives We aim to identify predictive factors of CV mortality in participants with HF, using cumulative exposure to risk factors before HF development. Methods Participants of Multi-Ethnic Study of Atherosclerosis (MESA) with incident HF were included. We used stepwise Akaike Information Criterion to select CV mortality predictors among clinical, biochemical, and imaging markers collected prior to HF. Using the AUC of B-spline-corrected curves, we estimated cumulative exposure to predictive factors from baseline to the last exam before HF. The prognostic performance for CV mortality after HF was evaluated using competing risk regression with non-CV mortality as the competing risk. Results Overall, 375 participants had new HF events (42.9% female, mean age: 74). Over an average follow-up of 4.7 years, there was no difference in the hazard of CV death for HF with reduced versus preserved ejection fraction (HR = 1.27, p = 0.23). The selected predictors of CV mortality in models with the least prediction error were age, cardiac arrest, myocardial infarction, and diabetes, QRS duration, HDL, cumulative exposure to total cholesterol and glucose, NT-proBNP, left ventricular mass, and statin use. The AUC of the models were 0.72 when including the latest exposure to predictive factors and 0.79 when including cumulative prior exposure to predictive factors (p = 0.20). Conclusion In HF patients, besides age and diagnosed diabetes or CVD, prior lipid profile, NT-proBNP, LV mass, and QRS duration available at the diagnosis time strongly predict CV mortality. Implementing cumulative exposure to cholesterol and glucose, instead of latest measures, improves predictive accuracy for HF mortality, though not reaching statistical significance.
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Affiliation(s)
- Mahsima Shabani
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Mohammad R. Ostovaneh
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, United States
| | | | - Colin O. Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Harjit Chahal
- Medstar Heart and Vascular Institute, Washington, DC, United States
| | - Hooman Bakhshi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Inova Heart and Vascular Institute, Falls Church, VA, United States
| | - Robyn L. McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Steven J. Shea
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC, United States
| | - Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karol E. Watson
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - João A. C. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiology, Johns Hopkins University, Baltimore, MD, United States,*Correspondence: João A. C. Lima,
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Xiong Z, Li J, Lin Y, Ye X, Xie P, Zhang S, Liu M, Huang Y, Liao X, Zhuang X. Intensity of hypertensive exposure in young adulthood and subclinical atherosclerosis in middle age: Evidence from the CARDIA study. Front Cardiovasc Med 2022; 9:959146. [PMID: 36568541 PMCID: PMC9768548 DOI: 10.3389/fcvm.2022.959146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background Chronically high blood pressure (HBP) is a known risk factor for cardiovascular diseases. We measured the intensity of hypertensive exposure in young adults and calculated its prognostic significance for subclinical atherosclerosis in middle age. Methods The Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled 5,115 healthy black and white Americans who were 18-30 years old at baseline (1985-1986). The intensity of hypertensive exposure was calculated as the area under the curve (mm Hg × years) from baseline to year 15. Coronary artery calcium (CAC) was identified at years 15, 20, and 25, and intima-media thickness (IMT) was identified at year 20. Results At baseline, the mean age was 40.1 years; 55.1% of participants were women, and 46.5% were black. After adjustment, cumulative systolic BP (SBP) was positively associated with CAC [hazard ratio (HR) = 1.23 (1.14, 1.32)] and IMT [β = 0.022 (0.017, 0.028)]. For CAC, the C-statistic for cumulative SBP was 0.643 (0.619, 0.667); compared to baseline SBP, the net reclassification index (NRI) of cumulative SBP was 0.180 (0.115, 0.256) and the integrated discrimination improvement (IDI) was 0.023 (0.012, 0.036). For IMT, the C-statistic for cumulative SBP was 0.674 (0.643, 0.705), the NRI was 0.220 (0.138, 0.305), and the IDI was 0.008 (0.004, 0.0012). Conclusion Greater intensity of hypertensive exposure in early adulthood is associated with subclinical atherosclerosis in middle age and provides better prognostic value than baseline BP for early cardiovascular risk.
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Affiliation(s)
- Zhenyu Xiong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Jiaying Li
- Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yifen Lin
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Ye
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Peihan Xie
- Department of Ultrasonography, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaozhao Zhang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yiquan Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China,Xinxue Liao
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China,Center for Information Technology and Statistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,*Correspondence: Xiaodong Zhuang
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22
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Zhang X, Yang J, Ruan H, Zheng Y, Zhao L, Li L, Zhang M, Duan L, He S. Association of cumulative blood pressure with cardiovascular mortality in Chinese older people: A longitudinal prospective study. Exp Gerontol 2022; 168:111952. [PMID: 36096321 DOI: 10.1016/j.exger.2022.111952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Long-term cumulative blood pressure (BP) was associated with cardiovascular mortality in middle-aged to older people. Whether cumulative BP was associated with cardiovascular mortality is uncertain in Chinese older people. DESIGN Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationwide, ongoing, prospective cohort study of community-dwelling Chinese older people. SETTING, AND PARTICIPANTS A total of 3361 older participants from the CLHLS study were included (men: 46.68 %, age: ≥65 years, median age: 78.00 years [IQR: 71.0-86.00 years]). METHODS Cumulative BP, including systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP), was determined by the area under the curve based on three measurements of BP (waves 2008, 2011, and 2014). The outcome was cardiovascular mortality, which was followed from wave 2014 to wave 2018. RESULTS During a median follow-up period of 3.98 years, 211 cardiovascular death were recorded. The higher cumulative SBP and PP tended to be positively linearly associated with an elevated risk of cardiovascular mortality. For each SD increment, the adjusted HRs of mortality risk was 1.28 (95 % CI: 1.11-1.47; p = 0.001) and 1.24 (95 % CI, 1.09-1.43; p = 0.002) for cumulative SBP and PP, respectively. While there was no association between cumulative DBP and cardiovascular mortality. In addition, multiple sensitivity analyses suggested robustness of the results. CONCLUSIONS/IMPLICATIONS Our results indicate that cumulative SBP and PP were associated with cardiovascular mortality in Chinese older people; however, there was no such association between cumulative DBP and mortality. Therefore, control of long-term SBP and PP may be required in those people.
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Affiliation(s)
- Xin Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Cardiology, Maternal and Child Health Hospital, Longquanyi District, Chengdu, China
| | - Haiyan Ruan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China; Department of Cardiology, Hospital of Traditional Chinese Medicine, Shuangliu District, Chengdu, China
| | - Yi Zheng
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Liming Zhao
- Department of Cardiovascular Medicine, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
| | - Liying Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Muxin Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China; Department of Cardiology, First People's Hospital, Longquanyi District, Chengdu, China
| | - Linjia Duan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
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23
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Time-averaged cumulative blood pressure and cardiovascular outcomes in heart failure with preserved ejection fraction: analysis from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. J Hypertens 2022; 40:1918-1926. [PMID: 36018222 DOI: 10.1097/hjh.0000000000003177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether time-averaged cumulative blood pressure (cumBP) is associated with the risk of cardiovascular outcomes among patients with heart failure with preserved ejection fraction. METHOD Three thousand, three hundred and thirty participants from Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included in this analysis with a median follow-up of 3 years. CumBP, expressed as mmHg-years, was the sum of mean BP for each pair of successive examinations multiplied by the time. Time-averaged cumBP was calculated by dividing cumBP by total exposure time, also expressed as mmHg. Clinical outcomes of our study including primary endpoint, all-cause death, cardiovascular death and heart failure hospitalization. Multivariable Cox hazard regression models and a restricted cubic spline model were used to assess the association and linearity between time-averaged cumBP and adverse outcomes. RESULTS There is a U-shaped relationship between time-averaged cumBP and primary endpoint, all-cause death, cardiovascular death and heart failure hospitalization among participants with HFpEF, with the nadir risk around 120-129 mmHg of SBP and 70-79 mmHg of DBP after adjusting for confounding variables. Treatment with spironolactone did not affect the association significantly. The finding remained robust across sensitivity analyses. CONCLUSION Higher or lower time-averaged cumBP was significantly associated with a higher risk of adverse events. Control of time-averaged cumulative BP within a reasonable range was an important component of hypertension management in HFpEF.
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24
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Jaeschke L, Becher M, Velásquez IM, Ahrens W, Bächle C, Baurecht H, Fricke J, Greiser KH, Günther K, Heier M, Karch A, Kluttig A, Krist L, Leitzmann M, Michels K, Mikolajczyk R, Peters A, Schipf S, Völzke H, Pischon T, Becher H. The bias from heaping on risk estimation: Effect of age at diagnosis of hypertension on risk of subsequent cardiovascular comorbidities. Ann Epidemiol 2022; 74:84-96. [DOI: 10.1016/j.annepidem.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/14/2022] [Accepted: 07/30/2022] [Indexed: 11/01/2022]
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25
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Huang Y, Zhou H, Zhang S, Zhong X, Lin Y, Xiong Z, Liu M, Yimamu A, Christopher O, Zhou Z, Zhuang X, Liao X. Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Retinal Microvasculature: The ARIC Study. J Am Heart Assoc 2022; 11:e25226. [PMID: 35876422 PMCID: PMC9375499 DOI: 10.1161/jaha.122.025226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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 The associations of time-averaged cumulative blood pressure (BP) from midlife to late life with microvasculature expressed as retinal vessel diameters is not well studied. The aim of this study was to evaluate the association of cumulative systolic BP and diastolic BP (DBP) with retinal vessel calibers, focusing on race differences. Methods and Results The analysis included 1818 adults from the ARIC (Atherosclerosis Risk in Communities) study attending the fifth visit (2011-2013; age 77±5 years, 17.1% Black participants). Time-averaged cumulative BPs were calculated as the sum of averaged BPs from adjacent consecutive visits (visits 1-5) indexed to total observation time (24±1 years). Summarized estimates for central retinal arteriolar equivalent and central retinal venular equivalent at the fifth visit represent average retinal vessel diameters. The arteriole:venule ratio was calculated. We tested for effect modification by race. Results from multiple linear regression models suggested that higher time-averaged cumulative DBP (β [95% CI] per 1-SD increase: -1.78 [-2.53, -1.02], P<0.001 and -0.005 [-0.009, -0.002], P=0.004, respectively) but not systolic BP (-0.52 [-1.30, 0.26], P=0.189 and 0.001 [-0.002, 0.005], P=0.485, respectively) was associated with smaller central retinal arteriolar equivalent and arteriole:venule ratio. The association between time-averaged cumulative DBP and arteriole:venule ratio was strongest in White participants (interaction P=0.007). The association of cumulative systolic BP and DBP with central retinal venular equivalent was strongest in Black participants (interaction P=0.015 and 0.011, respectively). Conclusions Exposure to higher BP levels, particularly DBP, from midlife to late life is associated with narrower retinal vessel diameters in late life. Furthermore, race moderated the association of cumulative BP exposure with retinal microvasculature.
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Affiliation(s)
- Yiquan Huang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Huimin Zhou
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Shaozhao Zhang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xiangbin Zhong
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Yifen Lin
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Zhenyu Xiong
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Menghui Liu
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Aili Yimamu
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Odong Christopher
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Ziwei Zhou
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xiaodong Zhuang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xinxue Liao
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
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Association between Age of Onset of Hypertension and Incident Atrial Fibrillation. J Pers Med 2022; 12:jpm12071186. [PMID: 35887683 PMCID: PMC9317856 DOI: 10.3390/jpm12071186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
We investigated whether age at hypertension (HTN) onset was associated with the risk of atrial fibrillation (AF) in the general population. This prospective longitudinal community-based cohort study included 9892 participants without AF at baseline, who underwent biennial electrocardiography for a median duration of 11.5 years. The participants were divided into five groups, consisting of a normotensive group (Group-N) and four HTN groups based on HTN onset age: <45 years (Group-H1); 45−54 years (Group-H2); 55−64 years (Group-H3); and ≥65 years (Group-H4). A multivariate Cox proportional hazards model showed that the presence of HTN at baseline was associated with higher AF risk (hazard ratio [HR], 1.93; 95% confidence interval [CI] 1.32−2.80). The participants in Group-H1 had the highest risk of AF (HR 3.18; CI 1.74−5.82), and the risk of AF decreased as HTN onset age increased across the four HTN groups (p for trend = 0.014). The AF onset age was significantly younger in participants in Group-H1 than in Groups-H2−H4. Early-onset HTN was associated with an increased risk of AF, and younger onset of AF in the general population. Surveillance for AF should be considered at a younger age in individuals with HTN.
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Forrester SN, Zmora R, Schreiner PJ, Jacobs DR, Roger VL, Thorpe RJ, Kiefe CI. Racial differences in the association of accelerated aging with future cardiovascular events and all-cause mortality: the coronary artery risk development in young adults study, 2007-2018. ETHNICITY & HEALTH 2022; 27:997-1009. [PMID: 33222499 PMCID: PMC8137718 DOI: 10.1080/13557858.2020.1839021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Variability of Cardiovascular disease (CVD) risk, including racial difference, is not fully accounted for by the variability of traditional CVD risk factors. We used a multiple biomarker model as a framework to explore known racial differences in CVD burden. DESIGN We measured associations between accelerated aging (AccA) measured by a combination of biomarkers, and cardiovascular morbidity and all-cause mortality using data from the Coronary Artery Risk Development in Young Adults study (CARDIA). AccA was defined as the difference between biological age, calculated using biomarkers with the Klemera and Doubal method, and chronological age. Using logistic regression, we assessed overall and race-specific associations between AccA, CVD, and all-cause mortality. RESULTS Among our cohort of 2959 Black or White middle-aged adults, after adjustment, a one-year increase in AccA was associated with increased odds of CVD (Odds Ratio (OR) = 1.04; 95% CI: 1.02, 1.06), stroke (OR = 1.12; 95% CI: 1.07, 1.17), and all-cause mortality (OR = 1.05; 95% CI: 1.02, 1.08). We did not find significant overall racial differences, but we did find race by sex differences where Black men differed markedly from White men in the strength of association with CVD (OR = 1.06, 95% CI: 1.01, 1.12). CONCLUSIONS We provide evidence that AccA is associated with future CVD.
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Affiliation(s)
- Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rachel Zmora
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Pamela J Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - David R Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Veronique L. Roger, Mayo Clinic, Division of Circulatory Failure, Rochester, MN, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Specific deformation pattern in hypertensive patients with septal bulge and preserved systolic function. Int J Cardiovasc Imaging 2022; 38:2323-2331. [DOI: 10.1007/s10554-022-02662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
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Rønningen PS, Berge T, Solberg MG, Enger S, Pervez MO, Orstad EB, Kvisvik B, Aagaard EN, Lyngbakken MN, Ariansen I, Røsjø H, Steine K, Tveit A. Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid-60s: Data From the ACE 1950 Study. J Am Heart Assoc 2022; 11:e023738. [PMID: 35621203 PMCID: PMC9238725 DOI: 10.1161/jaha.121.023738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.
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Affiliation(s)
- Peter Selmer Rønningen
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Trygve Berge
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway
| | - Magnar Gangås Solberg
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Steve Enger
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway
| | - Mohammad Osman Pervez
- Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Eivind Bjørkan Orstad
- Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Brede Kvisvik
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Erika Nerdrum Aagaard
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Magnus Nakrem Lyngbakken
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Inger Ariansen
- Deparment of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway
| | - Helge Røsjø
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division for Research and Innovation Akershus University Hospital Lørenskog Norway
| | - Kjetil Steine
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Arnljot Tveit
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
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Abstract
Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension. In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets. However, out-of-office BP evaluation using 24 h ambulatory or home BP monitoring is recommended by all major medical associations for obtaining further insights into the BP profile of an individual and how it relates to their daily activities. Importantly, the highly variable nature of office and out-of-office BP readings has been widely acknowledged, including the association of BP variability with cardiovascular outcomes. However, to date, the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice. Novel cuffless wearable technologies might provide a detailed assessment of the 24 h BP profile and behaviour over weeks or months. These devices offer many advantages for researchers and patients compared with traditional BP monitors, but their accuracy and utility remain uncertain. In this Review, we outline and compare conventional and novel methods and techniques for assessing average BP levels and BP variability, and reflect on the utility and potential of these methods for improving the treatment and management of patients with hypertension. The most commonly available blood pressure (BP) monitoring devices are useful for capturing a snapshot BP value, but most have limited utility in measuring BP variability. In this Review, Schutte and colleagues outline the advantages and disadvantages of conventional and novel techniques to measure average BP levels and BP variability. Although the dynamic nature of blood pressure (BP) is well-known, hypertension guidelines recommend using the average values of static BP readings (office or out-of-office), specifically aiming to level the fluctuations and peaks in BP readings. All current BP measurement methods have imperfect reproducibility owing to the continuous fluctuation in BP readings, making it difficult to accurately diagnose hypertension. Accumulating evidence from clinical trials, large registries and meta-analyses shows that increased BP variability predicts cardiovascular outcome, independently of the average BP values. To date, BP variability is overlooked, with limited application in clinical practice, probably owing to a variety of complex non-standardized BP variability assessment methods and indices, and uncertain thresholds and clinical usefulness. Novel cuffless wearable BP technologies can provide very large numbers of readings for days and months without the discomfort of traditional BP monitoring devices, and have the potential to replace current BP methods, once accuracy issues are resolved and their clinical usefulness is proved.
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31
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Gnanenthiran SR, Wang N, Di Tanna GL, Salam A, Webster R, de Silva HA, Guggilla R, Jan S, Maulik PK, Naik N, Selak V, Thom S, Prabhakaran D, Schutte AE, Patel A, Rodgers A. Association of Low-Dose Triple Combination Therapy vs Usual Care With Time at Target Blood Pressure: A Secondary Analysis of the TRIUMPH Randomized Clinical Trial. JAMA Cardiol 2022; 7:645-650. [PMID: 35416909 PMCID: PMC9008553 DOI: 10.1001/jamacardio.2022.0471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Cumulative exposure to high blood pressure (BP) is an adverse prognostic marker. Assessments of BP control over time, such as time at target, have been developed but assessments of the effects of BP-lowering interventions on such measures are lacking. Objective To evaluate whether low-dose triple combination antihypertensive therapy was associated with greater rates of time at target compared with usual care. Design, Setting, and Participants The Triple Pill vs Usual Care Management for Patients With Mild-to-Moderate Hypertension (TRIUMPH) trial was a open-label randomized clinical trial of low-dose triple BP therapy vs usual care conducted in urban hospital clinics in Sri Lanka from February 2016 to May 2017. Adults with hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg or in patients with diabetes or chronic kidney disease, systolic BP >130 mm Hg and/or diastolic BP >80 mm Hg) requiring initiation (untreated patients) or escalation (patients receiving monotherapy) of antihypertensive therapy were included. Patients were excluded if they were currently taking 2 or more blood pressure-lowering drugs or had severe or uncontrolled blood pressure, accelerated hypertension or physician-determined need for slower titration of treatment, a contraindication to the triple combination pill therapy, an unstable medical condition, or clinically significant laboratory values deemed by researchers to be unsuitable for the study. All 700 individuals in the original trial were included in the secondary analysis. This post hoc analysis was conducted from December 2020 to December 2021. Intervention Once-daily fixed-dose triple combination pill (telmisartan 20 mg, amlodipine 2.5 mg, and chlorthalidone 12.5 mg) therapy vs usual care. Main Outcomes and Measures Between-group differences in time at target were compared over 24 weeks of follow-up, with time at target defined as percentage of time at target BP. Results There were a total of 700 randomized patients (mean [SD] age, 56 [11] years; 403 [57.6%] women). Patients allocated to the triple pill group (n = 349) had higher time at target compared with those in the usual care group (n = 351) over 24 weeks' follow-up (64% vs 43%; risk difference, 21%; 95% CI, 16-26; P < .001). Almost twice as many patients receiving triple pill therapy achieved more than 50% time at target during follow-up (64% vs 37%; P < .001). The association of the triple pill with an increase in time at target was seen early, with most patients achieving more than 50% time at target by 12 weeks. Those receiving the triple pill achieved a consistently higher time at target at all follow-up periods compared with those receiving usual care (mean [SD]: 0-6 weeks, 36.3% [30.9%] vs 21.7% [28.9%]; P < .001; 6-12 weeks, 5.2% [31.9%] vs 33.7% [33.0%]; P < .001; 12-24 weeks, 66.0% [31.1%] vs 43.5% [34.3%]; P < .001). Conclusions and Relevance To our knowledge, this analysis provides the first estimate of time at target as an outcome assessing longitudinal BP control in a randomized clinical trial. Among patients with mild to moderate hypertension, treatment with a low-dose triple combination pill was associated with substantially higher time at target compared with usual care.
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Affiliation(s)
- Sonali R Gnanenthiran
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nelson Wang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Abdul Salam
- The George Institute for Global Health, Hyderabad, India University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Rama Guggilla
- Department of Population Medicine and Lifetsyle Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Bialystok, Poland
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Pallab K Maulik
- The George Institute for Global Health, Hyderabad, India University of New South Wales, Sydney, New South Wales, Australia
| | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi
| | - Vanessa Selak
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Simon Thom
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control and Public Health Foundation, New Delhi, India
| | - Aletta E Schutte
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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32
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Li C, Zhu Y, Ma Y, Hua R, Zhong B, Xie W. Association of Cumulative Blood Pressure With Cognitive Decline, Dementia, and Mortality. J Am Coll Cardiol 2022; 79:1321-1335. [PMID: 35393012 DOI: 10.1016/j.jacc.2022.01.045] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Elevated blood pressure (BP) has been linked to impaired cognition and dementia in older adults. However, few studies have accounted for long-term cumulative BP exposure. OBJECTIVES The aim of this study was to test whether long-term cumulative BP was independently associated with subsequent cognitive decline, incident dementia, and all-cause mortality among cognitively healthy adults. METHODS This study used data from the HRS (Health and Retirement Study) and ELSA (English Longitudinal Study of Ageing). Cumulative BP was calculated as the area under the curve using measurements from wave 0 (1998-1999) to wave 4 (2008-2009) in ELSA and wave 8 (2006-2007) to wave 10 (2010-2011) in the HRS. Outcomes included cognitive decline, incident dementia, and all-cause mortality. RESULTS A total of 7,566 and 9,294 participants from ELSA and the HRS were included (44.8% and 40.2% men and median age 62.0 years [IQR: 55.0-70.0 years] and 65.0 years [IQR: 58.0-72.0 years], respectively). The median follow-up duration was 8.0 years (IQR: 4.0-8.0 years) and 8.0 years (IQR: 6.0-8.0 years), respectively. Elevated cumulative systolic BP and pulse pressure were independently associated with accelerated cognitive decline (P < 0.001 for both), elevated dementia risk (P < 0.001 for both), and all-cause mortality (P < 0.001 for both), while a significant inverse association was observed for diastolic BP. Strong dose-response relationships were identified, with similar results for the 2 cohorts. CONCLUSIONS Long-term cumulative BP was associated with subsequent cognitive decline, dementia risk, and all-cause mortality in cognitively healthy adults aged ≥50 years. Efforts are required to control long-term systolic BP and pulse pressure and to maintain adequate diastolic BP.
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Affiliation(s)
- Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yidan Zhu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Baoliang Zhong
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China.
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33
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Ferguson-Stegall L, Shanley BJ, Huch AD, Puterbaugh BJ, Faust L, Phousirith A, Scheel H, Williams A, Webb M, Sloop O, Smet M. Hypertension in Healthy College Students: The Hypertension in Young Adults (HiYA) Study. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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Suvila K, Niiranen TJ. Interrelations Between High Blood Pressure, Organ Damage, and Cardiovascular Disease: No More Room for Doubt. Hypertension 2022; 79:516-517. [PMID: 35138870 DOI: 10.1161/hypertensionaha.121.18786] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Karri Suvila
- Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N.)
| | - Teemu J Niiranen
- Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N.).,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N.)
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35
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Rethy LB, McCabe ME, Kershaw KN, Ahmad FS, Lagu T, Pool LR, Khan SS. Neighborhood Poverty and Incident Heart Failure: an Analysis of Electronic Health Records from 2005 to 2018. J Gen Intern Med 2021; 36:3719-3727. [PMID: 33963504 PMCID: PMC8642536 DOI: 10.1007/s11606-021-06785-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/31/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neighborhood-level characteristics, such as poverty, have been associated with risk factors for heart failure (HF), including hypertension and diabetes mellitus. However, the independent association between neighborhood poverty and incident HF remains understudied. OBJECTIVE To evaluate the association between neighborhood poverty and incident HF using a "real-world" clinical cohort. DESIGN Retrospective cohort study of electronic health records from a large healthcare network. Individuals' residential addresses were geocoded at the census-tract level and categorized by poverty tertiles based on American Community Survey data (2007-2011). PARTICIPANTS Patients from Northwestern Medicine who were 30-80 years, free of cardiovascular disease at index visit (January 1, 2005-December 1, 2013), and followed for at least 5 years. MAIN MEASURES The association of neighborhood-level poverty tertile (low, intermediate, and high) and incident HF was analyzed using generalized linear mixed effect models adjusting for demographics (age, sex, race/ethnicity) and HF risk factors (body mass index, diabetes mellitus, hypertension, smoking status). KEY RESULTS Of 28,858 patients included, 75% were non-Hispanic (NH) White, 43% were men, 15% lived in a high-poverty neighborhood, and 522 (1.8%) were diagnosed with incident HF. High-poverty neighborhoods were associated with a 1.80 (1.35, 2.39) times higher risk of incident HF compared with low-poverty neighborhoods after adjustment for demographics and HF risk factors. CONCLUSIONS In a large healthcare network, incident HF was associated with neighborhood poverty independent of demographic and clinical risk factors. Neighborhood-level interventions may be needed to complement individual-level strategies to prevent and curb the growing burden of HF.
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Affiliation(s)
- Leah B Rethy
- Deparment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Megan E McCabe
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Faraz S Ahmad
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tara Lagu
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lindsay R Pool
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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36
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Nwabuo CC, Appiah D, Moreira HT, Vasconcellos HD, Yano Y, Reis JP, Shah RV, Murthy VL, Allen NB, Sidney S, Muntner P, Lewis CE, Lloyd-Jones DM, Schreiner PJ, Gidding SS, Lima JA. Long-term cumulative blood pressure in young adults and incident heart failure, coronary heart disease, stroke, and cardiovascular disease: The CARDIA study. Eur J Prev Cardiol 2021; 28:1445-1451. [PMID: 34695218 PMCID: PMC8653578 DOI: 10.1177/2047487320915342] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/05/2020] [Indexed: 11/02/2023]
Abstract
AIMS Cumulative blood pressure (BP) is a measure that incorporates the severity and duration of BP exposure. The prognostic significance of cumulative BP in young adults for cardiovascular diseases (CVDs) in comparison to BP severity alone is, however, unclear. METHODS AND RESULTS We investigated 3667 Coronary Artery Risk Development in Young Adults participants who attended six visits over 15 years (year-0 (1985-1986), year-2, year-5, year-7, year-l0, and year-15 exams). Cumulative BP was calculated as the area under the curve (mmHg × years) from year 0 through year 15. Cox models assessed the association between cumulative BP (year 0 through year 15), current BP (year 15), and BP change (year 0 and year 15) and CVD outcomes. Mean (standard deviation) age at year 15 was 40.2 (3.6) years, 44.1% were men, and 44.1% were African-American. Over a median follow-up of 16 years, there were 47 heart failure (HF), 103 coronary heart disease (CHD), 71 stroke, and 191 CVD events. Cumulative systolic BP (SBP) was associated with HF (hazard ratio (HR) = 2.14 (1.58-2.90)), CHD (HR = 1.49 (1.19-1.87)), stroke (HR = 1.81 (1.38-2.37)), and CVD (HR = 1.73 (1.47-2.05)). For CVD, the C-statistic for SBP (year 15) was 0.69 (0.65-0.73) and change in C-statistic with the inclusion of SBP change and cumulative SBP was 0.60 (0.56-0.65) and 0.72 (0.69-0.76), respectively. For CVD, using year-15 SBP as a reference, the net reclassification index (NRI) for cumulative SBP was 0.40 (p < 0.0001) and the NRI for SBP change was 0.22 (p = 0.001). CONCLUSIONS Cumulative BP in young adults was associated with the subsequent risk of HF, CHD, stroke, and CVD. Cumulative BP provided incremental prognostic value and improved risk reclassification for CVD, when compared to single BP assessments or changes in BP.
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Affiliation(s)
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, USA
| | | | | | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, USA
| | | | | | | | | | - Stephen Sidney
- Kaiser Permanente Northern California, Division of Research, USA
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37
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Schutte AE, Gnanenthiran SR. Toward a Better Understanding of Why Cumulative Blood Pressure Is Such a Strong Predictor of Cardiovascular Outcomes. Hypertension 2021; 78:1267-1269. [PMID: 34644169 DOI: 10.1161/hypertensionaha.121.18156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, Australia (A.E.S.).,Cardiovascular Division, George Institute for Global Health, Sydney, Australia (A.E.S., S.R.G.).,Hypertension in Africa Research Team, MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| | - Sonali R Gnanenthiran
- Cardiovascular Division, George Institute for Global Health, Sydney, Australia (A.E.S., S.R.G.)
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38
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Kim CS, Kim B, Choi HS, Bae EH, Ma SK, Han KD, Kim SW. Cumulative hypertension burden and risk of end-stage renal disease. Hypertens Res 2021; 44:1652-1661. [PMID: 34408283 DOI: 10.1038/s41440-021-00723-0] [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: 02/14/2021] [Revised: 06/23/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022]
Abstract
Hypertension is the leading risk factor for end-stage renal disease (ESRD). However, the association between sustained exposure to increased blood pressure (BP) and ESRD is not well established. This study investigated whether the cumulative hypertension burden is a substantial risk factor for ESRD. The incidence of ESRD among 2,144,801 participants identified from the Korean National Health Insurance Service database who had documented BP assessment data in their annual health check-up data from between 2006 and 2010, was determined. Over a median follow-up of 7.2 years, ESRD was identified in 1758 participants. Hypertension burden was defined as the cumulative exposure to hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) during four consecutive follow-up periods and ranged from 0 to 4. The hypertension burden was as follows: 0 (n = 1,164,488), 77.6%; 1 (n = 292,377), 13.6%; 2 (n = 114,397), 5.3%; 3 (n = 52,671), 2.5%; and 4 (n = 20,886), 1.0%. Compared to the hypertension burden of 0, the adjusted hazard ratio for ESRD was 1.35, 1.54, 1.51, and 2.28 for hypertension burdens of 1, 2, 3, and 4, respectively. A positive dose-dependent relationship between hypertension burden and ESRD was found (P for interaction < 0.001). This association was maintained for sustained exposure to both systolic and diastolic hypertension burden. In conclusion, hypertension burden increases the risk of ESRD. Our study underlines the usefulness of a new assessment of the hypertension burden over a certain period for predicting the risk of ESRD in a large population-based cohort.
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Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. .,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
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Lloyd-Jones DM, Lewis CE, Schreiner PJ, Shikany JM, Sidney S, Reis JP. The Coronary Artery Risk Development In Young Adults (CARDIA) Study: JACC Focus Seminar 8/8. J Am Coll Cardiol 2021; 78:260-277. [PMID: 34266580 PMCID: PMC8285563 DOI: 10.1016/j.jacc.2021.05.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022]
Abstract
The CARDIA (Coronary Artery Risk Development in Young Adults) study began in 1985 to 1986 with enrollment of 5,115 Black or White men and women ages 18 to 30 years from 4 US communities. Over 35 years, CARDIA has contributed fundamentally to our understanding of the contemporary epidemiology and life course of cardiovascular health and disease, as well as pulmonary, renal, neurological, and other manifestations of aging. CARDIA has established associations between the neighborhood environment and the evolution of lifestyle behaviors with biological risk factors, subclinical disease, and early clinical events. CARDIA has also identified the nature and major determinants of Black-White differences in the development of cardiovascular risk. CARDIA will continue to be a unique resource for understanding determinants, mechanisms, and outcomes of cardiovascular health and disease across the life course, leveraging ongoing pan-omics work from genomics to metabolomics that will define mechanistic pathways involved in cardiometabolic aging.
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Affiliation(s)
- Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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40
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Lin Y, Zhong X, Xiong Z, Zhang S, Liu M, Fan Y, Huang Y, Sun X, Zhou H, Xu X, Guo Y, Li Y, Yang D, Ye X, Zhuang X, Liao X. Intensity of Glycemic Exposure in Early Adulthood and Target Organ Damage in Middle Age: The CARDIA Study. Front Physiol 2021; 12:614532. [PMID: 34248653 PMCID: PMC8260980 DOI: 10.3389/fphys.2021.614532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
AIM To determine whether long-term intensity of glycemic exposure (IGE) during young adulthood is associated with multiple target organs function at midlife independent of single fasting glucose (FG) measurement. METHODS We included 2,859 participants, aged 18-30 years at Y0, in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. IGE was calculated as the sum of (average FG of two consecutive examinations × years between the examinations) over 25 years. Target organs function was indicated by cardiac structure, left ventricular (LV) systolic function, LV diastolic function, coronary artery calcium (CAC), and urine albumin-to-creatinine ratio (UACR) at Y25. We evaluated the associations between IGE with target organs function using linear regression models and estimated the associations between IGE with numbers of organs involved (0, 1, or ≥ 2 organs) using multinomial logistic regression models. RESULTS A 1-SD increment of IGE was significantly associated with worse target organs function after multivariable adjustment: left ventricular mass (β [SE], 5.468 [1.175]); global longitudinal strain (β [SE], 0.161 [0.071]); E/e' ratio (β[SE], 0.192 [0.071]); CAC score (β [SE], 27.948 [6.116]); and log UACR (β [SE], 0.076 [0.010]). Besides, IGE was independently associated with having ≥ 2 organs involved in both overall population (OR [95% CI], 1.48 [1.23, 1.41], P < 0.001) and subgroups stratified by diabetes at Y25. CONCLUSION Higher intensity of glycemic exposure during young adulthood was independently associated with subclinical alterations of target organs function at midlife. Our findings highlight the importance of early screening and management of IGE in youth.
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Affiliation(s)
- Yifen Lin
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiangbin Zhong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhenyu Xiong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Shaozhao Zhang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yongqiang Fan
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yiquan Huang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiuting Sun
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Huimin Zhou
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xingfeng Xu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuqi Li
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Daya Yang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Ye
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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Ying W, Post WS, Michos ED, Subramanya V, Ndumele CE, Ouyang P, Ambale-Venkatesh B, Doria De Vasconcellos H, Nwabuo CC, Schreiner PJ, Lewis CE, Reis J, Lloyd-Jones D, Sidney S, Lima JAC, Vaidya D. Associations between menopause, cardiac remodeling, and diastolic function: the CARDIA study. Menopause 2021; 28:1166-1175. [PMID: 34127631 DOI: 10.1097/gme.0000000000001815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Heart failure with preserved ejection fraction (HFpEF) affects more women than men. Menopause may influence HFpEF development in women. We assessed cross-sectional and longitudinal associations between menopause and echocardiographic measures of left ventricular (LV) function and cardiac remodeling. METHODS We studied 1,723 women with available echo data from at least two of: year 5 (Y5) (1990-1991), Y25 (2010-2011), or Y30 (2015-2016) in the Coronary Artery Risk Development in Young Adults study. Cardiac structure and function were measured using 2D and Doppler echocardiography. Cross-sectional associations between menopausal status and repeated echo measures at Y25 and Y30 were analyzed using linear mixed models. Two-segmented models were used to compare longitudinal changes in echocardiographic measures in the premenopausal period to changes in the postmenopausal period. RESULTS Mean ± SD age (years) at enrollment was 27 ± 3 in those with menopause by Y25, 25 ± 3 in those with menopause between Y25 and Y30, and 21 ± 3 in those premenopausal at Y30. There were no significant differences in race, body mass index, systolic blood pressure, or diabetes between the groups. Postmenopausal women had higher early diastolic mitral inflow (E) to annular (e') velocity ratio than premenopausal after adjusting for demographics and risk factors (P < 0.05). Menopause was associated with relative increases in the rates of change in LV mass and left atrial volume, even after adjustment. Change in E/e' ratio was similar before and after menopause. CONCLUSIONS Menopause is associated cross-sectionally with worse diastolic function and longitudinally with adverse LV and left atrial remodeling. This may contribute to the increased HFpEF risk in postmenopausal women.
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Affiliation(s)
- Wendy Ying
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Chiadi E Ndumele
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Chike C Nwabuo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Jared Reis
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Donald Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Joao A C Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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42
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Kula AJ, Prince DK, Flynn JT, Bansal N. BP in Young Adults with CKD and Associations with Cardiovascular Events and Decline in Kidney Function. J Am Soc Nephrol 2021; 32:1200-1209. [PMID: 33692088 PMCID: PMC8259674 DOI: 10.1681/asn.2020081156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND BP is an important modifiable risk factor for cardiovascular events and CKD progression in middle-aged or older adults with CKD. However, studies describing the relationship between BP with outcomes in young adults with CKD are limited. METHODS In an observational study, we focused on 317 young adults (aged 21-40 years) with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Exposures included baseline systolic BP evaluated continuously (per 10 mm Hg increase) and in categories (<120, 120-129, and ≥130 mm Hg). Primary outcomes included cardiovascular events (heart failure, myocardial infarction, stroke, or all-cause death) and CKD progression (50% decline of eGFR or ESKD). We used Cox proportional hazard models to test associations between baseline systolic BP with cardiovascular events and CKD progression. RESULTS Cardiovascular events occurred in 52 participants and 161 had CKD progression during median follow-up times of 11.3 years and 4.1 years, respectively. Among those with baseline systolic BP ≥130 mm Hg, 3%/yr developed heart failure, 20%/yr had CKD progression, and 2%/yr died. In fully adjusted models, baseline systolic BP ≥130 mm Hg (versus systolic BP<120 mm Hg) was significantly associated with cardiovascular events or death (hazard ratio [HR], 2.13; 95% confidence interval [95% CI], 1.05 to 4.32) and CKD progression (HR, 1.68; 95% CI, 1.10 to 2.58). CONCLUSIONS Among young adults with CKD, higher systolic BP is significantly associated with a greater risk of cardiovascular events and CKD progression. Trials of BP management are needed to test targets and treatment strategies specifically in young adults with CKD.
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Affiliation(s)
- Alexander J. Kula
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - David K. Prince
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Joseph T. Flynn
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Nisha Bansal
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
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Within-visit SBP variability from childhood to adulthood and markers of cardiovascular end-organ damage in mid-life. J Hypertens 2021; 39:1865-1875. [PMID: 34397629 DOI: 10.1097/hjh.0000000000002855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Within-visit SBP variability is associated with age and SBP, but its long-term clinical significance is unknown. We examined the association between child, adult, and life-time within-visit SBP variability with markers of end-organ damage using data from a 31-year longitudinal study. METHODS Within-visit SBP variability was calculated as the standard deviation of three sitting SBP readings among up to 3010 participants aged 6-18 years (childhood) who were re-measured up to seven times to mid-adulthood. Markers of cardiovascular end-organ damage in adulthood were carotid intima--media thickness, brachial flow-mediated dilatation, carotid distensibility, pulse wave velocity, left ventricular mass index, carotid plaque, and coronary artery calcification. RESULTS The mean (standard deviation) cumulative within-visit SBP variability was 2.7 (1.5) mmHg in childhood, 3.9 (1.9) mmHg in adulthood and 3.7 (1.5) mmHg across the observed life-time. Childhood within-visit SBP variability was not correlated with its subsequent values measured from 3 to 31 years later. With adjustment for age, sex, cumulative SBP, BMI and serum lipids, neither child, adult, or life-time cumulative within-visit SBP variability associated with markers of cardiovascular end-organ damage. However, higher child, adult, and life-time cumulative SBP significantly associated with higher carotid intima--media thickness, higher pulse wave velocity, lower brachial flow-mediated dilatation, lower carotid distensibility in adulthood. CONCLUSION Within-visit SBP variability from childhood to adulthood does not provide additional predictive utility over SBP over the same period of the life course.
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Maredia H, Bowring MG, Massie AB, Bae S, Kernodle A, Oyetunji S, Merlo C, Higgins RSD, Segev DL, Bush EL. Better Understanding the Disparity Associated With Black Race in Heart Transplant Outcomes: A National Registry Analysis. Circ Heart Fail 2021; 14:e006107. [PMID: 33525893 PMCID: PMC7887117 DOI: 10.1161/circheartfailure.119.006107] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Black heart transplant recipients have higher risk of mortality than White recipients. Better understanding of this disparity, including subgroups most affected and timing of the highest risk, is necessary to improve care of Black recipients. We hypothesize that this disparity may be most pronounced among young recipients, as barriers to care like socioeconomic factors may be particularly salient in a younger population and lead to higher early risk of mortality. METHODS We studied 22 997 adult heart transplant recipients using the Scientific Registry of Transplant Recipients data from January 2005 to 2017 using Cox regression models adjusted for recipient, donor, and transplant characteristics. RESULTS Among recipients aged 18 to 30 years, Black recipients had 2.05-fold (95% CI, 1.67-2.51) higher risk of mortality compared with non-Black recipients (P<0.001, interaction P<0.001); however, the risk was significant only in the first year post-transplant (first year: adjusted hazard ratio, 2.30 [95% CI, 1.60-3.31], P<0.001; after first year: adjusted hazard ratio, 0.84 [95% CI, 0.54-1.29]; P=0.4). This association was attenuated among recipients aged 31 to 40 and 41 to 60 years, in whom Black recipients had 1.53-fold ([95% CI, 1.25-1.89] P<0.001) and 1.20-fold ([95% CI, 1.09-1.33] P<0.001) higher risk of mortality. Among recipients aged 61 to 80 years, no significant association was seen with Black race (adjusted hazard ratio, 1.12 [95% CI, 0.97-1.29]; P=0.1). CONCLUSIONS Young Black recipients have a high risk of mortality in the first year after heart transplant, which has been masked in decades of research looking at disparities in aggregate. To reduce overall racial disparities, clinical research moving forward should focus on targeted interventions for young Black recipients during this period.
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Affiliation(s)
- Hasina Maredia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amber Kernodle
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shakirat Oyetunji
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian Merlo
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert S. D. Higgins
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Errol L. Bush
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Steffen LM, Yi SY, Duprez D, Zhou X, Shikany JM, Jacobs DR. Walnut consumption and cardiac phenotypes: The Coronary Artery Risk Development in Young Adults (CARDIA) study. Nutr Metab Cardiovasc Dis 2021; 31:95-101. [PMID: 33097410 PMCID: PMC8574984 DOI: 10.1016/j.numecd.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Observational studies and clinical trials have shown cardiovascular benefits of nut consumption, including walnuts. However, the relations of walnut consumption with systolic and diastolic function, risk factors for heart failure, are unknown. We examined the associations of walnut consumption with cardiac structure and function parameters in black and white adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. METHODS AND RESULTS After exclusions, the study population included 3341 participants. Dietary intake was assessed using the CARDIA Diet History questionnaire at baseline, year 7 and year 20 exams. Cardiac structure and function were measured by echocardiography at year 25. Multivariable linear regression evaluated the associations of walnut consumption with blood pressure (BP), heart rate, and cardiac phenotypes, adjusting for age, sex, race, lifestyle habits, and clinical characteristics. We found the majority of walnut consumers compared to non-consumers were females, whites, and more highly educated, and had lower waist circumference, diastolic BP, and heart rate, and higher diet quality score. Even though cardiac structure and function measures were generally within normal ranges among participants, walnut consumers had significantly better values for diastolic function parameters A wave, E/A ratio, septal and lateral e' than non-consumers. Further adjustment for body mass index and diabetes status did not materially change the significance between walnut consumer groups. Systolic function parameters did not differ by walnut group. CONCLUSION Compared to non-consumers, walnut consumption is associated with better diastolic dysfunction in young to middle-aged adults.
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Affiliation(s)
- Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - So Yun Yi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Duprez
- Cardiology Division, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Xia Zhou
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Sedaghat S, Sorond F, Yaffe K, Sidney S, Kramer HJ, Jacobs DR, Launer LJ, Carnethon MR. Decline in kidney function over the course of adulthood and cognitive function in midlife. Neurology 2020; 95:e2389-e2397. [PMID: 32878993 DOI: 10.1212/wnl.0000000000010631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that end-stage renal disease (ESRD) risk exposure during young adulthood is related to worse cognitive performance in midlife. METHODS We included 2,604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age 35 years, 54% women, 45% Black). Estimated glomerular filtration rate and albumin-to-creatinine ratio were measured every 5 years at year (Y) 10 through Y30. At each visit, moderate/high risk of ESRD according to the Kidney Disease: Improving Global Outcomes guidelines (estimated glomerular filtration rate <60 mL/min/1.73 m2 or albumin-to-creatinine ratio >30 mg/g) was defined, totaled over examinations, and categorized into 0 episodes, 1 episode, and >1 episodes of ESRD risk. At Y30, participants underwent global and multidomain cognitive assessment. We used analysis of covariance to assess the association of ESRD risk categories with cognitive function, controlling for cardiovascular risk factors. RESULTS Over the course of 20 years, 427 participants (16% of the study population) had ≥1 episodes of ESRD risk exposure. Individuals with more risk episodes had lower composite cognitive function (p < 0.001), psychomotor speed (p < 0.001), and executive function (p = 0.007). All these associations were independent of sociodemographic status and cardiovascular risk factors. CONCLUSIONS In this population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course are associated with worse cognitive performance at midlife. Preserving kidney function in young age needs to be investigated as a potential strategy to preserve cognitive function in midlife.
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Affiliation(s)
- Sanaz Sedaghat
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD.
| | - Farzaneh Sorond
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Kristine Yaffe
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Stephen Sidney
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Holly J Kramer
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - David R Jacobs
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Lenore J Launer
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Mercedes R Carnethon
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
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Siransy‐Balayssac E, Ouattara S, Yéo TA, Kondo AL, Touré M, Dah CS, Bogui P. Physiological variations of blood pressure according to gender and age among healthy young black Africans aged between 18 and 30 years in Côte d'Ivoire, West Africa. Physiol Rep 2020; 8:e14579. [PMID: 32986938 PMCID: PMC7521662 DOI: 10.14814/phy2.14579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
In Africa, abnormal high blood pressure is common and affects young subjects. The risk of organ damage and mortality increases with blood pressure level. Therefore, the purpose of this study was to assess the blood pressure profile of a black African population aged between 18 and 30 years in Côte d'Ivoire. Five hundred fifty-one healthy black African students, men and women, with sedentary lifestyle, aged between 18 and 30 years were selected. Systolic (SBP) and diastolic (DBP) blood pressures and heart rate were recorded after 5 min of rest. Regression models were used to estimate the effects of age, gender, and body mass index (BMI) on SBP and DBP. Each increase of 1 year in age and 1 kg/m2 of BMI is significantly associated, respectively, with an increase of 20% (p = .002) and 17% (p = .008) in the risk of having an SBP ≥ 130 mmHg. The same risk is 3.8 times greater for men than women (p = .01). Among subjects with SBP < 120 mmHg, men have an SBP 5.22 mmHg higher than women (p < .001). The increase in the age of 1 year is significantly correlated with a rise of 36% of having a DBP ≥ 85 mmHg (p = .0001). Also, in men population, the age increase of 1 year is associated with a rise of 41% of having a DBP ≥ 85 mmHg (p = .0001). Among young black African students aged between 18 and 30 years in Côte d'Ivoire, SBP is positively associated with male gender, age, and BMI. For DBP, it is only an increase with age.
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Affiliation(s)
- Edwige Siransy‐Balayssac
- Laboratoire de Physiologie et d'Explorations FonctionnellesUnité de Formation et de Recherche en Sciences MédicalesUniversité Félix Houphouët Boigny01 BPV 34 Abidjan 01COTE D'IVOIRE
- Service des Explorations FonctionnellesCentre hospitalier universitaire de Yopougon21 BP 632 Abidjan 21COTE D'IVOIRE
| | - Soualiho Ouattara
- Laboratoire de Physiologie et d'Explorations FonctionnellesUnité de Formation et de Recherche en Sciences MédicalesUniversité Félix Houphouët Boigny01 BPV 34 Abidjan 01COTE D'IVOIRE
| | - Téniloh Augustin Yéo
- Laboratoire de Physiologie et d'Explorations FonctionnellesUnité de Formation et de Recherche en Sciences MédicalesUniversité Félix Houphouët Boigny01 BPV 34 Abidjan 01COTE D'IVOIRE
| | - Aya Liliane Kondo
- Laboratoire de Physiologie et d'Explorations FonctionnellesUnité de Formation et de Recherche en Sciences MédicalesUniversité Félix Houphouët Boigny01 BPV 34 Abidjan 01COTE D'IVOIRE
| | - Massiré Touré
- Laboratoire de Physiologie et d'Explorations FonctionnellesUnité de Formation et de Recherche en Sciences MédicalesUniversité Félix Houphouët Boigny01 BPV 34 Abidjan 01COTE D'IVOIRE
| | - Cyrille Serges Dah
- Laboratoire de Physiologie et d'Explorations FonctionnellesUnité de Formation et de Recherche en Sciences MédicalesUniversité Félix Houphouët Boigny01 BPV 34 Abidjan 01COTE D'IVOIRE
- Service des Explorations FonctionnellesCentre hospitalier universitaire de CocodyBPV 13 AbidjanCOTE D'IVOIRE
| | - Pascal Bogui
- Laboratoire de Physiologie et d'Explorations FonctionnellesUnité de Formation et de Recherche en Sciences MédicalesUniversité Félix Houphouët Boigny01 BPV 34 Abidjan 01COTE D'IVOIRE
- Service des Explorations FonctionnellesCentre hospitalier universitaire de Yopougon21 BP 632 Abidjan 21COTE D'IVOIRE
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Teramoto K, Nadruz W, Matsushita K, Claggett B, John JE, Skali H, Solomon S, Cheng S, Shah AM. Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Cardiac Structure, Function, and Heart Failure. Hypertension 2020; 76:808-818. [PMID: 32536273 PMCID: PMC8262121 DOI: 10.1161/hypertensionaha.120.14833] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/13/2020] [Indexed: 01/09/2023]
Abstract
Limited data exist regarding systolic blood pressure (SBP) through mid- to late-life and late-life cardiac function and heart failure (HF) risk. Among 4578 HF-free participants in the ARIC study (Atherosclerosis Risk in Communities) attending the fifth visit (2011-2013; age 75±5 years), time-averaged cumulative SBP was calculated as the sum of averaged SBPs from adjacent consecutive visits (visits 1-5) indexed to total observation time (24±1 years). Calculations were performed using measured SBPs and also incorporating antihypertensive medication specific effect constants (underlying SBP). Outcomes included comprehensive echocardiography at visit 5 and post-visit 5 incident HF, HF with preserved ejection fraction, and reduced ejection fraction. Higher cumulative SBP was associated with greater left ventricular mass and worse diastolic measures (all P<0.001), associations that were stronger with underlying compared with cumulative SBP (all P<0.05). At 5.6±1.2 years follow-up post-visit 5, higher cumulative measured and underlying SBP were associated with incident HF (hazard ratio per 10 mm Hg for measured: 1.12 [1.01-1.24]; underlying: 1.19 [95% CI, 1.10-1.30]) and HF with preserved ejection fraction (measured: 1.15 [1.00-1.33]; underlying: 1.28 [1.14-1.45]), but not HF with reduced ejection fraction (measured: 1.11 [0.94-1.32]; underlying: 1.11 [0.96-1.24]). Associations with HF and HF with preserved ejection fraction were more robust with cumulative underlying compared with measured SBP (all P<0.05). Time-averaged cumulative SBP in mid to late life is associated with worse cardiac function and risk of incident HF, especially HF with preserved ejection fraction, in late life. These associations were stronger considering underlying as opposed to measured SBP, highlighting the importance of prevention and effective treatment of hypertension to prevent late-life cardiac dysfunction and HF.
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Affiliation(s)
- Kanako Teramoto
- Division of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Wilson Nadruz
- Cardiology Division, State University of Campinas, Campinas, São Paulo, Brazil
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jenine E. John
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Scott Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW To review the current evidence on research related to age of hypertension onset-its definition, correlates, heritability, and association with adverse outcomes. We also propose a framework for implementing assessment of hypertension onset age into clinical practice. RECENT FINDINGS Prior studies have used both objective measurements and self-report to determine age of hypertension onset or early-onset hypertension. Yet, no criterion for standard definition currently exists for either. Data from epidemiological and clinical studies demonstrate that early-onset hypertension is a highly heritable trait that confers an increased risk for cardiovascular death and end-organ damage compared with late-onset hypertension. Literature to date suggests that (parental) age of hypertension onset can be feasibly assessed for estimating (1) risk of future hypertension in non-hypertensive persons; and (2) the propensity for cardiovascular disease in individuals with established hypertension.
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Affiliation(s)
- Karri Suvila
- Division of Medicine, Turku University Hospital, Turku, Finland.
- Department of Internal Medicine, University of Turku, Turku, Finland.
| | - Ville Langén
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Susan Cheng
- The Framingham Heart Study, Framingham, MA, USA
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Teemu J Niiranen
- Department of Internal Medicine, University of Turku, Turku, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
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50
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Yokoe I, Kobayashi H, Kobayashi Y, Nishiwaki A, Sugiyama K, Nagasawa Y, Ikumi N, Karasawa H, Okumura Y, Kitamura N, Takei M. Impact of biological treatment on left ventricular dysfunction determined by global circumferential, longitudinal and radial strain values using cardiac magnetic resonance imaging in patients with rheumatoid arthritis. Int J Rheum Dis 2020; 23:1363-1371. [DOI: 10.1111/1756-185x.13942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/29/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Isamu Yokoe
- Department of Rheumatology and Internal Medicine Kyoundo Hospital Sasaki Institute Tokyo Japan
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Hitomi Kobayashi
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
- Division of Rheumatology Itabashi Chuo Medical Center Tokyo Japan
| | - Yasuyuki Kobayashi
- Department of Medical Information and Communication Technology Research Graduate School of Medicine St. Marianna University School of Medicine Kawasaki Japan
| | - Atsuma Nishiwaki
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Kaita Sugiyama
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Yousuke Nagasawa
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Natsumi Ikumi
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Hiromi Karasawa
- Department of Rheumatology and Internal Medicine Kyoundo Hospital Sasaki Institute Tokyo Japan
| | - Yasuo Okumura
- Division of Cardiology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Noboru Kitamura
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Masami Takei
- Division of Hematology and Rheumatology Department of Medicine Nihon University School of Medicine Tokyo Japan
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