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Fujii T, Ikari Y. Epidemiological and Prognostic Importance of New-Onset Cancer as a Net Adverse Clinical Outcome after ST-Elevation Myocardial Infarction. J Cardiovasc Dev Dis 2024; 11:256. [PMID: 39330314 PMCID: PMC11432219 DOI: 10.3390/jcdd11090256] [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: 07/17/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/28/2024] Open
Abstract
The study assessed the epidemiological frequency and prognostic impact of new-onset cancer as an additional net adverse clinical outcome in patients after ST-elevation myocardial infarction (STEMI), considering its potential clinical significance alongside classical endpoints. This study was designed as a single-center observational study, including 1285 consecutive patients who were diagnosed as STEMI patients as the subject, and the frequency and prognosis of new-onset cancer after STEMI onset were assessed. The incidence of all-cause death, nonfatal myocardial infarction (MI), stroke, and bleeding were analyzed as classical endpoints. Throughout an average of a 1241.4 days observation period, cancers were observed in 7.0% of patients (n = 90), showing development at a constant rate throughout this period (incidence rate, 0.06/1000 person-years). The average duration from STEMI onset to cancer diagnosis was 1371.4 days. Death, MI, or stroke were observed in 21.3%, 4.0%, 6.5%, and 12.8%, giving incidence rates of 0.18, 0.03, 0.06, and 0.11/1000 person-years, respectively. Long-term mortality was higher in patients with newly diagnosed cancer than in patients without cancer (36.7% vs. 20.1%, p < 0.01). Cancer after STEMI should be considered as an additional major adverse clinical event because of its high incidence, constant development, and high mortality in comparison to classical endpoints.
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Affiliation(s)
- Toshiharu Fujii
- Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan;
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2
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Mennander A, Nielsen SJ, Skyttä T, Smith ML, Martinsson A, Pivodic A, Hansson EC, Jeppsson A. Cardiac surgery and long-term risk for incident cancer: A nationwide population-based study. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00690-1. [PMID: 39153716 DOI: 10.1016/j.jtcvs.2024.08.006] [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: 04/22/2024] [Revised: 07/03/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE Previous studies indicate an increased long-term risk for incident cancer and cancer-specific mortality in patients undergoing cardiac surgery. We compared the risk for incident cancer and cancer-specific mortality between patients and matched control subjects from the general population. METHODS All patients (n = 127,119) undergoing first-time coronary artery or heart valve surgery in Sweden during 1997-2020 were included in a population-based observational cohort study based on individual data from the SWEDEHEART registry and 4 other mandatory national registries. The patients were compared with an age-, sex-, and place of residence-matched control population (n = 415,287) using multivariable Cox proportional hazards regression models adjusted for baseline characteristics, comorbidities, and socioeconomic factors. A propensity score-matched analysis with 81,522 well-balanced pairs was also performed. RESULTS Median follow-up was 9.2 (range, 0-24) years. A total of 31,361/127,119 patients (24.7%) and 102,959/415,287 control subjects (24.8%) developed cancer during follow-up. The crude event rates were 2.75 and 2.83 per 100 person-years, respectively. The adjusted risk for cancer and cancer-specific mortality was lower in patients (adjusted hazard ratios 0.86 [95% CI, 0.85-0.88] and 0.64 [95% CI, 0.62-0.65], respectively). The propensity score-matched analysis showed similar results (hazard ratios, 0.88 [95% CI, 0.86-0.90] and 0.65 [95% CI, 0.63-0.68], respectively). The results were consistent in subgroups based on sex, age, and comorbidities. CONCLUSIONS Patients who underwent cardiac surgery have lower risk for cancer and cancer-specific mortality than matched control subjects.
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Affiliation(s)
- Ari Mennander
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Tampere University Hospital, Heart Hospital, Tampere, Finland.
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tanja Skyttä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Maya Landenhed Smith
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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3
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Pelliccia F, Gragnano F, Pasceri V, Marazzi G, Cacciotti L, Placanica A, Niccoli G, Palmerini T, Speciale G, Granatelli A, Calabrò P. Gender-related differences in changes of estimated bleeding risk in patients on dual antiplatelet therapy: the RE-SCORE multicenter prospective registry. Platelets 2022; 33:1228-1236. [DOI: 10.1080/09537104.2022.2102602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | - Felice Gragnano
- Division of Clinical Cardiology, A.O.R.N. ‘Sant’Anna e San Sebastiano’, Caserta, Italy
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Vincenzo Pasceri
- Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Giulio Speciale
- Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | - Paolo Calabrò
- Division of Clinical Cardiology, A.O.R.N. ‘Sant’Anna e San Sebastiano’, Caserta, Italy
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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Pelliccia F, Gragnano F, Pasceri V, Cesaro A, Zimarino M, Calabrò P. Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention. J Clin Med 2022; 11:3574. [PMID: 35806860 PMCID: PMC9267626 DOI: 10.3390/jcm11133574] [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: 05/31/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/07/2022] Open
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor in patients undergoing percutaneous coronary intervention (PCI) reduces the risk of ischemic events but reduces the risk of ischemic events but increases the risk of bleeding, which in turn is associated with increased morbidity and mortality. With the aim to offer personalized treatment regimens to patients undergoing PCI, much effort has been devoted in the last decade to improve the identification of patients at increased risk of bleeding complications. Several clinical scores have been developed and validated in large populations of patients with coronary artery disease (CAD) and are currently recommended by guidelines to evaluate bleeding risk and individualize the type and duration of antithrombotic therapy after PCI. In clinical practice, these risk scores are conventionally computed at the time of PCI using baseline features and risk factors. Yet, bleeding risk is dynamic and can change over time after PCI, since patients can worsen or improve their clinical status and accumulate comorbidities. Indeed, evidence now exists that the estimated risk of bleeding after PCI can change over time. This concept is relevant, as the inappropriate estimation of bleeding risk, either at the time of revascularization or subsequent follow-up visits, might lead to erroneous therapeutic management. Serial evaluation and recalculation of bleeding risk scores during follow-up can be important in clinical practice to improve the identification of patients at higher risk of bleeding while on DAPT after PCI.
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Affiliation(s)
- Francesco Pelliccia
- Department of Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, 00166 Rome, Italy
| | - Felice Gragnano
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale ‘Sant’Anna e San Sebastiano’, 81100 Caserta, Italy; (F.G.); (A.C.); (P.C.)
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 80131 Naples, Italy
| | - Vincenzo Pasceri
- Interventional Cardiology, San Filippo Neri Hospital, 00135 Rome, Italy;
| | - Arturo Cesaro
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale ‘Sant’Anna e San Sebastiano’, 81100 Caserta, Italy; (F.G.); (A.C.); (P.C.)
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 80131 Naples, Italy
| | - Marco Zimarino
- Institute of Cardiology, “G. d’Annunzio” University, 66100 Chieti, Italy;
- Cath Lab, Ospedale Policlinico SS. Annunziata Annunziata Hospital, 66100 Chieti, Italy
| | - Paolo Calabrò
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale ‘Sant’Anna e San Sebastiano’, 81100 Caserta, Italy; (F.G.); (A.C.); (P.C.)
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 80131 Naples, Italy
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5
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Zeng H, Nanayakkara GK, Shao Y, Fu H, Sun Y, Cueto R, Yang WY, Yang Q, Sheng H, Wu N, Wang L, Yang W, Chen H, Shao L, Sun J, Qin X, Park JY, Drosatos K, Choi ET, Zhu Q, Wang H, Yang X. DNA Checkpoint and Repair Factors Are Nuclear Sensors for Intracellular Organelle Stresses-Inflammations and Cancers Can Have High Genomic Risks. Front Physiol 2018; 9:516. [PMID: 29867559 PMCID: PMC5958474 DOI: 10.3389/fphys.2018.00516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/20/2018] [Indexed: 12/28/2022] Open
Abstract
Under inflammatory conditions, inflammatory cells release reactive oxygen species (ROS) and reactive nitrogen species (RNS) which cause DNA damage. If not appropriately repaired, DNA damage leads to gene mutations and genomic instability. DNA damage checkpoint factors (DDCF) and DNA damage repair factors (DDRF) play a vital role in maintaining genomic integrity. However, how DDCFs and DDRFs are modulated under physiological and pathological conditions are not fully known. We took an experimental database analysis to determine the expression of 26 DNA DDCFs and 42 DNA DDRFs in 21 human and 20 mouse tissues in physiological/pathological conditions. We made the following significant findings: (1) Few DDCFs and DDRFs are ubiquitously expressed in tissues while many are differentially regulated.; (2) the expression of DDCFs and DDRFs are modulated not only in cancers but also in sterile inflammatory disorders and metabolic diseases; (3) tissue methylation status, pro-inflammatory cytokines, hypoxia regulating factors and tissue angiogenic potential can determine the expression of DDCFs and DDRFs; (4) intracellular organelles can transmit the stress signals to the nucleus, which may modulate the cell death by regulating the DDCF and DDRF expression. Our results shows that sterile inflammatory disorders and cancers increase genomic instability, therefore can be classified as pathologies with a high genomic risk. We also propose a new concept that as parts of cellular sensor cross-talking network, DNA checkpoint and repair factors serve as nuclear sensors for intracellular organelle stresses. Further, this work would lead to identification of novel therapeutic targets and new biomarkers for diagnosis and prognosis of metabolic diseases, inflammation, tissue damage and cancers.
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Affiliation(s)
- Huihong Zeng
- Department of Histology and Embryology, Basic Medical School, Nanchang University, Nanchang, China
| | - Gayani K Nanayakkara
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Ying Shao
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Hangfei Fu
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Yu Sun
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Ramon Cueto
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - William Y Yang
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Qian Yang
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Department of Ultrasound, Xijing Hospital, Shaanxi, China
| | - Haitao Sheng
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Department of Emergency Medicine, Shengjing Hospital, Liaoning, China
| | - Na Wu
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Department of Endocrinology, Shengjing Hospital, Liaoning, China
| | - Luqiao Wang
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Department of Cardiovascular Medicine, The First Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Wuping Yang
- Department of Histology and Embryology, Basic Medical School, Nanchang University, Nanchang, China
| | - Hongping Chen
- Department of Histology and Embryology, Basic Medical School, Nanchang University, Nanchang, China
| | - Lijian Shao
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Jianxin Sun
- Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Xuebin Qin
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Joon Y Park
- Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Konstantinos Drosatos
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Eric T Choi
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Departments of Pharmacology, and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Qingxian Zhu
- Department of Histology and Embryology, Basic Medical School, Nanchang University, Nanchang, China
| | - Hong Wang
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Xiaofeng Yang
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
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Hasin T, Iakobishvili Z, Weisz G. Associated Risk of Malignancy in Patients with Cardiovascular Disease: Evidence and Possible Mechanism. Am J Med 2017; 130:780-785. [PMID: 28344133 DOI: 10.1016/j.amjmed.2017.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 12/31/2022]
Abstract
Cardiovascular disease and malignancy are leading causes of morbidity and mortality. Increased risk of malignancy was identified in patients with cardiovascular disease, including patients with heart failure, heart failure after myocardial infarction, patients undergoing cardiac intervention, and patients after a thrombotic event. Common risk factors and biological pathways can explain this association and are explored in this review. Further research is needed to establish the causes of malignancy in this population and direct possible intervention.
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Affiliation(s)
- Tal Hasin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Zaza Iakobishvili
- Department of Cardiology, Rabin Medical Center, Petach Tiqwa, Israel
| | - Giora Weisz
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
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7
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Hasin T, Gerber Y, Weston SA, Jiang R, Killian JM, Manemann SM, Cerhan JR, Roger VL. Heart Failure After Myocardial Infarction Is Associated With Increased Risk of Cancer. J Am Coll Cardiol 2017; 68:265-271. [PMID: 27417004 DOI: 10.1016/j.jacc.2016.04.053] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with excess morbidity and mortality for which noncardiac causes are increasingly recognized. The authors previously described an increased risk of cancer among HF patients compared with community controls. OBJECTIVES This study examined whether HF was associated with an increased risk of subsequent cancer among a homogenous population of first myocardial infarction (MI) survivors. METHODS A prospective cohort study was conducted among Olmsted County, Minnesota, residents with incident MI from 2002 to 2010. Patients with prior cancer or HF diagnoses were excluded. RESULTS A total of 1,081 participants (mean age 64 ± 15 years; 60% male) were followed for 5,327 person-years (mean 4.9 ± 3.0 years). A total of 228 patients developed HF, and 98 patients developed cancer (excluding nonmelanoma skin cancer). Incidence density rates for cancer diagnosis (per 1,000 person-years) were 33.7 for patients with HF and 15.6 for patients without HF (p = 0.002). The hazard ratio (HR) for cancer associated with HF was 2.16 (95% confidence interval [CI]: 1.39 to 3.35); adjusted for age, sex, and Charlson comorbidity index; HR: 1.71 (95% CI: 1.07 to 2.73). The HRs for mortality associated with cancer were 4.90 (95% CI: 3.10 to 7.74) for HF-free and 3.91 (95% CI: 1.88 to 8.12) for HF patients (p for interaction = 0.76). CONCLUSIONS Patients who develop HF after MI have an increased risk of cancer. This finding extends our previous report of an elevated cancer risk after HF compared with controls, and calls for a better understanding of shared risk factors and underlying mechanisms.
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Affiliation(s)
- Tal Hasin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Susan A Weston
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ruoxiang Jiang
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jill M Killian
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sheila M Manemann
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - James R Cerhan
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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