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Parsa S, Saleh A, Raygor V, Hoeting N, Rao A, Navar AM, Rohatgi A, Kay F, Abbara S, Khera A, Joshi PH. Measurement and Application of Incidentally Detected Coronary Calcium: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1557-1567. [PMID: 38631775 DOI: 10.1016/j.jacc.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
Coronary artery calcium (CAC) scoring is a powerful tool for atherosclerotic cardiovascular disease risk stratification. The nongated, noncontrast chest computed tomography scan (NCCT) has emerged as a source of CAC characterization with tremendous potential due to the high volume of NCCT scans. Application of incidental CAC characterization from NCCT has raised questions around score accuracy, standardization of methodology including the possibility of deep learning to automate the process, and the risk stratification potential of an NCCT-derived score. In this review, the authors aim to summarize the role of NCCT-derived CAC in preventive cardiovascular health today as well as explore future avenues for eventual clinical applicability in specific patient populations and broader health systems.
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Affiliation(s)
- Shyon Parsa
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA; Department of Internal Medicine, Stanford University Hospital, Stanford, California, USA
| | - Adam Saleh
- Texas A&M University, Engineering Medicine, Houston, Texas, USA
| | - Viraj Raygor
- Sutter Health, Cardiovascular Health, Palo Alto, California, USA
| | - Natalie Hoeting
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anjali Rao
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anand Rohatgi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Fernando Kay
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suhny Abbara
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parag H Joshi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA.
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Grinberg T, Eisen A, Talmor-Barkan Y, Kornowski R, Hamdan A, Witberg G, Ayers C, Joshi P, Rohatgi A, Khera A, de Lemos JA, Neeland IJ. Novel plasma biomarkers of coronary artery calcium incidence or progression: Insights from the prospective multi-ethnic Dallas Heart Study cohort. Atherosclerosis 2024; 390:117469. [PMID: 38342026 PMCID: PMC10988770 DOI: 10.1016/j.atherosclerosis.2024.117469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/17/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND AND AIMS Identifying the association of novel plasma biomarkers with coronary artery calcium (CAC) incidence or progression may provide insights into the pathophysiology of atherogenesis and plaque formation. METHODS Participants of the Dallas Heart Study (DHS), a multi-ethnic cohort of ambulatory individuals at low-intermediate risk for future atherosclerotic cardiovascular disease (ASCVD), who had their blood tested for 31 biomarkers reflecting multiple pathophysiological pathways, underwent 2 serial non-contrast computed tomography assessments for CAC a median ∼7 years apart. The collected biomarkers were explored for association with CAC incidence or progression using univariate and multivariate analysis. RESULTS A total of 1424 participants were included; mean age 43 years, 39 % male, and nearly half African-American. Over a 7-year interval between the two CAC measurements, 340 participants (23.9 %) had CAC incidence or progression, 105 (7.4 %) with incident CAC, and 309 (21.7 %) with CAC progression. Although several plasma biomarkers were associated with CAC incidence or progression in a univariate model, only soluble intercellular adhesion molecule-1 (sICAM-1), related to atherosclerosis by the inflammatory pathway, remained independently associated in a multivariate model adjusted for traditional risk factors. CONCLUSIONS Further studies are needed to characterize the role of sICAM-1 in CAC evolvement to establish whether it has a pivotal mechanistic contribution or is rather an innocent bystander. Alternate measures of coronary atherosclerosis may be needed to elucidate contributors to atherosclerosis incidence or progression.
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Affiliation(s)
- Tzlil Grinberg
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Alon Eisen
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor-Barkan
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Colby Ayers
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Parag Joshi
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Anand Rohatgi
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Amit Khera
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - James A de Lemos
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, TX, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Albert MA, Churchwell K, Desai N, Johnson JC, Johnson MN, Khera A, Mieres JH, Rodriguez F, Velarde G, Williams DR, Wu JC. Addressing Structural Racism Through Public Policy Advocacy: A Policy Statement From the American Heart Association. Circulation 2024; 149:e312-e329. [PMID: 38226471 DOI: 10.1161/cir.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
During the COVID-19 pandemic, the American Heart Association created a new 2024 Impact Goal with health equity at its core, in recognition of the increasing health disparities in our country and the overwhelming evidence of the damaging effect of structural racism on cardiovascular and stroke health. Concurrent with the announcement of the new Impact Goal was the release of an American Heart Association presidential advisory on structural racism, recognizing racism as a fundamental driver of health disparities and directing the American Heart Association to advance antiracist strategies regarding science, business operations, leadership, quality improvement, and advocacy. This policy statement builds on the call to action put forth in our presidential advisory, discussing specific opportunities to leverage public policy in promoting overall well-being and rectifying those long-standing structural barriers that impede the progress that we need and seek for the health of all communities. Although this policy statement discusses difficult aspects of our past, it is meant to provide a forward-looking blueprint that can be embraced by a broad spectrum of stakeholders who share the association's commitment to addressing structural racism and realizing true health equity.
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Lennon NJ, Kottyan LC, Kachulis C, Abul-Husn NS, Arias J, Belbin G, Below JE, Berndt SI, Chung WK, Cimino JJ, Clayton EW, Connolly JJ, Crosslin DR, Dikilitas O, Velez Edwards DR, Feng Q, Fisher M, Freimuth RR, Ge T, Glessner JT, Gordon AS, Patterson C, Hakonarson H, Harden M, Harr M, Hirschhorn JN, Hoggart C, Hsu L, Irvin MR, Jarvik GP, Karlson EW, Khan A, Khera A, Kiryluk K, Kullo I, Larkin K, Limdi N, Linder JE, Loos RJF, Luo Y, Malolepsza E, Manolio TA, Martin LJ, McCarthy L, McNally EM, Meigs JB, Mersha TB, Mosley JD, Musick A, Namjou B, Pai N, Pesce LL, Peters U, Peterson JF, Prows CA, Puckelwartz MJ, Rehm HL, Roden DM, Rosenthal EA, Rowley R, Sawicki KT, Schaid DJ, Smit RAJ, Smith JL, Smoller JW, Thomas M, Tiwari H, Toledo DM, Vaitinadin NS, Veenstra D, Walunas TL, Wang Z, Wei WQ, Weng C, Wiesner GL, Yin X, Kenny EE. Selection, optimization and validation of ten chronic disease polygenic risk scores for clinical implementation in diverse US populations. Nat Med 2024; 30:480-487. [PMID: 38374346 PMCID: PMC10878968 DOI: 10.1038/s41591-024-02796-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
Polygenic risk scores (PRSs) have improved in predictive performance, but several challenges remain to be addressed before PRSs can be implemented in the clinic, including reduced predictive performance of PRSs in diverse populations, and the interpretation and communication of genetic results to both providers and patients. To address these challenges, the National Human Genome Research Institute-funded Electronic Medical Records and Genomics (eMERGE) Network has developed a framework and pipeline for return of a PRS-based genome-informed risk assessment to 25,000 diverse adults and children as part of a clinical study. From an initial list of 23 conditions, ten were selected for implementation based on PRS performance, medical actionability and potential clinical utility, including cardiometabolic diseases and cancer. Standardized metrics were considered in the selection process, with additional consideration given to strength of evidence in African and Hispanic populations. We then developed a pipeline for clinical PRS implementation (score transfer to a clinical laboratory, validation and verification of score performance), and used genetic ancestry to calibrate PRS mean and variance, utilizing genetically diverse data from 13,475 participants of the All of Us Research Program cohort to train and test model parameters. Finally, we created a framework for regulatory compliance and developed a PRS clinical report for return to providers and for inclusion in an additional genome-informed risk assessment. The initial experience from eMERGE can inform the approach needed to implement PRS-based testing in diverse clinical settings.
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Affiliation(s)
| | - Leah C Kottyan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Josh Arias
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gillian Belbin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sonja I Berndt
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - James J Cimino
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - David R Crosslin
- Tulane University, New Orleans, LA, USA
- University of Washington, Seattle, WA, USA
| | | | | | - QiPing Feng
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Tian Ge
- Mass General Brigham, Boston, MA, USA
| | | | | | | | | | - Maegan Harden
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Margaret Harr
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joel N Hirschhorn
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Clive Hoggart
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Hsu
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | | | | | - Amit Khera
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Katie Larkin
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nita Limdi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Ruth J F Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yuan Luo
- Northwestern University, Evanston, IL, USA
| | | | - Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa J Martin
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Li McCarthy
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Tesfaye B Mersha
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Bahram Namjou
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Nihal Pai
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | | | - Cynthia A Prows
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | - Heidi L Rehm
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Dan M Roden
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Robb Rowley
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | | | - Hemant Tiwari
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | - Zhe Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wei-Qi Wei
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Eimear E Kenny
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Affiliation(s)
- Amit Khera
- From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.K.); and the Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, and the Intramural Research Program, National Institute on Minority Health and Health Disparities - both at the National Institutes of Health, Bethesda, MD (T.M.P.-W.)
| | - Tiffany M Powell-Wiley
- From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.K.); and the Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, and the Intramural Research Program, National Institute on Minority Health and Health Disparities - both at the National Institutes of Health, Bethesda, MD (T.M.P.-W.)
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Ndumele CE, Neeland IJ, Tuttle KR, Chow SL, Mathew RO, Khan SS, Coresh J, Baker-Smith CM, Carnethon MR, Després JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV, Rangaswami J. A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1636-1664. [PMID: 37807920 DOI: 10.1161/cir.0000000000001186] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome.
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Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, Coresh J, Mathew RO, Baker-Smith CM, Carnethon MR, Despres JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation 2023; 148:1606-1635. [PMID: 37807924 DOI: 10.1161/cir.0000000000001184] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system and has profound impacts on morbidity and mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with the most significant clinical impact being the high associated incidence of cardiovascular disease events and cardiovascular mortality. There is a high prevalence of poor cardiovascular-kidney-metabolic health in the population, with a disproportionate burden seen among those with adverse social determinants of health. However, there is also a growing number of therapeutic options that favorably affect metabolic risk factors, kidney function, or both that also have cardioprotective effects. To improve cardiovascular-kidney-metabolic health and related outcomes in the population, there is a critical need for (1) more clarity on the definition of cardiovascular-kidney-metabolic syndrome; (2) an approach to cardiovascular-kidney-metabolic staging that promotes prevention across the life course; (3) prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health; and (4) strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence. It is also critical to incorporate considerations of social determinants of health into care models for cardiovascular-kidney-metabolic syndrome and to reduce care fragmentation by facilitating approaches for patient-centered interdisciplinary care. This presidential advisory provides guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome and details a multicomponent vision for effectively and equitably enhancing cardiovascular-kidney-metabolic health in the population.
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Deets A, Joshi PH, Chandra A, Singh K, Khera A, Virani SS, Ballantyne CM, Otvos JD, Dullaart RPF, Gruppen EG, Connelly MA, Ayers C, Navar AM, Pandey A, Wilkins JT, Rohatgi A. Novel Size-Based High-Density Lipoprotein Subspecies and Incident Vascular Events. J Am Heart Assoc 2023; 12:e031160. [PMID: 37929707 PMCID: PMC10727395 DOI: 10.1161/jaha.123.031160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023]
Abstract
Background High-density lipoprotein (HDL) particle concentration likely outperforms HDL cholesterol in predicting atherosclerotic cardiovascular events. Whether size-based HDL subspecies explain the atheroprotective associations of HDL particle concentration remains unknown. Our objective was to assess whether levels of specific size-based HDL subspecies associate with atherosclerotic cardiovascular disease in a multiethnic pooled cohort and improve risk prediction beyond traditional atherosclerotic cardiovascular disease risk factors. Methods and Results Seven HDL size-based subspecies were quantified by nuclear magnetic resonance (LP4 algorithm; H1=smallest; H7=largest) among participants without prior atherosclerotic cardiovascular disease in ARIC (Atherosclerosis Risk in Communities), MESA (Multi-Ethnic Study of Atherosclerosis), PREVEND (Prevention of Renal and Vascular Endstage Disease), and DHS (Dallas Heart Study) cohorts (n=15 371 people). Multivariable Cox proportional hazards models were used to evaluate the association between HDL subspecies and incident myocardial infarction (MI) or ischemic stroke at follow-up (average 8-10 years) adjusting for HDL cholesterol and risk factors. Improvement in risk prediction was assessed via discrimination and reclassification analysis. Within the pooled cohort (median age 57 years; female 54%; Black 22%) higher H1 (small) and H4 (medium) concentrations were inversely associated with incident MI (hazard ratio [HR]/SD, H1 0.88 [95% CI, 0.81-0.94]; H4 0.89 [95% CI, 0.82-0.97]). H4 but not H1 improved risk prediction indices for incident MI. Increasing H2 and H4 were inversely associated with improved risk prediction indices for composite end point of stroke, MI, and cardiovascular death (HR/SD, H2 0.94 [95% CI, 0.88-0.99]; H4 0.91 [95% CI, 0.85-0.98]). Levels of the large subspecies (H6 and H7) were not associated with any vascular end point. Conclusions Two of 7 HDL size-based subspecies modestly improved risk prediction for MI and composite vascular end points in a large multiethnic pooled cohort. These findings support assessment of precise HDL subspecies for future studies regarding clinical utility.
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Affiliation(s)
- Austin Deets
- University of Texas Southwestern Medical CenterDallasTX
| | | | - Alvin Chandra
- University of Texas Southwestern Medical CenterDallasTX
| | | | - Amit Khera
- University of Texas Southwestern Medical CenterDallasTX
| | - Salim S. Virani
- Michael E. Debakey Veteran Affairs Medical CenterHoustonTX
- Baylor College of MedicineHoustonTX
| | | | | | - Robin P. F. Dullaart
- University of Groningen and University Medical Center GroningenGroningenThe Netherlands
| | - Eke G. Gruppen
- University of Groningen and University Medical Center GroningenGroningenThe Netherlands
| | | | - Colby Ayers
- University of Texas Southwestern Medical CenterDallasTX
| | | | | | | | - Anand Rohatgi
- University of Texas Southwestern Medical CenterDallasTX
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Raygor V, Hoeting N, Ayers C, Joshi P, Canan A, Abbara S, Assadourian JN, Khera A, Peterson ED, Navar AM. Accuracy of incidental visual coronary artery calcium assessment compared with dedicated coronary artery calcium scoring. J Cardiovasc Comput Tomogr 2023; 17:453-458. [PMID: 37863760 DOI: 10.1016/j.jcct.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION CAC can be detected on routine chest computed tomography (CT) scans and may contribute to CVD risk estimation, but the accuracy of visual CAC scoring may be affected by the specialty of the interpreting radiologist and/or the use of contrast. METHODS The accuracy of visual CAC estimation on non-gated CT scans was evaluated at UT Southwestern Medical Center (UTSW) and Parkland Health and Hospital System (PHHS). All adults who underwent CAC scanning and a non-gated CT scan within 6 months were identified and the scores from the two CTs were compared overall and stratified by type of reader and whether contrast was used. Visual CAC categories of none, small, moderate, and large were compared to CAC = 0, 1-99, 100-399, and ≥400, respectively. RESULTS From 2016 to 2021, 934 patients (mean age 60 ± 12 y, 43% male, 61% White, 34% Black, 24% Hispanic, 54% from PHHS) had both CT scans. Of these, 441 (47%) had no CAC, 278 (30%) small, 147 (16%) moderate, and 66 (7%) large CAC on non-gated CT. Visual CAC estimates were highly correlated with CAC scores (Kendalls tau-b = 0.76, p < 0.0001). Among those with no visual CAC, 76% had CAC = 0 (72% of contrast-enhanced vs 85% of non-contrast scans, 88% of scans interpreted by CT radiologist vs 78% of those interpreted by other radiologist). In those with moderate-to-large visual CAC, 99% had CAC >0 and 88% had CAC ≥100, including 89% of those with contrast, 90% of those without contrast, 80% of those read by a CT radiologist, and 88% of those read by a non-CT radiologist. DISCUSSION Visual CAC estimates on non-gated CT scans are concordant with Agatston score categories from cardiac CT scans. A lack of visual CAC on non-gated CT scans may not be sufficient to "de-risk" patients, particularly for contrast-enhanced scans and those read by non-CT radiologists. However, the presence of moderate-to-large CAC, including on contrasted scans and regardless of radiologist type, is highly predictive of CAC and may be used to identify high-risk patients for prevention interventions.
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Affiliation(s)
- Viraj Raygor
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Natalie Hoeting
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA
| | - Colby Ayers
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA
| | - Parag Joshi
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Arzu Canan
- University of Texas Southwestern, Cardiothoracic Imaging, Department of Radiology, Dallas, TX, USA
| | - Suhny Abbara
- University of Texas Southwestern, Cardiothoracic Imaging, Department of Radiology, Dallas, TX, USA
| | | | - Amit Khera
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Eric D Peterson
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA
| | - Ann Marie Navar
- University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA.
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Al Rifai M, Taffet GE, Matsushita K, Virani SS, De Lemos J, Khera A, Berry J, Ndumele C, Aguilar D, Sun C, Hoogeveen RC, Selvin E, Ballantyne CM, Nambi V. Age-Related Differences in the Contribution of Systolic Blood Pressure and Biomarkers to Cardiovascular Disease Risk Prediction: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Cardiol 2023; 204:295-301. [PMID: 37567021 PMCID: PMC10528351 DOI: 10.1016/j.amjcard.2023.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/02/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
We sought to determine how biomarkers known to be associated with hypertension-induced end-organ injury complement the use of systolic blood pressure (SBP) for cardiovascular disease (CVD) risk prediction at different ages. Using data from visits 2 (1990 to 1992) and 5 (2011 to 2013) of the Atherosclerosis Risk in Communities (ARIC) study, 3 models were used to predict CVD (composite of coronary heart disease, stroke, and heart failure). Model A included traditional risk factors (TRFs) except SBP, model B-TRF plus SBP, and model C-TRF plus biomarkers (high-sensitivity troponin T [hsTnT] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]). Harrel's C-statistics were used to assess risk discrimination for CVD comparing models B and A and C and B. At visit 2, the addition of SBP to TRF (model B vs model A) significantly improved the C-statistic (∆C-statistic, 95% confidence interval 0.010, 0.007 to 0.013) whereas the addition of hsTnT to TRF (model C vs model B) decreased the C-statistic (∆C-statistic -0.0038, -0.0075 to -0.0001) compared with SBP. At visit 5, the addition of SBP to TRF did not significantly improve the C-statistic (∆C-statistic 0.001, -0.002 to 0.005) whereas the addition of both hsTnT and NT-proBNP to TRF significantly improved the C-statistic compared with SBP (∆C-statistic 0.028, 0.015 to 0.041 and 0.055, 0.036 to 0.074, respectively). In summary, the incremental value of SBP for CVD risk prediction diminishes with age whereas the incremental value of hsTnT and NT-proBNP increases with age.
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Affiliation(s)
- Mahmoud Al Rifai
- Division of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - George E Taffet
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland
| | - Salim S Virani
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas; Aga Khan University, Karachi, Pakistan
| | - James De Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jarrett Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chiadi Ndumele
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Aguilar
- Division of Cardiology, Department of Medicine, Louisiana State University Health New Orleans School of Medicine, New Orleans, Los Angeles
| | - Caroline Sun
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Ron C Hoogeveen
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland
| | - Christie M Ballantyne
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Department of Veterans Affairs Medical Center , Section of Cardiology, Houston, Texas.
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11
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Lennon NJ, Kottyan LC, Kachulis C, Abul-Husn N, Arias J, Belbin G, Below JE, Berndt S, Chung W, Cimino JJ, Clayton EW, Connolly JJ, Crosslin D, Dikilitas O, Velez Edwards DR, Feng Q, Fisher M, Freimuth R, Ge T, Glessner JT, Gordon A, Guiducci C, Hakonarson H, Harden M, Harr M, Hirschhorn J, Hoggart C, Hsu L, Irvin R, Jarvik GP, Karlson EW, Khan A, Khera A, Kiryluk K, Kullo I, Larkin K, Limdi N, Linder JE, Loos R, Luo Y, Malolepsza E, Manolio T, Martin LJ, McCarthy L, Meigs JB, Mersha TB, Mosley J, Namjou B, Pai N, Pesce LL, Peters U, Peterson J, Prows CA, Puckelwartz MJ, Rehm H, Roden D, Rosenthal EA, Rowley R, Sawicki KT, Schaid D, Schmidlen T, Smit R, Smith J, Smoller JW, Thomas M, Tiwari H, Toledo D, Vaitinadin NS, Veenstra D, Walunas T, Wang Z, Wei WQ, Weng C, Wiesner G, Xianyong Y, Kenny E. Selection, optimization, and validation of ten chronic disease polygenic risk scores for clinical implementation in diverse populations. medRxiv 2023:2023.05.25.23290535. [PMID: 37333246 PMCID: PMC10275001 DOI: 10.1101/2023.05.25.23290535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Polygenic risk scores (PRS) have improved in predictive performance supporting their use in clinical practice. Reduced predictive performance of PRS in diverse populations can exacerbate existing health disparities. The NHGRI-funded eMERGE Network is returning a PRS-based genome-informed risk assessment to 25,000 diverse adults and children. We assessed PRS performance, medical actionability, and potential clinical utility for 23 conditions. Standardized metrics were considered in the selection process with additional consideration given to strength of evidence in African and Hispanic populations. Ten conditions were selected with a range of high-risk thresholds: atrial fibrillation, breast cancer, chronic kidney disease, coronary heart disease, hypercholesterolemia, prostate cancer, asthma, type 1 diabetes, obesity, and type 2 diabetes. We developed a pipeline for clinical PRS implementation, used genetic ancestry to calibrate PRS mean and variance, created a framework for regulatory compliance, and developed a PRS clinical report. eMERGE's experience informs the infrastructure needed to implement PRS-based implementation in diverse clinical settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li Hsu
- Fred Hutchinson Cancer Center and University of Washington
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- Fred Hutchinson Cancer Center and University of Washington
| | | | | | | | | | - Dan Roden
- Vanderbilt University Medical Center
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12
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Raygor V, Ayers C, Segar MW, Agusala K, Khera A, Pandey A, Joshi PH. Impact of Family History of Premature Coronary Artery Disease on Noninvasive Testing in Stable Chest Pain. J Am Heart Assoc 2023; 12:e029266. [PMID: 37158070 DOI: 10.1161/jaha.122.029266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Viraj Raygor
- Division of Cardiology, Department of Internal Medicine Parkland Hospital Dallas TX USA
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Matthew W Segar
- Department of Cardiology Texas Heart Institute Houston TX USA
| | - Kartik Agusala
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
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13
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Gardner CD, Vadiveloo MK, Petersen KS, Anderson CAM, Springfield S, Van Horn L, Khera A, Lamendola C, Mayo SM, Joseph JJ. Popular Dietary Patterns: Alignment With American Heart Association 2021 Dietary Guidance: A Scientific Statement From the American Heart Association. Circulation 2023; 147:1715-1730. [PMID: 37128940 DOI: 10.1161/cir.0000000000001146] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The evolution of dietary guidelines from isolated nutrients to broader dietary pattern recommendations results from growing knowledge of the synergy between nutrients and their food sources as they influence health. Macronutrient and micronutrient needs can be met by consuming various dietary patterns, but guidance is often required to facilitate population-wide adherence to wise food choices to achieve a healthy dietary pattern. This is particularly true in this era with the proliferation of nutrition misinformation and misplaced emphasis. In 2021, the American Heart Association issued a scientific statement outlining key principles of a heart-healthy dietary pattern that could be operationalized in various ways. The objective of this scientific statement is to assess alignment of commonly practiced US dietary patterns with the recently published American Heart Association criteria, to determine clinical and cultural factors that affect long-term adherence, and to propose approaches for adoption of healthy dietary patterns. This scientific statement is intended to serve as a tool for clinicians and consumers to evaluate whether these popular dietary pattern(s) promote cardiometabolic health and suggests factors to consider when adopting any pattern to improve alignment with the 2021 American Heart Association Dietary Guidance. Numerous patterns strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH [Dietary Approaches to Stop Hypertension], pescetarian, vegetarian) can be adapted to reflect personal and cultural preferences and budgetary constraints. Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.
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14
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Rodriguez F, Khera A. How Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention. Circulation 2023; 147:1204-1207. [PMID: 37068134 PMCID: PMC10281650 DOI: 10.1161/circulationaha.123.064041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Fatima Rodriguez
- Department of Internal Medicine, Division of Cardiology and the Cardiovascular Institute, Stanford University, CA (F.A.)
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (A.K.)
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15
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Khawaja T, Linge J, Leinhard OD, Al-Kindi SG, Rajagopalan S, Khera A, de Lemos JA, Joshi P, Neeland IJ. Coronary artery calcium, hepatic steatosis, and atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus: Results from the Dallas heart study. Prog Cardiovasc Dis 2023:S0033-0620(23)00027-0. [PMID: 36931545 DOI: 10.1016/j.pcad.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) risk amongst those with type 2 diabetes (T2D) is heterogenous. The role of imaging-based cardiometabolic biomarkers (e.g., coronary artery calcium [CAC] score, and hepatic triglyceride content [HTC]) in CVD risk stratification in T2D is unclear. To better understand this, we sought to evaluate the individual and joint associations between CAC and hepatic steatosis (HS) with clinical atherosclerotic CVD (ASCVD) in Dallas Heart Study (DHS) participants with and without T2D. METHODS We examined participants in the DHS, a multi-ethnic cohort study, without self-reported ASCVD. CAC scoring was performed via computed tomography with the mean of two consecutive scores used. HTC was measured using magnetic resonance spectroscopy, and HS was defined as HTC >5.5% The primary outcome was incident ASCVD, defined as coronary heart disease (CHD; myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery), ischemic stroke, transient ischemic attack, or CVD death. Cox regression analyses, and interaction testing was performed to evaluate the individual and joint associations between CAC and HS with ASCVD. The association between HS and coronary heart disease was validated in the UK Biobank (UKB). RESULTS A total of 1252 DHS participants were included with mean age 44.8 ± 9.3 years, mean body mass index 28.7 ± 5.9 kg/m2, 55% female, and 59% black with an overall prevalence of T2D of 9.7%. CAC scores were significantly higher (p < 0.01) and HS was significantly more prevalent in those with T2D (p < 0.01). Over a median of 12.3 years, 8.3% of participants experienced ASCVD events. The ASCVD event rate was significantly higher in participants with T2D (20.5% vs 7.0%, p < 0.01). Continuous CAC was associated with ASCVD events in the overall cohort regardless of T2D status with a significant interaction present between CAC and T2D status on ASCVD, Pinteraction = 0.02. HTC was not associated with ASCVD risk in participants without T2D but was inversely associated with risk in participants with T2D (HR 0.91, 95% CI 0.83-0.99 per 1% increase in HTC, p = 0.02), Pinteraction = 0.02. Amongst 37,266 UKB participants, 4.5% had T2D. CHD events occurred in 2.2% of participants, with 10.2% of events occurring amongst those with T2D. An inverse relationship between HTC and CHD was also found amongst those with T2D in UKB with a significant interaction between T2D status and HTC on CHD (HR per 1% increase in HTC 0.95, 95% CI 0.91-0.99, p = 0.01, Pinteraction = 0.02). CONCLUSIONS In the DHS, we found that CAC was associated with ASCVD risk independent of T2D status. We did not observe an association between HTC and ASCVD in participants without T2D, but there was an inverse association between HTC and ASCVD in those with T2D that was replicated in the UKB cohort. Further investigation is warranted to understand the possible protective association of HS in participants with T2D.
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Affiliation(s)
- Tasveer Khawaja
- Harrington Heart and Vascular Institute, University Hospitals Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Jennifer Linge
- AMRA Medical AB, Linköping, Sweden; Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Olof D Leinhard
- AMRA Medical AB, Linköping, Sweden; Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Amit Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Parag Joshi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland and Case Western Reserve University, Cleveland, OH, USA.
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Rizzo M, Colletti A, Penson PE, Katsiki N, Mikhailidis DP, Toth PP, Gouni-Berthold I, Mancini J, Marais D, Moriarty P, Ruscica M, Sahebkar A, Vinereanu D, Cicero AFG, Banach M, Al-Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Gouni-Berthold I, Bhaskar S, Bielecka-Dąbrowa A, Bjelakovic B, Bruckert E, Bytyçi I, Cafferata A, Ceska R, Cicero AF, Chlebus K, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Gouni-Berthold I, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, John Mancini G, David Marais A, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Mohammad Nabavi S, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Serban MC, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh HI, Zhisheng J, Zirlik A. Nutraceutical approaches to non-alcoholic fatty liver disease (NAFLD): A position paper from the International Lipid Expert Panel (ILEP). Pharmacol Res 2023; 189:106679. [PMID: 36764041 DOI: 10.1016/j.phrs.2023.106679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease. The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.
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Affiliation(s)
- Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Via del Vespro 141, 90127 Palermo, Italy.
| | - Alessandro Colletti
- Department of Science and Drug Technology, University of Turin, Turin, Italy
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, Medical School, University College London (UCL), London, UK
| | - Peter P Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Ioanna Gouni-Berthold
- Department of Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
| | - John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Patrick Moriarty
- Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dragos Vinereanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular disease risk research center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy; IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
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Yuan C, Palka JM, Rohatgi A, Joshi P, Berry J, Khera A, Brown ES. The Relationship Between Coronary Artery Calcification and Carotid Intima Media Thickness and Hippocampal Volume: An Analysis From the Dallas Heart Study. J Acad Consult Liaison Psychiatry 2023; 64:218-225. [PMID: 36681150 DOI: 10.1016/j.jaclp.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Higher rates of dementia are reported in people with a history of coronary artery disease. Smaller hippocampal volume (HV) is a risk factor for the development of dementia. OBJECTIVE This study assessed whether coronary artery calcification (CAC) and carotid intima media thickness (CIMT) are associated with HV in participants from the Dallas Heart Study, a community-based study of Dallas County, Texas, residents. METHODS Data from a total of n = 1821 participants in the Dallas Heart Study with brain magnetic resonance imaging, CAC, and CIMT information were included in the present study, after excluding those with a history of myocardial infarction or stroke. To evaluate the effect of CAC and CIMT on total HV, 4 linear regression analyses were conducted in which the primary predictor was (1) CAC as a continuous metric; (2) CAC as a binary metric (CAC = 0 vs. CAC ≥ 1); (3) CAC as a continuous metric but only for those with CAC >0; and (4) CIMT as a continuous metric. Demographic and cardiovascular disease risk factors, as well as intracranial volume, were entered into the model as covariates. RESULTS Participants were largely women (58.2%) with a mean age of 49.7 ± 10.3 years. Forty-six percent of the sample reported being Black, and approximately 14% reported being Hispanic. All 3 variations of the CAC effect were nonsignificant predictors of total HV (β = -0.013, P = 0.602; β = -0.011, P = 0.650; β = 0.036, P = 0.354, respectively), as was the effect of CIMT (β = 0.009, P = 0.686). CONCLUSIONS Current findings suggest nonsignificant relationships between both CAC and CIMT and between CAC and total HV, while controlling for other related factors in a large, diverse, community-based sample of people without a history of myocardial infarction or stroke. In the context of existing evidence that both coronary artery disease and smaller HV are associated with the development of dementia, the present findings suggest that neither marker of the cardiovascular disease examined here is associated with a reduction in HV in the population studied. Longitudinal studies are needed to assess relationships between CAC and CIMT and between CAC and HV over time.
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Affiliation(s)
- Christine Yuan
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Jayme M Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Parag Joshi
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Jarett Berry
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX; The Altshuler Center for Education & Research, Metrocare Services, Dallas, TX.
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Eason S, Khera A, Gore O, Sayers MH. Screening for familial hypercholesterolaemia; extending a role for blood programs in promoting public health. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Familial hypercholesterolaemia (FH) is a genetic disorder characterized by high levels of cholesterol with evidence of coronary arterial disease at an early age. The prevalence of FH has been recently reported as 1/200 to 1/250 in the general population and although early identification and treatment is recommended (2019 ESC/EAS Guidelines for the Management of Dyslipidaemias), the disorder is largely underdiagnosed in asymptomatic individuals.1
A number of blood programs has recognised the opportunity that blood donation provides to identify ostensibly healthy individuals who might be unaware of risks to their health. These programs have included, along with mandated serological testing, such assays as non-fasting total cholesterol (TC) and haemoglobin A1C. They have also taken steps to notify individuals whose results suggest risk for cardiovascular disease or diabetes.
Purpose
Since our blood donation program has a long history of providing donors information about their TC, we tested whether some donors with elevated TC met the criteria for FH.
Methods
We reviewed unlinked total non-fasting cholesterol results from volunteers donating between 2015 and June 2019. Cholesterols were measured on a chemistry analyzer system (Beckman Coulter AU680) on residual blood after routine testing for infectious disease markers. For volunteers donating more than once, we included only their highest TC recording. TC was classified by American Heart Association (AHA) 2020 Goal Metrics as high, if ≥240 mg/dL (6.2 mmol/L) in donors ≥20 years of age and ≥200 (5.1 mmol/L) in donors <20 years of age. 2 We applied the United States Center for Disease Control Cooperative MEDPED diagnostic criteria for FH. Using these criteria, FH is diagnosed when TC exceeds 270 mg/dL (7.0 mmol/L) in individuals less than 20, 290 mg/dL (7.5 mmol/L) in individuals 20 to 29, 340 mg/dL (8.8 mmol/L) in individuals 30 to 39, and 360 mg/dL (9.3 mmol/L) in individuals 40 years of age and older. 3
Results
There were 432,389 unique donors during the study period. The overall prevalence of high cholesterol, 11.1% and the prevalence of FH 0.24% are similar to published data for the general population. As shown in the table, the prevalence of FH was highest in blood donors 20 to 29 years of age and was lower in those over 30 years, while the prevalence of high TC was higher in older age groups.
Conclusion
There is a subset of blood donors, at all ages who can be identified as satisfying familial hypercholesterolaemia criteria that could benefit from additional evaluation and family screening. A sizeable proportion of blood donors have high cholesterol despite not having FH.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Eason
- Carter BloodCare , Dallas , United States of America
| | - A Khera
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - O Gore
- University of Colorado, Division of Cardiology , Aurora , United States of America
| | - M H Sayers
- Carter BloodCare , Dallas , United States of America
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19
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Khera A, Lee R, Rohde E, Jayaram H, Kathiresan S, Bellinger A. An in vivo CRISPR base editing therapy to inactivate the ANGPTL3 gene: nomination of a development candidate for VERVE-201. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lowering cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is the primary treatment for patients with homozygous familial hypercholesterolemia (HoFH) and established atherosclerotic cardiovascular disease. Due to access, adherence, and healthcare infrastructure limitations, an important fraction of such patients fail to achieve adequate lowering of LDL-C. Durable inactivation in the liver of a cholesterol-raising gene with a one-time therapy offers potential to address this unmet need.
Purpose
Both human genetic and pharmacologic studies have validated inactivation of the angiopoietin-like protein 3 gene (ANGPTL3) as an approach to lower LDL-C and triglyceride levels, particularly when ANGPTL3 reductions >80% can be achieved. Here, we outline a series of preclinical activities to optimize “VERVE-201”, a CRISPR base editing therapy targeting ANGPTL3.
Methods
Preclinical development efforts prioritized: (i) identification of a DNA site where editing of a single base pair inactivates ANGPTL3; and (ii) selection of a guide RNA and adenine base editor combination that precisely and specifically inactivates ANGPTL3; and (iii) a delivery approach suitable for all patients, including those with HoFH who lack sufficient low-density lipoprotein receptors (LDLR) needed for hepatic uptake of traditional lipid nanoparticles.
Results
Bioinformatic and in vitro screening of target sites in the ANGPTL3 gene identified a location where a single A•T to G•C DNA base pair edit leads to disruption of a splice donor and read through into a premature stop codon. To maximize editing of the ANGPTL3 gene while minimizing “off-target” editing elsewhere in the genome, >200 rationally engineered and chemically modified base editing and gRNA configurations were evaluated. Lead candidates were evaluated in primary human hepatocytes to quantify ANGPTL3 editing as well as any “off-target” editing at >600 candidate sites. In a cynomolgus monkey non-human primate model, a single dose of a drug product precursor that used a lipid nanoparticle delivery mechanism achieved potent and durable effects, with a 96% decrease from baseline in circulating ANGPTL3 616 days following administration. The non-human primate homologue to VERVE-201 (“VERVE-201cyno”) incorporates a GalNAc targeting ligand into the lipid nanoparticle, which bypasses LDLR to enable uptake via the liver-specific asialoglycoprotein receptor. VERVE-201cyno led to robust suppression of circulating ANGPTL3 in both a non-human primate model of HoFH and wild-type monkeys, with an average reduction of 89% and 88% respectively 90 days following administration.
Conclusions
These preclinical data provide the scientific foundation for nomination of a development candidate for VERVE-201, a “once-and-done” gene editing therapy intended to precisely, potently, and durably inactivate hepatic ANGPTL3 and thereby lower LDL-C and triglyceride concentrations permanently.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Verve Therapeutics
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Affiliation(s)
- A Khera
- Verve Therapeutics , Cambridge , United States of America
| | - R Lee
- Verve Therapeutics , Cambridge , United States of America
| | - E Rohde
- Verve Therapeutics , Cambridge , United States of America
| | - H Jayaram
- Verve Therapeutics , Cambridge , United States of America
| | - S Kathiresan
- Verve Therapeutics , Cambridge , United States of America
| | - A Bellinger
- Verve Therapeutics , Cambridge , United States of America
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20
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Cainzos-Achirica M, Quispe R, Mszar R, Dudum R, Al Rifai M, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Toth PP, Rana JS, Lima JAC, Doria de Vasconcellos H, Lloyd-Jones D, Joshi PH, Ayers C, Khera A, Blaha MJ, Greenland P, Nasir K. Coronary Artery Calcium Score to Refine the Use of PCSK9i in Asymptomatic Individuals: A Multicohort Study. J Am Heart Assoc 2022; 11:e025737. [PMID: 35943062 PMCID: PMC9496288 DOI: 10.1161/jaha.122.025737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The value of coronary artery calcium (CAC) in the allocation of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitors) among individuals without clinically evident atherosclerotic cardiovascular disease (ASCVD) is unknown for indications that do not require confirmed familial hypercholesterolemia. We aimed to assess the ability of CAC to stratify ASCVD risk under 3 non–familial hypercholesterolemia PCSK9i allocation paradigms. Methods and Results We included participants without clinically evident ASCVD from MESA (Multi‐Ethnic Study of Atherosclerosis), CARDIA (Coronary Artery Risk Development in Young Adults) study, DHS (Dallas Heart Study), and HNR (Heinz Nixdorf Recall) study. Three PCSK9i eligibility scenarios were defined: a broad scenario informed only by high low‐density lipoprotein cholesterol levels (N=567), a restrictive one combining higher low‐density lipoprotein cholesterol levels and presence of ≥2 additional risk factors (N=127), and a high‐risk scenario where individuals with subclinical organ damage or high estimated risk would be treated to achieve low‐density lipoprotein cholesterol <55 mg/dL (N=471). The high‐risk scenario had the highest ASCVD event rates (27.8% at 10 years). CAC=0 was observed in 35% participants in the broad scenario, 25% in the restrictive scenario, and 16% in the high‐risk scenario. In all, CAC=0 was associated with the lowest incident ASCVD rates at 5 and 10 years, and CAC burden was independently associated with ASCVD events adjusting for traditional risk factors. Conclusions CAC may be used to refine the allocation of PCSK9i, potentially leading to a more conservative use if CAC=0. The value of CAC testing is greater in scenarios that use low‐density lipoprotein cholesterol levels and/or traditional risk factors to define PCSK9i eligibility (CAC=0 present in 1 of 3–4 patients), whereas its prevalence is lower when allocation is informed by presence of noncoronary subclinical organ damage.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
| | - Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
| | - Reed Mszar
- Center for Outcomes Research Yale School of Medicine New Haven CT
| | - Ramzi Dudum
- Division of Cardiovascular Medicine Stanford University Stanford CA
| | | | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany.,Department of Epidemiology, School of Public Health Boston University Boston MA
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Sara Schramm
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD.,CGH Medical Center Sterling IL.,University of Illinois College of Medicine Peoria IL
| | - Jamal S Rana
- Divisions of Cardiology and Research Kaiser Permanente Northern California Oakland CA
| | - Joao A C Lima
- Division of Cardiovascular Imaging Johns Hopkins Medical Institutions Baltimore MD
| | | | - Donald Lloyd-Jones
- Departments of Preventive Medicine and Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD.,Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research Johns Hopkins University Baltimore MD
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
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21
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Abstract
This review examines key studies published in 2021 that are related to primary prevention of atherosclerotic cardiovascular disease (ASCVD). Major randomized clinical trials (RCTs) concerning traditional risk factors or ASCVD events, meta‐analyses, and key observational studies related to primary prevention of ASCVD were considered. The review includes interventions for weight loss, cardiometabolic and renal disease, blood pressure control, diet, and the occurrence of cardiovascular disease events. A few studies considered both primary and secondary prevention populations. The review is not exhaustive. We did not include studies that focused on heart failure or clinical presentations that may be difficult to classify, such as acute or chronic ischemic cardiovascular disease without myocardial infarction. Our purpose was to highlight recent research that will help the reader stay abreast of the changing field of cardiovascular prevention.
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Affiliation(s)
- Tamar S Polonsky
- Department of Medicine University of Chicago Medicine Chicago IL
| | - Amit Khera
- Department of Medicine University of Texas, Southwestern Dallas TX
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22
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Rao S, Jamal Siddiqi T, Khan MS, Michos ED, Navar AM, Wang TJ, Greene SJ, Prabhakaran D, Khera A, Pandey A. Association of polypill therapy with cardiovascular outcomes, mortality, and adherence: A systematic review and meta-analysis of randomized controlled trials. Prog Cardiovasc Dis 2022; 73:48-55. [PMID: 35114251 PMCID: PMC10535365 DOI: 10.1016/j.pcad.2022.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
Prior studies have reported improvements in population-level risk factor burden and cardiovascular disease (CVD) outcomes using polypills for CVD risk reduction. However, a comprehensive assessment of the impact of polypills on CVD outcomes, mortality, adherence, and side effects across different settings has not previously been reported. We performed a systematic review and meta-analysis of randomized controlled trials examining the association between polypill therapy and CVD outcomes published before February 2021. The primary outcome of interest was the risk of major adverse CVD events (MACE). Risk ratios for dichotomous outcomes were converted to log RR and pooled using a generic inverse variance weighted random-effects model. Data for continuous outcomes were pooled using random-effects modeling and presented as mean differences with 95% CIs. Eight studies representing 25,584 patients were included for analysis. In the overall pooled analysis, the use of polypills was associated with a non-significant reduction in the risk of MACE (RR: 0.85; 95% CI: 0.70-1.02) and significant reductions in the risk of all-cause mortality (RR: 0.90; 95% CI: 0.81-1.00). The reductions in the risk of MACE with polypill use varied by baseline risk and nature of the study population (primary prevention vs. secondary prevention), with the most significant risk reduction among lower-risk cohorts, including within primary prevention populations [RR 0.70 (0.62, 0.79)]. Among measures of CVD risk factors, modest but significant reductions were observed for systolic and diastolic blood pressure [systolic: mean difference 1.99 mmHg (95% CI: -3.07 to -0.91); diastolic: mean difference 1.30 mmHg (95% CI: -2.42 to -0.19), but not for levels of total or low-density lipoprotein-cholesterol. Use of the polypill strategy significantly improved drug adherence (RR: 1.31; 95% CI: 1.11-1.55) with no association between polypill use and rates of adverse events or drug discontinuation. The use of polypill formulations is associated with significant reductions in CVD risk factors and the risk of all-cause mortality and MACE, particularly in the low-risk and primary prevention population.
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Affiliation(s)
- Shreya Rao
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Tariq Jamal Siddiqi
- Division of Cardiology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Erin D Michos
- Division of Cardiology, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Thomas J Wang
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC, United States of America
| | | | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America.
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23
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Penson PE, Bruckert E, Marais D, Reiner Ž, Pirro M, Sahebkar A, Bajraktari G, Mirrakhimov E, Rizzo M, Mikhailidis DP, Sachinidis A, Gaita D, Latkovskis G, Mazidi M, Toth PP, Pella D, Alnouri F, Postadzhiyan A, Yeh HI, Mancini GBJ, von Haehling S, Banach M, Al‐Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Bhaskar S, Bytyçi I, Bjelakovic B, Bruckert E, Cafferata A, Ceska R, Cicero AF, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, Mancini GJ, Marais AD, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Nabavi SM, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Sattar N, Serban M, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh H, Zhisheng J, Zirlik A. Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP). J Cachexia Sarcopenia Muscle 2022; 13:1596-1622. [PMID: 35969116 PMCID: PMC9178378 DOI: 10.1002/jcsm.12960] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin-associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3-5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)-what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real-world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step-by-step patient-centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long-term compliance with lipid-lowering therapy.
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Affiliation(s)
- Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Eric Bruckert
- Pitié-Salpetrière Hospital and Sorbonne University, Cardio metabolic Institute, Paris, France
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Matteo Pirro
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinic of Cardiology, University Clinical Centre of Kosova, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Internal Disease, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Erkin Mirrakhimov
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Diseases, Bishkek, Kyrgyzstan
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School, University College London (UCL), London, UK
| | - Alexandros Sachinidis
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Timisoara, Romania.,Clinica de Cardiologie, Institutul de Boli Cardiovasculare Timisoara, Timisoara, Romania
| | - Gustavs Latkovskis
- Pauls Stradins Clinical University Hospital, Riga, Latvia.,University of Latvia, Riga, Latvia
| | - Mohsen Mazidi
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Pella
- 2nd Department of Cardiology of the East Slovak Institute of Cardiovascular Disease and Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
| | - Fahad Alnouri
- Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre Riyadh, Riyadh, Saudi Arabia
| | - Arman Postadzhiyan
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - G B John Mancini
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Maciej Banach
- Polish Moother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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24
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Huff JL, Plante I, Blattnig SR, Norman RB, Little MP, Khera A, Simonsen LC, Patel ZS. Cardiovascular Disease Risk Modeling for Astronauts: Making the Leap From Earth to Space. Front Cardiovasc Med 2022; 9:873597. [PMID: 35665268 PMCID: PMC9161032 DOI: 10.3389/fcvm.2022.873597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
NASA has recently completed several long-duration missions to the International Space Station and is solidifying plans to return to the Moon, with an eye toward Mars and beyond. As NASA pushes the boundaries of human space exploration, the hazards of spaceflight, including space radiation, levy an increasing burden on astronaut health and performance. The cardiovascular system may be especially vulnerable due to the combined impacts of space radiation exposure, lack of gravity, and other spaceflight hazards. On Earth, the risk for cardiovascular disease (CVD) following moderate to high radiation doses is well-established from clinical, environmental, and occupational exposures (largely from gamma- and x-rays). Less is known about CVD risks associated with high-energy charged ions found in space and increasingly used in radiotherapy applications on Earth, making this a critical area of investigation for occupational radiation protection. Assessing CVD risk is complicated by its multifactorial nature, where an individual's risk is strongly influenced by factors such as family history, blood pressure, and lipid profiles. These known risk factors provide the basis for development of a variety of clinical risk prediction models (CPMs) that inform the likelihood of medical outcomes over a defined period. These tools improve clinical decision-making, personalize care, and support primary prevention of CVD. They may also be useful for individualizing risk estimates for CVD following radiation exposure both in the clinic and in space. In this review, we summarize unique aspects of radiation risk assessment for astronauts, and we evaluate the most widely used CVD CPMs for their use in NASA radiation risk assessment applications. We describe a comprehensive dual-use risk assessment framework that supports both clinical care and operational management of space radiation health risks using quantitative metrics. This approach is a first step in using personalized medicine for radiation risk assessment to support safe and productive spaceflight and long-term quality of life for NASA astronauts.
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Affiliation(s)
- Janice L. Huff
- National Aeronautics and Space Administration, Langley Research Center, Hampton, VA, United States
- *Correspondence: Janice L. Huff
| | - Ianik Plante
- KBR, Houston, TX, United States
- National Aeronautics and Space Administration, Johnson Space Center, Houston, TX, United States
| | - Steve R. Blattnig
- National Aeronautics and Space Administration, Langley Research Center, Hampton, VA, United States
| | - Ryan B. Norman
- National Aeronautics and Space Administration, Langley Research Center, Hampton, VA, United States
| | - Mark P. Little
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services (DHHS), Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Amit Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lisa C. Simonsen
- National Aeronautics and Space Administration, NASA Headquarters, Washington, DC, United States
| | - Zarana S. Patel
- KBR, Houston, TX, United States
- National Aeronautics and Space Administration, Johnson Space Center, Houston, TX, United States
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25
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Duvalyan A, Gangwar A, Joshi PH, Khera A, Navar AM, Wu E, Rohatgi A. Abstract 400: Cardiometabolic Profile Of Haptoglobin Genotype In A Multi-Ethnic Diabetes Cohort. Arterioscler Thromb Vasc Biol 2022. [DOI: 10.1161/atvb.42.suppl_1.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background:
Haptoglobin has three common genotypes: Hp 1-1, Hp 2-1, and Hp 2-2. The Hp 2-2 genotype, known to have poorer antioxidizing capacity, is associated with worse cardiovascular outcomes in select patients with diabetes. In this study, we explore the association between various cardiometabolic biomarker profiles and the three Hp genotypes in a multiethnic population.
Methods:
A cross-sectional analysis was performed for all participants with diabetes in the Dallas Heart Study and Multi-Ethnic Study of Atherosclerosis cohorts. Hp genotype was measured in 1,158 participants (399 from DHS and 759 from MESA) using ELISA technique (Savyon Diagnostics, Ltd). Associations between Hp genotype and 26 cardiometabolic circulating and imaging biomarkers were assessed by ANOVA and stratified by ethnicity.
Results:
The study included 51% women, 44% Black (513 of 1,158: Hp 1-1=45%, Hp 2-1=35%, Hp 2-2=20%), 26% Hispanic (300 of 1,158: Hp 1-1=25%, Hp 2-1=49%, Hp 2-2=26%), 20% White (237 of 1,158: Hp 1-1=16%, Hp 2-1=56%, Hp 2-2=28%), and 9.2% Asian/Pacific Islander/East Indian (107 of 1,158: Hp 1-1=15%, Hp 2-1=36%, Hp 2-2=49%) participants. Significant differences were seen in lipid metabolism as well as atherosclerosis, inflammatory, structural, and endothelial markers with no significant differences seen in imaging biomarkers. In White participants, Hp 1-1 was associated with elevated total cholesterol (p=0.016), LDL-p (p=0.001), and LDL-C (p=0.004). In Asian/Pacific Islander/East Indian participants, Hp 2-2 was associated with elevated systolic blood pressure (p=0.029), BMI (p=0.029), and inflammatory markers such as IL-6 (p=0.018) and D-dimer (p=0.027). In Black participants, Hp 2-2 was associated with elevated ICAM (p=0.048) and BMI (p=0.007). Lastly, in Hispanic participants, no significant associations were seen. In exploratory analysis, when comparing Hp 1-1 and Hp 2-1 with Hp 2-2, there was greater magnitude effect size of certain biomarkers in Black and Asian participants, suggesting potential differential effects by ethnicity.
Conclusion:
Associations between Hp genotype and various cardiometabolic biomarkers are varied and ethnicity dependent with further studies needed to investigate the underlying physiologic mechanisms.
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Jasani R, Ahmad Z, Schneider R, Tujardon C, Basit M, Khera A. Applying an LDL-C threshold-based approach to identify individuals with familial hypercholesterolemia. J Clin Lipidol 2022; 16:508-515. [DOI: 10.1016/j.jacl.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/10/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
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Patrikar S, Bhatti V, Suryam V, Kotwal A, Basannar D, Khera A, Kashyap S, Sharma A. Health technology assessment of varicella vaccine in the Armed Forces. Med J Armed Forces India 2022; 78:213-220. [PMID: 35463553 PMCID: PMC9023555 DOI: 10.1016/j.mjafi.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Indian Armed Forces, on entry, vaccinates all cadets and recruits with varicella vaccine for the prevention of varicella. This health technology assessment (HTA) report puts forth evidence for HTA of varicella vaccination in the Armed Forces in various domains namely clinical, societal, ethical, economic, and legal. Methods The policy question under each domain has been developed according to best-practice methods for HTA. The costs included were hospitalization cost due to varicella infection; training lost cost; the varicella vaccine cost; cost of the side effects of vaccine; and the outbreak investigation cost. The incremental cost-effectiveness ratio (ICER) for varicella cases averted and man-days saved, and quality-adjusted life years (QALYs) gained due to varicella vaccination strategy were calculated. Results Evidence suggests a reduction of 81% in hospitalization rates with 19392 man-days saved per 1 lakh population due to varicella vaccination strategy. The ICER for varicella cases averted is estimated to be Rs 56732/- per case averted and Rs 5687/- per man-day saved. QALYs gained due to two-dose varicella vaccination strategy is estimated to be 1152 per 1 lakh population with cost per QALY gained Rs 95735/-. Conclusion The study showed a large reduction in hospitalizations and consequently man-days lost after the introduction of the vaccination strategy. The QALYs was another aspect of importance brought out by this study. Thus, a two-dose vaccination strategy for varicella-zoster virus (VZV) for the Armed Forces trainees is a cost-effective policy.
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Affiliation(s)
- Seema Patrikar
- Senior Lecturer in Statistics, Department of Community Medicine, Armed Forces Medical College, Pune, India
- Corresponding author.
| | - V.K. Bhatti
- Brig Medical, HQ 17 Corps, C/o 99 APO, India
| | - Vani Suryam
- Col Medical (Health), O/o DGMS (Army), AG's Branch, IHQ of MoD, New Delhi, India
| | - A. Kotwal
- Executive Director, NHSRC, New Delhi, India
| | - D.R. Basannar
- Scientist 'F', Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - A. Khera
- Senior Advisor (Community Medicine) & Col Health, HQ Delhi Area, Delhi, India
| | - Surekha Kashyap
- Regional Director, Academy of Hospital Administration (WRC), India
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Rosner CM, Atkins M, Saeed IM, de Lemos JA, Khera A, Maghsoudi A, Min J, Tehrani BN, O’Connor CM, deFilippi CR. Patients With Myocarditis Associated With COVID-19 Vaccination. J Am Coll Cardiol 2022; 79:1317-1319. [PMID: 35361355 PMCID: PMC8958986 DOI: 10.1016/j.jacc.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 12/25/2022]
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Mehta A, Vasquez N, Ayers CR, Patel J, Hooda A, Khera A, Blumenthal RS, Shapiro MD, Rodriguez CJ, Tsai MY, Sperling LS, Virani SS, Blaha MJ, Joshi PH. Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk. J Am Coll Cardiol 2022; 79:757-768. [PMID: 35210030 PMCID: PMC10966924 DOI: 10.1016/j.jacc.2021.11.058] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. OBJECTIVES This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. METHODS Plasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor-adjusted Cox regression models. RESULTS Among MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. CONCLUSIONS Lp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nestor Vasquez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaideep Patel
- Virginia Commonwealth University Pauley Heart Center, Richmond, Virginia, USA
| | - Ananya Hooda
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Michael D Shapiro
- Section of Cardiology, Department of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Carlos J Rodriguez
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Salim S Virani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Mauricio R, Singh K, Sanghavi M, Ayers CR, Rohatgi A, Vongpatanasin W, de Lemos JA, Khera A. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is associated with subclinical and clinical ASCVD: The Dallas Heart Study. Atherosclerosis 2022; 346:46-52. [DOI: 10.1016/j.atherosclerosis.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 11/02/2022]
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Affiliation(s)
- Rina Mauricio
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Affiliation(s)
- Corey K Bradley
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Amit Khera
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ann Marie Navar
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Cainzos-Achirica M, Quispe R, Dudum R, Greenland P, Lloyd-Jones D, Rana JS, Lima JAC, Doria de Vasconcellos H, Joshi PH, Khera A, Ayers C, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Toth PP, Patel KV, Blaha MJ, Bittencourt M, Nasir K. CAC for Risk Stratification Among Individuals With Hypertriglyceridemia Free of Clinical Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging 2021; 15:641-651. [PMID: 34922873 DOI: 10.1016/j.jcmg.2021.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In this study, we sought to evaluate whether the coronary artery calcium (CAC) score can enhance current paradigms for risk stratification among individuals with hypertriglyceridemia in primary prevention. The eligibility criteria for icosapent ethyl (IPE) were used as case example. BACKGROUND Recent trials of atherosclerotic cardiovascular disease (ASCVD) risk-reduction therapies for individuals with hypertriglyceridemia without clinical ASCVD restricted enrollment to participants with diabetes or various other risk factors. These criteria were mirrored in the Food and Drug Administration product label for IPE. METHODS We pooled 2,345 participants with triglycerides 150 to <500 mg/dL (or >178-<500 mg/dL if not on a statin) and without clinical ASCVD from MESA, CARDIA, the Dallas Heart Study, and the Heinz Nixdorf Recall study. We evaluated the incidence of ASCVD events overall, by IPE eligibility (as defined in the product label), and further stratified by CAC scores (0, >0-100, >100). The number needed to treat for 5 years (NNT5) to prevent 1 event was estimated among IPE-eligible participants, assuming a 21.8% relative risk reduction with IPE. In exploratory analyses, the NNT5 was also estimated among noneligible participants. RESULTS There was marked heterogeneity in CAC burden overall (45% CAC 0; 24% CAC >100) and across IPE eligibility strata. Overall, 17% of participants were eligible for IPE and 11.9% had ASCVD events within 5 years. Among participants eligible for IPE, 38% had CAC >100, and their event rates were markedly higher (15.9% vs 7.2%) and the NNT5 2.2-fold lower (29 vs 64) than those of the 25% eligible participants with CAC 0. Among the 83% participants not eligible for IPE, 20% had CAC >100, and their 5-year incidence of ASCVD (13.9%) was higher than the overall incidence among IPE-eligible participants. CONCLUSIONS CAC can improve current risk stratification and therapy allocation paradigms among individuals with hypertriglyceridemia without clinical ASCVD. Future trials of risk-reduction therapies in hypertriglyceridemia could use CAC >100 to enroll a high-risk study sample, with implications for a larger target population.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Center for Outcomes Research, Houston Methodist, Houston, Texas, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Renato Quispe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine, Stanford, California, USA
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald Lloyd-Jones
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jamal S Rana
- Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Parag H Joshi
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Khera
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Colby Ayers
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Sara Schramm
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; CGH Medical Center, Sterling, Illinois, USA; University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marcio Bittencourt
- Center for Clinical and Epidemiologic Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Center for Outcomes Research, Houston Methodist, Houston, Texas, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Thamman R, Eshtehardi P, Narang A, Lundberg G, Khera A. Roles and Impact of Journal's Social Media Editors. Circ Cardiovasc Qual Outcomes 2021; 14:e007443. [PMID: 34749514 DOI: 10.1161/circoutcomes.120.007443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ritu Thamman
- University of Pittsburgh School of Medicine, PA (R.T.)
| | - Parham Eshtehardi
- Northside Heart and Vascular Institute, Northside Hospital, Atlanta, GA (P.E.)
| | - Akhil Narang
- Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA (A.N.)
| | - Gina Lundberg
- Northwestern University Feinberg School of Medicine, Chicago, IL (G.L.)
| | - Amit Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.K.)
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35
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McEvoy JW, Ziaeian B, Joseph Y, Williams KA, Virani SS, Sidney C. Smith SCS, Daniel M, Miedema MD, Michos ED, Arnett DK, Lloyd-Jones D, Khera A, Hahn EJ, Goldberger ZD, Himmelfarb CD, Buroker AB, Albert MA, Blumenthal RS. Рекомендации - 2019 Американского колледжа кардиологии (АСС) / Американской ассоциации сердца (АНА) по первичной профилактике сердечно-сосудистых заболеваний. Hypertension 2021. [DOI: 10.22141/2224-1485.2.64.2019.168753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
No abstract
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36
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Muthukumar A, Narasimhan M, Li QZ, Mahimainathan L, Hitto I, Fuda F, Batra K, Jiang X, Zhu C, Schoggins J, Cutrell JB, Croft CL, Khera A, Drazner MH, Grodin JL, Greenberg BM, Mammen PP, Morrison SJ, de Lemos JA. In-Depth Evaluation of a Case of Presumed Myocarditis After the Second Dose of COVID-19 mRNA Vaccine. Circulation 2021; 144:487-498. [PMID: 34133883 PMCID: PMC8340727 DOI: 10.1161/circulationaha.121.056038] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Alagarraju Muthukumar
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Madhusudhanan Narasimhan
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Quan-Zhen Li
- Department of Immunology (Q.-Z.L.), University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Lenin Mahimainathan
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Imran Hitto
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Franklin Fuda
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Kiran Batra
- Department of Radiology (K.B.), University of Texas Southwestern Medical Center, Dallas
| | - Xuan Jiang
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Chengsong Zhu
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - John Schoggins
- Department of Microbiology (J.S.), University of Texas Southwestern Medical Center, Dallas
| | - James B. Cutrell
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Carol L. Croft
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Mark H. Drazner
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Justin L. Grodin
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Benjamin M. Greenberg
- Department of Neurology and Neurotherapeutics (B.M.G.), University of Texas Southwestern Medical Center, Dallas
- Department of Pediatrics (B.M.G.), University of Texas Southwestern Medical Center, Dallas
| | - Pradeep P.A. Mammen
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Sean J. Morrison
- Howard Hughes Medical Institute (S.J.M.), University of Texas Southwestern Medical Center, Dallas
- Children’s Medical Center Research Institute (S.J.M.), University of Texas Southwestern Medical Center, Dallas
| | - James A. de Lemos
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
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Patel P, Dhindsa D, Eapen DJ, Khera A, Gulati M, Stone NJ, Yancy CW, Rumsfeld JS, Sperling LS. Optimizing the Potential for Telehealth in Cardiovascular Care (in the Era of COVID-19): Time Will Tell. Am J Med 2021; 134:945-951. [PMID: 33845033 PMCID: PMC8553403 DOI: 10.1016/j.amjmed.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022]
Abstract
Before the coronavirus disease 2019 (COVID-19) pandemic, use of telehealth services had been limited in cardiovascular care. Potential benefits of telehealth include improved access to care, more efficient care management, reduced costs, the ability to assess patients within their homes while involving key caretakers in medical decisions, maintaining social distance, and increased patient satisfaction. Challenges include changes in payment models, issues with data security and privacy, potential depersonalization of the patient-clinician relationship, limitations in the use of digital health technologies, and the potential impact on disparities, including socioeconomic, gender, and age-related issues and access to technology and broadband. Implementation and expansion of telehealth from a policy and reimbursement practice standpoint are filled with difficult decisions, yet addressing these are critical to the future of health care.
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Affiliation(s)
- Parth Patel
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Devinder Dhindsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga
| | - Danny J Eapen
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix
| | - Neil J Stone
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Ill
| | - John S Rumsfeld
- American College of Cardiology, Washington DC; University of Colorado School of Medicine, Aurora
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.
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Ajufo E, Rao S, Navar AM, Pandey A, Ayers CR, Khera A. Corrigendum to U.S. Population at Increased Risk of Severe Illness from COVID-19. Am J Prev Cardiol 2021; 6:100195. [PMID: 34131652 PMCID: PMC8192061 DOI: 10.1016/j.ajpc.2021.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.ajpc.2021.100156.].
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Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX
| | - Shreya Rao
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
| | - Ann Marie Navar
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX.,Department of Clinical Sciences, UT Southwestern Medical Center; Dallas, TX
| | - Ambarish Pandey
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
| | - Colby R Ayers
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
| | - Amit Khera
- Department of Internal Medicine, UT Southwestern Medical Center; Dallas, TX.,Division of Cardiology, UT Southwestern Medical Center; Dallas, TX
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Rosner CM, Genovese L, Tehrani BN, Atkins M, Bakhshi H, Chaudhri S, Damluji AA, de Lemos JA, Desai SS, Emaminia A, Flanagan MC, Khera A, Maghsoudi A, Mekonnen G, Muthukumar A, Saeed IM, Sherwood MW, Sinha SS, O'Connor CM, deFilippi CR. Myocarditis Temporally Associated With COVID-19 Vaccination. Circulation 2021; 144:502-505. [PMID: 34133885 PMCID: PMC8340723 DOI: 10.1161/circulationaha.121.055891] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Carolyn M Rosner
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Leonard Genovese
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Behnam N Tehrani
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Melany Atkins
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Fairfax Radiology Centers, VA (M.A.)
| | - Hooman Bakhshi
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Saquib Chaudhri
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Abdulla A Damluji
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - James A de Lemos
- Departments of Internal Medicine and Pathology, University of Texas Southwestern Medical Center, Dallas, TX (J.A.d.L., A.K., A. Muthukumar)
| | - Shashank S Desai
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Abbas Emaminia
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Michael Casey Flanagan
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Amit Khera
- Departments of Internal Medicine and Pathology, University of Texas Southwestern Medical Center, Dallas, TX (J.A.d.L., A.K., A. Muthukumar)
| | - Alireza Maghsoudi
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Virginia Heart, Falls Church, VA (I.M.S., A. Maghsoudi)
| | - Girum Mekonnen
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Alagarraju Muthukumar
- Departments of Internal Medicine and Pathology, University of Texas Southwestern Medical Center, Dallas, TX (J.A.d.L., A.K., A. Muthukumar)
| | - Ibrahim M Saeed
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Virginia Heart, Falls Church, VA (I.M.S., A. Maghsoudi)
| | - Matthew W Sherwood
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Shashank S Sinha
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Christopher M O'Connor
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Division of Cardiology, Duke University, Durham, NC (C.M.O'C.)
| | - Christopher R deFilippi
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
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Bays HE, Khera A, Blaha MJ, Budoff MJ, Toth PP. Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging"). Am J Prev Cardiol 2021; 6:100176. [PMID: 34327499 PMCID: PMC8315431 DOI: 10.1016/j.ajpc.2021.100176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published "Ten Things to Know About Ten Cardiovascular Disease Risk Factors." Similarly, this "ASPC Top Ten Imaging" summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk - both important in preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville KY 40213 USA
| | - Amit Khera
- UT Southwestern Medical Center, Dallas, TX USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore MD USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA USA
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081 USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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41
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McGowan MP, Cuchel M, Ahmed CD, Khera A, Weintraub WS, Wilemon KA, Ahmad Z. A proof-of-concept study of cascade screening for Familial Hypercholesterolemia in the US, adapted from the Dutch model. Am J Prev Cardiol 2021; 6:100170. [PMID: 34327496 PMCID: PMC8315349 DOI: 10.1016/j.ajpc.2021.100170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Dutch cascade screening model for FH was the most successful of such programs in the world. It remains unclear whether aspects of the Dutch model (i.e. direct engagement with FH probands and relatives outside usual healthcare settings) are feasible in the US. This is especially important since prior attempts at cascade screening in the US have had very low screening rates (<10% of families screened). METHODS We conducted a multi-site single-arm proof-of-concept study in which the US-based FH Foundation (a 501c3 research and advocacy organization) directly engaged with FH probands and relatives similar to the approach taken by the Dutch "Foundation for Tracing FH." RESULTS Eleven unrelated probands with genetically confirmed FH were enrolled. Mean age was 43 years; 82% were women, and 82% were of European ancestry. Prior to enrolling into the study, only 2 families (18% screening rate) were screened for FH with both lipid measurements and genetic testing. Two probands declined cascade screening due to fear over genetic discrimination. Nine total relatives engaged with the FH Foundation. Mean age was 43 years and 44% were women. Seven of those relatives (from 6 families; 55% screening rate) consented to be screened for FH with lipid measurement and genetic testing. The two additional relatives - men ages 39 and 49 - agreed to lipid measurements but not genetic testing, each noting he would like to think more about genetic testing. CONCLUSIONS Our proof-of-concept study demonstrates the feasibility of the FH Foundation engaging FH probands and their relatives outside the usual healthcare settings for cascade screening, similar to the Dutch model. We found only 18% of families had already been screened, and after engaging with the FH Foundation, 55% of families were willing to participate in cascade screening. These findings suggest the methods described here may improve cascade screening rates in the US.
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Affiliation(s)
- Mary P. McGowan
- The FH Foundation, Winter Park, FL, United States, Division of Cardiology, Department of Medicine Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Marina Cuchel
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - William S. Weintraub
- MedStar Washington Hospital Center, Department of Medicine, Georgetown University, United States
| | | | - Zahid Ahmad
- Division of Nutrition and Metabolic Disease, Department of Internal Medicine, UT Southwestern Medical Center, 5232 Harry Hines Blvd, MC 8537, Dallas, TX 75390, United States
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Abohashem S, Osborne M, Abbasi T, Zureigat H, Dar T, Ghoneem A, Etiwy M, Aragam K, Elmariah S, Khera A, Tawakol A. POLYGENIC RISK SCORE FOR CORONARY ARTERY DISEASE ASSOCIATES WITH INCIDENCE OF CALCIFIC AORTIC STENOSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ustunkaya T, Ajufo E, Ayers C, Mauricio R, Rohatgi A, Joshi P, Khera A. USING READILY AVAILABLE CLINICAL INFORMATION TO IDENTIFY INDIVIDUALS WITH HIGH LIPOPROTEIN A LEVELS: THE DALLAS HEART STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02917-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Flores Rosario K, Mehta A, Ayers C, Engel Gonzalez P, Pandey A, Khera R, Kaplan R, Blaha MJ, Khera A, Blumenthal RS, Nasir K, Rodriguez CJ, Joshi PH. Performance of the Pooled Cohort Equations in Hispanic Individuals Across the United States: Insights From the Multi-Ethnic Study of Atherosclerosis and the Dallas Heart Study. J Am Heart Assoc 2021; 10:e018410. [PMID: 33870702 PMCID: PMC8200750 DOI: 10.1161/jaha.120.018410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karen Flores Rosario
- Division of Cardiology Department of Medicine Duke University Hospital Durham NC
| | - Anurag Mehta
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Colby Ayers
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Pedro Engel Gonzalez
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Rohan Khera
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Robert Kaplan
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY.,Division of Public Health Sciences Fred Hutchinson Cancer Research Center Seattle WA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Amit Khera
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Khurram Nasir
- Department of Cardiology Debakey Heart & Vascular Center Houston Methodist Hospital Houston TX
| | - Carlos J Rodriguez
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY.,Division of Cardiology Montefiore Medical Center Bronx NY
| | - Parag H Joshi
- Division of Cardiology Department of Medicine University of Texas Southwestern Dallas TX
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Ekram S, Arunkumar KV, Mowar A, Khera A. Evaluation of stability and esthetic outcome following rigid fixation of a new sagittal genioplasty technique - A clinical study. Natl J Maxillofac Surg 2021; 12:17-24. [PMID: 34188396 PMCID: PMC8191550 DOI: 10.4103/njms.njms_76_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/18/2020] [Accepted: 09/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background Routine and popular conventional genioplasty procedure is often curvilinear, requires lower border extension below, and behind the mental foramen, which after advancement has a tendency to produce step deformity, butt contact, hence nonunion, instability, and increased relapse tendencies. The present technique is aimed to study the new sagittal genioplasty technique and its efficacy to overcome the above-mentioned drawbacks of conventional genioplasty. This technique also aids in correcting mild-to-moderate breathing irregularities. Materials and Methods A total of 10 patients included in this study. The comparative analysis of the displacement of the chin in vertical and horizontal directions following surgery was evaluated by measuring the difference between preoperative, immediate postoperative, 3 and 6 months postoperative on lateral cephalometric radiographs. Results The study of new sagittal chin advancement results showed an advantage over conventional technique in terms of esthetics outcome (no jowl), easy to perform without damaging the mental nerve, superior healing with less relapse, and better surface area contact. Conclusion In this study, the new technique of sagittal genioplasty overcomes the disadvantages of conventional genioplasty. However, this technique is best suited for patients who require straight or moderately vertical augmentation advancement genioplasty and is not suitable for asymmetry corrections, i.e., centering genioplasty and double sliding genioplasty.
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Affiliation(s)
- Subia Ekram
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - K V Arunkumar
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Apoorva Mowar
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Amit Khera
- Department of Orthodontic and Dentofacial Orthopedics, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
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Ajufo E, Rao S, Navar AM, Pandey A, Ayers CR, Khera A. U.S. population at increased risk of severe illness from COVID-19. Am J Prev Cardiol 2021; 6:100156. [PMID: 33615285 PMCID: PMC7880833 DOI: 10.1016/j.ajpc.2021.100156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background The U.S. Centers for Disease Control and Prevention (CDC) recognizes that older adults and individuals with certain medical conditions are at increased risk of severe COVID-19 infection. Understanding the proportion of the population at risk of severe infection, including among those with heart disease, could assist current vaccine strategy efforts. Methods Using data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), we estimated the weighted prevalence of any of eight of eleven increased-risk conditions (including age ≥65) in U.S. adults aged ≥18 (N = 10,581) and extrapolated these results to a population of 233.8 million U.S. adults ≥18, and subgroups from the overall population defined by race/ethnicity, education, income and history of heart disease. Results An estimated 176.1 million individuals representing 75.4% of U.S. adults had at least one increased-risk condition, 40.3% ≥2 and, 18.5% ≥3 conditions. Approximately 129 million adults aged <65 (69.2%) were also estimated to be at increased-risk. Compared to Whites, similar proportions of Blacks in the overall population (78.0 vs. 75.6%, p>0.05) and Hispanics in the younger population (70.8 vs 68.4%) were estimated to be at increased-risk. Conversely, a greater proportion of individuals with lower education and income levels were estimated to be at increased-risk both in the overall and younger population. In addition, an estimated 6.2 million individuals (14.5%) had heart disease. Among these, virtually all had at least one additional CDC risk factor (97.9%) and most had ≥2 or ≥3 risk factors (83.8% and 58.5%, respectively). Conclusions As vaccination strategies are being explored, these results demonstrate that >75% of adults in the U.S. would be considered at increased-risk for severe COVID-19 infection by CDC criteria. Risk factor prevalence alone may not adequately capture the totality of risk, particularly among Black and Hispanic racial/ethnic groups and those with heart disease.
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Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Shreya Rao
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ann Marie Navar
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Colby R Ayers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Amit Khera
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
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Cainzos-Achirica M, Patel KV, Quispe R, Joshi PH, Khera A, Ayers C, Lima JAC, Rana JS, Greenland P, Bittencourt MS, Cardoso R, Blankstein R, Blumenthal RS, Blaha MJ, Nasir K. Coronary Artery Calcium for the Allocation of GLP-1RA for Primary Prevention of Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging 2021; 14:1470-1472. [PMID: 33582063 DOI: 10.1016/j.jcmg.2020.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
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Ajufo E, Ayers CR, Vigen R, Joshi PH, Rohatgi A, de Lemos JA, Khera A. Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease. JAMA Cardiol 2021; 6:179-187. [PMID: 33112372 DOI: 10.1001/jamacardio.2020.4939] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance Higher coronary artery calcium (CAC) identifies individuals at increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether it can also identify individuals likely to derive net benefit from aspirin therapy is unclear. Objective To examine the association between CAC, bleeding, and ASCVD and explore the net estimated effect of aspirin at different CAC thresholds. Design, Setting, and Participants Prospective population-based cohort study of Dallas Heart Study participants, free from ASCVD and not taking aspirin at baseline. Data were analyzed between February 1, 2020, and July 15, 2020. Exposures Coronary artery calcium score in the following categories: 0, 1-99, and 100 or higher. Main Outcomes and Measures Major bleeding and ASCVD events were identified from International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. Meta-analysis-derived aspirin effect estimates were applied to observed ASCVD and bleeding rates to model the net effect of aspirin at different CAC thresholds. Results A total of 2191 participants (mean [SD], age 44 [9.1] years, 1247 women [57%], and 1039 black individuals [47%]) had 116 major bleeding and 123 ASCVD events over a median follow-up of 12.2 years. Higher CAC categories (CAC 1-99 and ≥100 vs CAC 0) were associated with both ASCVD and bleeding events (hazard ratio [HR], 1.6; 95% CI, 1.1-2.4; HR, 2.6; 95% CI, 1.5-4.3; HR, 4.8; 95% CI, 2.8-8.2; P < .001; HR, 5.3; 95% CI, 3.6-7.9; P < .001), but the association between CAC and bleeding was attenuated after multivariable adjustment. Applying meta-analysis estimates, irrespective of CAC, aspirin use was estimated to result in net harm in individuals at low (<5%) and intermediate (5%-20%) 10-year ASCVD risk and net benefit in those at high (≥20%) ASCVD risk. Among individuals at lower bleeding risk, a CAC score of at least 100 identified individuals who would experience net benefit, but only in those at borderline or higher (≥5%) 10-year ASCVD risk. In individuals at higher bleeding risk, there would be net harm from aspirin irrespective of CAC and ASCVD risk. Conclusions and Relevance Higher CAC is associated with both ASCVD and bleeding events, with a stronger association with ASCVD. A high CAC score identifies individuals estimated to derive net benefit from primary prevention aspirin therapy from those who would not, but only in the setting of lower bleeding risk and estimated ASCVD risk that is not low.
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Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Rebecca Vigen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Parag H Joshi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Anand Rohatgi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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Segar MW, Rao S, Navar AM, Michos ED, Lewis A, Correa A, Sims M, Khera A, Hughes AE, Pandey A. County-level phenomapping to identify disparities in cardiovascular outcomes: An unsupervised clustering analysis: Short title: Unsupervised clustering of counties and risk of cardiovascular mortality. Am J Prev Cardiol 2020; 4:100118. [PMID: 34327478 PMCID: PMC8315381 DOI: 10.1016/j.ajpc.2020.100118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Significant heterogeneity in cardiovascular disease (CVD) risk and healthcare resource allocation has been demonstrated in the United States, but optimal methods to capture heterogeneity in county-level characteristics that contribute to CVD mortality differences are unclear. We evaluated the feasibility of unsupervised machine learning (ML)-based phenomapping in identifying subgroups of county-level social and demographic risk factors with differential CVD outcomes. METHODS We performed a cross-sectional study using county-level data from 2008 to 2018 from the Centers for Disease Control (CDC) WONDER platform and the 2020 Robert Wood Johnson County Health Rankings program. Unsupervised clustering was performed on 46 facets of population characteristics spanning the demographic, health behaviors, socioeconomic, and healthcare access domains. Spatial autocorrelation was assessed using the Moran's I test, and temporal trends in age-adjusted CVD outcomes were evaluated using linear mixed effect models and least square means. RESULTS Among 2676 counties, 4 county-level phenogroups were identified (Moran's I p-value <0.001). Phenogroup 1 (N = 924; 24.5%) counties were largely white, suburban households with high income and access to healthcare. Phenogroup 2 counties (N = 451; 16.9%) included predominantly Hispanic residents and below-average prevalence of CVD risk factors. Phenogroup 3 (N = 951; 35.5%) counties included rural, white residents with the lowest levels of access to healthcare. Phenogroup 4 (350; 13.1%) comprised counties with predominantly Black residents, substantial cardiovascular comorbidities, and physical and socioeconomic burdens. Least square means in age-adjusted cardiovascular mortality over time increased in a stepwise fashion from 223 in phenogroup 1 to 317 per 100,000 residents in phenogroup 4. CONCLUSIONS Unsupervised ML-based clustering on county-level population characteristics can identify unique phenogroups with differential risk of CVD mortality. Phenogroup identification may aid in developing a uniform set of preventive initiatives for clustered counties to address regional differences in CVD mortality.
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Affiliation(s)
- Matthew W. Segar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shreya Rao
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alana Lewis
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amy E. Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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50
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Al Rifai M, Shapiro MD, Sayani S, Gulati M, Levine G, Rodriguez F, Mahtta D, Khera A, Petersen LA, Virani SS. Racial and Geographic Disparities in Internet Use in the United States Among Patients with Atherosclerotic Cardiovascular Disease. Am J Cardiol 2020; 134:146-147. [PMID: 32892994 PMCID: PMC7418766 DOI: 10.1016/j.amjcard.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, Arizona
| | - Glenn Levine
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Research Institute, Stanford University, Stanford, California
| | - Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amit Khera
- Division of Cardiology, University of Texas, Southwestern School of Medicine, Dallas, Texas
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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