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Haring B, Andrews CA, Hovey K, Shadyab AH, LaCroix A, Martin LW, Rosal MC, Kuller LH, Salmoirago-Blotcher E, Saquib N, Koo P, Laddu D, Stefanick ML, Manson JE, Wassertheil-Smoller S, LaMonte MJ. Systolic Blood Pressure and Survival to Very Old Age: Results From the Women's Health Initiative. Circulation 2024. [PMID: 38623761 DOI: 10.1161/circulationaha.123.067302] [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: 10/01/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The relationship between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine which SBP levels in women ≥65 years of age with or without blood pressure medication were associated with the highest probability of surviving to 90 years of age. METHODS The study population consisted of 16570 participants enrolled in the Women's Health Initiative who were eligible to survive to 90 years of age by February 28, 2020, without a history of cardiovascular disease, diabetes, or cancer. Blood pressure was measured at baseline (1993 through 1998) and then annually through 2005. The outcome was defined as survival to 90 years of age with follow-up. Absolute probabilities of surviving to 90 years of age were estimated for all combinations of SBP and age using generalized additive logistic regression modeling. The SBP that maximized survival was estimated for each age, and a 95% CI was generated. RESULTS During a median follow-up of 19.8 years, 9723 of 16 570 women (59%) survived to 90 years of age. Women with an SBP between 110 and 130 mm Hg at attained ages of 65, 70, 75, and 80 years had a 38% (95% CI, 34%-48%), 54% (52%-56%), 66% (64%-67%), or 75% (73%-78%) absolute probability to survive to 90 years of age, respectively. The probability of surviving to 90 years of age was lower for greater SBP levels. Women at the attained age of 80 years with 0%, 20%, 40%, 60%, 80%, or 100% time in therapeutic range (defined as an SBP between 110 and 130 mm Hg) had a 66% (64%-69%), 68% (67%-70%), 71% (69%-72%), 73% (71%-74%), 75% (72%-77%), or 77% (74%-79%) absolute survival probability to 90 years of age. CONCLUSIONS For women >65 years of age with low cardiovascular disease and other chronic disease risk, an SBP level <130 mm Hg was found to be associated with longevity. These findings reinforce current guidelines targeting an SBP target <130 mm Hg in older women.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Germany (B.H.)
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (B.H., S.W.-S.)
| | - Chris A Andrews
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.)
| | - Kathleen Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.)
| | - Aladdin H Shadyab
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California, San Diego, La Jolla. (A.H.S.)
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla. (A.H.S., A.L.)
| | - Andrea LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla. (A.H.S., A.L.)
| | - Lisa Warsinger Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.)
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.C.R.)
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, PA (L.H.K.)
| | | | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia (N.S.)
| | - Patrick Koo
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baroness Erlanger Hospital, University of Tennessee College of Medicine Chattanooga (P.K.)
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (D.L.)
| | - Marcia L Stefanick
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA (M.L.S.)
- Departments of Obstetrics and Gynecology, Stanford University, Palo Alto, CA (M.L.S.)
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (B.H., S.W.-S.)
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.)
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Thai NQN, LaCroix AZ, Haring B, Wactawski-Wende J, Manson JE, Posis AIB, Shadyab AH. The association of leukocyte telomere length with exceptional longevity among older women. GeroScience 2024; 46:2083-2092. [PMID: 37843740 PMCID: PMC10828273 DOI: 10.1007/s11357-023-00964-6] [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] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023] Open
Abstract
The association of leukocyte telomere length (LTL) with survival to late life with intact mobility has not been adequately studied. This prospective cohort study consisted of 1451 postmenopausal women from a Women's Health Initiative ancillary study, who were eligible, because of birth year, to survive to age 90 as of March 6, 2021. LTL was measured by Southern blot at baseline (1993-1998). Associations between LTL and survival to age 90 were evaluated using logistic regression models adjusted for socio-demographic characteristics, health factors, and lifestyle factors. Multinominal logistic regression was utilized to examine associations of LTL with survival to age 90 with or without intact mobility. Mediation analysis examined the extent to which incident coronary heart disease and stroke-mediated the association between LTL and longevity. Overall, 76.7% of women were White, and 23.3% were Black; average age at baseline was 70.4±3.5 years. Relative to death before age 90, the odds of survival to age 90 were 60% higher (OR, 1.60; 95% CI, 1.28-2.01), the odds of survival to age 90 with mobility limitation were 72% higher (OR, 1.72; 95% CI, 1.33-2.21), and the odds of survival to age 90 with intact mobility were 44% higher (OR, 1.44; 95% CI, 1.06-1.95) for every one kilobase longer LTL. Absence of CHD, stroke, or CHD/stroke mediated the association of LTL with survival to age 90 by 11.1%, 37.4%, and 31.3%, respectively; however, these findings were not significant. Longer LTL was associated with higher odds of survival to age 90 among older women.
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Affiliation(s)
- Nhat Quang N Thai
- UCSD-SDSU Joint-Doctoral Program in Public Health (Epidemiology), University of California, San Diego, La Jolla, CA, USA.
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Bernhard Haring
- Division of Cardiology, University Heart Center, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo - SUNY, Buffalo, NY, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, BA, Boston, MA, USA
| | - Alexander Ivan B Posis
- UCSD-SDSU Joint-Doctoral Program in Public Health (Epidemiology), University of California, San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
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Markwirth P, Haring B. Age- and sex-specific physiological cardiac remodeling: the search for the Fountain of Youth. Clin Res Cardiol 2024:10.1007/s00392-024-02431-4. [PMID: 38498196 DOI: 10.1007/s00392-024-02431-4] [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] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
Graphical Abstract
Figure: Concepts of cardiac aging. Abbreviations: E/e’, transmitral early velocity to early diastolic mitral annular velocity; EF, ejection fraction; LV, left ventricular; LVEDD, left ventricular end-diastolic diameter; M/V left, ventricular mass to volume ratio.
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Affiliation(s)
- Philipp Markwirth
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
| | - Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany.
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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4
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Dalal PJ, Giro P, Rasmussen-Torvik LJ, Yancy CW, Shah SJ, Reiner AP, Haring B, Martin LW, Wells GL, Manson JE, Kooperberg C, Eaton CB, Patel RB. Heart Failure Risk Among African-American Women With an ICAM1 Missense Variant. JACC Heart Fail 2024:S2213-1779(24)00145-8. [PMID: 38530700 DOI: 10.1016/j.jchf.2024.02.002] [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] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND A common genetic variant of ICAM1 among African-American individuals (rs5491; p.K56M) is associated with heart failure (HF) hospitalization, but whether this risk is specific to heart failure with preserved ejection fraction (HFpEF) remains unclear. Older women are at high risk for HFpEF, and the relationship between rs5491 and HFpEF across the age spectrum is unknown. OBJECTIVES This study assessed risk of HF and its subtypes conferred by ICAM1 p.K56M (rs5491). METHODS Associations of rs5491 with risk of HF and its subtypes were estimated among African American individuals in WHI (Women's Health Initiative). The study evaluated whether the association between rs5491 and HF hospitalizations was modified by baseline age. Subsequently, African-American women in WHI and MESA (Multi-Ethnic Study of Atherosclerosis) were pooled and analyses were repeated. RESULTS Among 8,401 women in WHI, the minor allele frequency of rs5491 was 20.7%, and 731 HF hospitalizations occurred over 19.2 years. The rs5491 variant was not associated with HF or its subtypes across WHI. Interaction analyses suggested that age as a continuous variable modified the association of rs5491 with HFpEF hospitalization (interaction P = 0.04). Upon categorizing women into age decades, rs5491 conferred increased risk of HFpEF among women ≥70 years (HR per additional rs5491 allele: 1.82 [95% CI: 1.25-2.65]; P = 0.002) but was not associated with HFpEF risk among women <70 years. Pooling African-American women in WHI (n = 8,401) and MESA (n = 856) demonstrated that the effect modification by age on the association of rs5491 with HFpEF became more significant (interaction P = 0.009), with consistent HFpEF risk effect estimates among women ≥70 years. CONCLUSIONS ICAM1 p.K56M (rs5491) is associated with HFpEF among African-American women ≥70 years.
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Affiliation(s)
- Prarthana J Dalal
- Division of Hematology and Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Pedro Giro
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lisa Warsinger Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Gretchen L Wells
- Division of Cardiology, University of Alabama Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Department of Family Medicine, Department of Epidemiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ravi B Patel
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Gomez SE, Larson J, Hlatky MA, Rodriguez F, Wheeler M, Greenland P, LaMonte M, Froelicher V, Stefanick ML, Wallace R, Kooperberg C, Tinker LF, Schoenberg J, Soliman EZ, Vitolins MZ, Saquib N, Nuño T, Haring B, Perez MV. Prevalence of frequent premature ventricular contractions and nonsustained ventricular tachycardia in older women screened for atrial fibrillation in the Women's Health Initiative. Heart Rhythm 2024:S1547-5271(24)00212-1. [PMID: 38403238 DOI: 10.1016/j.hrthm.2024.02.040] [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: 11/06/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Frequent premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) have been associated with cardiovascular disease and mortality. Their prevalence, especially in ambulatory populations, is understudied and limited by few female participants and the use of short-duration (24- to 48-hour) monitoring. OBJECTIVE The objective of this study was to report the prevalence of frequent PVCs and NSVT in a community-based population of women likely to undergo electrocardiogram (ECG) screening by sequential patch monitoring. METHODS Participants from the Women's Health Initiative Strong and Healthy (WHISH) trial with no history of atrial fibrillation (AF) but 5-year predicted risk of incident AF ≥5% by CHARGE-AF score were randomly selected to undergo screening with 7-day ECG patch monitors at baseline, 6 months, and 12 months. Recordings were reviewed for PVCs and NSVT (>5 beats); data were analyzed with multivariate regression models. RESULTS There were 1067 participants who underwent ECG screening at baseline, 866 at 6 months, and 777 at 12 months. Frequent PVCs were found on at least 1 patch from 4.3% of participants, and 1 or more episodes of NSVT were found in 12 (1.1%) women. PVC frequency directly correlated with CHARGE-AF score and NSVT on any patch. Detection of frequent PVCs increased with sequential monitoring. CONCLUSION In postmenopausal women at high risk for AF, frequent PVCs were relatively common (4.3%) and correlated with higher CHARGE-AF score. As strategies for AF screening continue to evolve, particularly in those individuals at high risk of AF, the prevalence of incidental ventricular arrhythmias is an important benchmark to guide clinical decision-making.
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Affiliation(s)
- Sofia E Gomez
- Department of Medicine, Stanford University School of Medicine, Stanford, California.
| | | | - Mark A Hlatky
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew Wheeler
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Philip Greenland
- Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Michael LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Victor Froelicher
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | | | | | | | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nazmus Saquib
- Department of Epidemiology, Sulaiman Alrajhi University, Al Bukayriyah, Saudi Arabia
| | - Tomas Nuño
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Bernhard Haring
- Department of Internal Medicine, University of Würzburg, Würzburg, Germany
| | - Marco V Perez
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Haring B, Schumacher H, Mancia G, Teo KK, Lonn EM, Mahfoud F, Schmieder R, Mann JFE, Sliwa K, Yusuf S, Böhm M. Triglyceride-glucose index, low-density lipoprotein levels, and cardiovascular outcomes in chronic stable cardiovascular disease: results from the ONTARGET and TRANSCEND trials. Eur J Prev Cardiol 2024; 31:311-319. [PMID: 37890035 DOI: 10.1093/eurjpc/zwad340] [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: 09/19/2023] [Revised: 09/22/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
AIMS The triglyceride-glucose index (TyG) has been proposed as an alternative to insulin resistance and as a predictor of cardiovascular outcomes. Little is known on its role in chronic stable cardiovascular disease and its predictive power at controlled low density lipoprotein (LDL) levels. METHODS AND RESULTS Our study population consisted of 29 960 participants in the ONTARGET and TRANSCEND trials that enrolled patients with known atherosclerotic disease. Triglycerides and glucose were measured at baseline. TyG was calculated as the logarithmized product of fasting triglycerides and glucose divided by 2. The primary endpoint of both trials was a composite of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. The secondary endpoint was all-cause death and the components of the primary endpoint. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) with extensive covariate adjustment for demographic, medical history, and lifestyle factors. During a mean follow-up of 4.3 years, 4895 primary endpoints and 3571 all-cause deaths occurred. In fully adjusted models, individuals in the highest compared to the lowest quartile of the TyG index were at higher risk for the primary endpoint (HR 1.14; 95% CI 1.05-1.25) and for myocardial infarction (HR 1.30; 95% CI 1.11-1.53). A higher TyG index did not associate with the primary endpoint in individuals with LDL levels < 100 mg/dL. CONCLUSION A higher TyG index is associated with a modestly increased cardiovascular risk in chronic stable cardiovascular disease. This association is largely attenuated when LDL levels are controlled. REGISTRATION www.clinicaltrials.gov: NCT00153101.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University, Kirrberger Strasse 100, 66421 Homburg, Germany
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Giuseppe Mancia
- Instituto Clinico Universitario Policlinico di Monza, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milano, Italy
| | - Koon K Teo
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Canada
| | - Eva M Lonn
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Canada
| | - Felix Mahfoud
- Department of Medicine III, Saarland University, Kirrberger Strasse 100, 66421 Homburg, Germany
| | - Roland Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany
| | - Johannes F E Mann
- KfH Kidney Centre, München, Germany
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany
| | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa & IIDMM, University of Cape Town, Cape Town, South Africa
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Canada
| | - Michael Böhm
- Department of Medicine III, Saarland University, Kirrberger Strasse 100, 66421 Homburg, Germany
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7
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Hrytsenko Y, Shea B, Elgart M, Kurniansyah N, Lyons G, Morrison AC, Carson AP, Haring B, Mitchel BD, Psaty BM, Jaeger BC, Gu CC, Kooperberg C, Levy D, Lloyd-Jones D, Choi E, Brody JA, Smith JA, Rotter JI, Moll M, Fornage M, Simon N, Castaldi P, Casanova R, Chung RH, Kaplan R, Loos RJ, Kardia SLR, Rich SS, Redline S, Kelly T, O’Connor T, Zhao W, Kim W, Guo X, Der Ida Chen Y, Sofer T. Machine learning models for blood pressure phenotypes combining multiple polygenic risk scores. medRxiv 2023:2023.12.13.23299909. [PMID: 38168328 PMCID: PMC10760279 DOI: 10.1101/2023.12.13.23299909] [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: 01/05/2024]
Abstract
We construct non-linear machine learning (ML) prediction models for systolic and diastolic blood pressure (SBP, DBP) using demographic and clinical variables and polygenic risk scores (PRSs). We developed a two-model ensemble, consisting of a baseline model, where prediction is based on demographic and clinical variables only, and a genetic model, where we also include PRSs. We evaluate the use of a linear versus a non-linear model at both the baseline and the genetic model levels and assess the improvement in performance when incorporating multiple PRSs. We report the ensemble model's performance as percentage variance explained (PVE) on a held-out test dataset. A non-linear baseline model improved the PVEs from 28.1% to 30.1% (SBP) and 14.3% to 17.4% (DBP) compared with a linear baseline model. Including seven PRSs in the genetic model computed based on the largest available GWAS of SBP/DBP improved the genetic model PVE from 4.8% to 5.1% (SBP) and 4.7% to 5% (DBP) compared to using a single PRS. Adding additional 14 PRSs computed based on two independent GWASs further increased the genetic model PVE to 6.3% (SBP) and 5.7% (DBP). PVE differed across self-reported race/ethnicity groups, with primarily all non-White groups benefitting from the inclusion of additional PRSs.
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Affiliation(s)
- Yana Hrytsenko
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- CardioVascular Institute (CVI), Beth Israel Deaconess Medical Center, Boston, MA
| | - Benjamin Shea
- CardioVascular Institute (CVI), Beth Israel Deaconess Medical Center, Boston, MA
| | - Michael Elgart
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | - Genevieve Lyons
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alanna C. Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bernhard Haring
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine III, Saarland University, Homburg, Saarland, Germany
| | - Braxton D. Mitchel
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bruce M. Psaty
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Byron C. Jaeger
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - C Charles Gu
- The Center for Biostatistics and Data Science, Washington University, St. Louis, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Daniel Levy
- The Population Sciences Branch of the National Heart, Lung and Blood Institute, Bethesda, MD, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Eunhee Choi
- Columbia Hypertension Laboratory, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer A Brody
- Department of Medicine, University of Washington, Seattle, WA, USA
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthew Moll
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- VA Boston Healthcare System, West Roxbury, MA, USA
| | - Myriam Fornage
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Noah Simon
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA
| | - Peter Castaldi
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Ramon Casanova
- Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Ren-Hua Chung
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Taipei City, Taiwan
| | - Robert Kaplan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty for Health and Medical Sciences, University of Copenhagen, Denmark, DK
| | - Sharon L. R. Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tanika Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Timothy O’Connor
- Department of Medicine III, Saarland University, Homburg, Saarland, Germany
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wonji Kim
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yii Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Tamar Sofer
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- CardioVascular Institute (CVI), Beth Israel Deaconess Medical Center, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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8
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Haring B, Markwirth P, Böhm M. Age-Related Changes of Pulmonary Artery Systolic Pressure: Prevention Is Key. J Am Coll Cardiol 2023; 82:2193-2196. [PMID: 38030348 DOI: 10.1016/j.jacc.2023.10.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Philipp Markwirth
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
| | - Michael Böhm
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
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Shadyab AH, Manson JE, Allison MA, Laddu D, Wassertheil-Smoller S, Van Horn L, Wild RA, Banack HR, Tabung FK, Haring B, Sun Y, LeBlanc ES, Wactawski-Wende J, LeBoff MS, Naughton MJ, Luo J, Schnatz PF, Natale G, Ostfeld RJ, LaCroix AZ. Association of Later-Life Weight Changes With Survival to Ages 90, 95, and 100: The Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2023; 78:2264-2273. [PMID: 37642339 PMCID: PMC10692416 DOI: 10.1093/gerona/glad177] [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] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Associations of weight changes and intentionality of weight loss with longevity are not well described. METHODS Using longitudinal data from the Women's Health Initiative (N = 54 437; 61-81 years), we examined associations of weight changes and intentionality of weight loss with survival to ages 90, 95, and 100. Weight was measured at baseline, year 3, and year 10, and participants were classified as having weight loss (≥5% decrease from baseline), weight gain (≥5% increase from baseline), or stable weight (<5% change from baseline). Participants reported intentionality of weight loss at year 3. RESULTS A total of 30 647 (56.3%) women survived to ≥90 years. After adjustment for relevant covariates, 3-year weight loss of ≥5% vs stable weight was associated with lower odds of survival to ages 90 (OR, 0.67; 95% CI, 0.64-0.71), 95 (OR, 0.65; 95% CI, 0.60-0.71), and 100 (OR, 0.62; 95% CI, 0.49-0.78). Compared to intentional weight loss, unintentional weight loss was more strongly associated with lower odds of survival to age 90 (OR, 0.83; 95% CI, 0.74-0.94 and OR, 0.49; 95% CI, 0.44-0.55, respectively). Three-year weight gain of ≥5% vs stable weight was not associated with survival to age 90, 95, or 100. The pattern of results was similar among normal weight, overweight, and obese women in body mass index (BMI)-stratified analyses. CONCLUSIONS Weight loss of ≥5% vs stable weight was associated with lower odds of longevity, more strongly for unintentional weight loss than for intentional weight loss. Potential inaccuracy of self-reported intentionality of weight loss and residual confounding were limitations.
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Affiliation(s)
- Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew A Allison
- Department of Family Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert A Wild
- Division of Reproductive Endocrinology and Infertility, Departments of Obstetrics and Gynecology, and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hailey R Banack
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fred K Tabung
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
- Department of Medicine I, University of Wurzburg, Wurzburg, Germany
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yangbo Sun
- Department of Preventive Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Erin S LeBlanc
- Kaiser Permanente, Center for Health Research, Portland, Oregon, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, New York, USA
| | - Meryl S LeBoff
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Peter F Schnatz
- Department of Obstetrics/Gynecology and Internal Medicine, Reading Hospital/Tower Health, West Reading, Pennsylvania, USA
| | - Ginny Natale
- Department of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook University, Stony Brook, New York, USA
| | - Robert J Ostfeld
- Division of Cardiology, Montefiore Health System, Bronx, New York, USA
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
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Lauder L, Pérez Navarro P, Götzinger F, Ewen S, Al Ghorani H, Haring B, Lepper PM, Kulenthiran S, Böhm M, Link A, Scheller B, Mahfoud F. Mechanical thrombectomy in intermediate- and high-risk acute pulmonary embolism: hemodynamic outcomes at three months. Respir Res 2023; 24:257. [PMID: 37880651 PMCID: PMC10601326 DOI: 10.1186/s12931-023-02552-w] [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] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Mechanical thrombectomy has been shown to reduce thrombus burden and pulmonary artery pressure (PAP) and to improve right ventricular (RV) function in patients with high-risk or intermediate-high-risk pulmonary embolism (PE). As hemodynamic data after mechanical thrombectomy for PE are scarce, we aimed to assess the hemodynamic effects of mechanical thrombectomy in acute PE with right heart overload. METHODS In this prospective, open-label study, patients with acute symptomatic, computed tomography-documented PE with signs of right heart overload underwent mechanical thrombectomy using the FlowTriever System. Right heart catheterization was performed immediately before and after thrombectomy and after three months. Transthoracic echocardiography was performed before thrombectomy, discharge, and at three months. This analysis was done after 20 patients completed three months of follow-up. RESULTS Twenty-nine patients (34% female) underwent mechanical thrombectomy, of which 20 completed three months follow-up with right heart catheterization. Most patients were at high (17%) or intermediate-high (76%) risk and had bilateral PE (79%). Before thrombectomy, systolic PAP (sPAP) was severely elevated (mean 51.3 ± 11.6 mmHg). Mean sPAP dropped by -15.0 mmHg (95% confidence interval [CI]: -18.9 to -11.0; p < 0.001) immediately after the procedure and continued to decrease from post-thrombectomy to three months (-6.4 mmHg, 95% CI: -10-0 to -2.9; p = 0.002). RV/left ventricular (LV) ratio immediately reduced within two days by -0.37 (95% CI: -0.47 to -0.27; p < 0.001). The proportion of patients with a tricuspid annular plane systolic excursion (TAPSE)/sPAP ratio < 0.31 mm/mmHg decreased from 28% at baseline to 0% before discharge and at three months (p = 0.007). There were no procedure-related major adverse events. CONCLUSIONS Mechanical thrombectomy for acute PE was safe and immediately reduced PAP and improved right heart function. The reduction in PAP was maintained at three months follow-up.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany.
| | - Patricia Pérez Navarro
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Felix Götzinger
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Hussam Al Ghorani
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Bernhard Haring
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie und Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Saarraaken Kulenthiran
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Andreas Link
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Bruno Scheller
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany
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11
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Buder F, Mahfoud F, Böhm M, Haring B. What Is the Relevance of Low Standing Blood Pressure? Am J Hypertens 2023; 36:586-587. [PMID: 37565408 DOI: 10.1093/ajh/hpad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Felix Buder
- Department of Medicine III, Saarland University, Homburg, Germany
| | - Felix Mahfoud
- Department of Medicine III, Saarland University, Homburg, Germany
| | - Michael Böhm
- Department of Medicine III, Saarland University, Homburg, Germany
| | - Bernhard Haring
- Department of Medicine III, Saarland University, Homburg, Germany
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12
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Haring B, Hunt RP, Shadyab AH, Eaton C, Kaplan R, Martin LW, Panjrath G, Kuller LH, Assimes T, Kooperberg C, Wassertheil-Smoller S. Cardiovascular Disease and Mortality in Black Women Carrying the Amyloidogenic V122I Transthyretin Gene Variant. JACC Heart Fail 2023; 11:1189-1199. [PMID: 36930136 PMCID: PMC10508305 DOI: 10.1016/j.jchf.2023.02.003] [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] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Long-term data on cardiovascular disease (CVD) and mortality in female carriers of the transthyretin (TTR) V122I (pV142I) variant, one of the most common variants of hereditary transthyretin cardiac amyloidosis, are sparse and the effects of blood pressure, heart rate, body mass index, and physical activity on CVD outcomes remain largely unknown. OBJECTIVES The aim was to first examine the relationship of TTR V122I (pV142I) carrier status with CVD and mortality and second to investigate the effects of blood pressure, heart rate, body mass index, and physical activity in a large cohort of postmenopausal women. METHODS The study population consisted of 9,862 non-Hispanic Black/African American women, 9,529 noncarriers and 333 TTR V122I carriers, enrolled in the Women's Health Initiative at 40 centers in the United States. Women were generally healthy and postmenopausal at the time of enrollment (1993-1998). CVD was defined as a composite endpoint consisting of coronary heart disease, stroke, acute heart failure or CVD death, and all-cause mortality. CVD cases were based on self-reported annual mailed health updates. All information was centrally adjudicated by trained physicians. HRs and 95% CIs were obtained from adjusted Cox proportional hazards models. RESULTS Among 9,862 Black female participants (mean age: 62 years [IQR: 56-67 years]), the population frequency of the TTR V122I variant was 3.4% (333 variant carriers and 9,529 noncarriers). During a mean follow-up of 16.1 years (IQR: 9.7-22.2 years), incident CVD occurred in 2,229 noncarriers and 96 carriers, whereas 2,689 noncarriers and 108 carriers died. In adjusted models including demographic, lifestyle, and medical history covariates, TTR V122I carriers were at higher risk of the composite endpoint CVD (HR: 1.52; 95% CI: 1.22-1.88), acute heart failure (HR: 2.21; 95% CI: 1.53-3.18), coronary heart disease (HR: 1.80; 95% CI: 1.30-2.47), CVD death (HR: 1.70; 95% CI: 1.26-2.30), and all-cause mortality (HR: 1.28; 95% CI: 1.04-1.56). The authors found a significant interaction by age but not by blood pressure, heart rate, body mass index, or physical activity. CONCLUSIONS Black female TTR V122I (pV142I) carriers have a higher CVD and all-cause mortality risk compared to noncarriers. In case of clinical suspicion of amyloidosis, they should be screened for TTR V122I (pV142I) carrier status to ensure early treatment onset.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany; Department of Medicine I, University of Würzburg, Würzburg, Bavaria, Germany; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Rebecca P Hunt
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, La Jolla, California, USA
| | - Charles Eaton
- Center for Primary Care and Prevention, Department of Family Medicine, Department of Epidemiology, Warren Alpert Medical Scholl of Brown University, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Lisa Warsinger Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Gurusher Panjrath
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Themistocles Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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Schuermans A, Nakao T, Uddin MM, Hornsby W, Ganesh S, Shadyab AH, Liu S, Haring B, Shufelt CL, Taub MA, Mathias RA, Kooperberg C, Reiner AP, Bick AG, Manson JE, Natarajan P, Honigberg MC. Age at Menopause, Leukocyte Telomere Length, and Coronary Artery Disease in Postmenopausal Women. Circ Res 2023; 133:376-386. [PMID: 37489536 PMCID: PMC10528840 DOI: 10.1161/circresaha.123.322984] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Premature menopause is a risk factor for accelerated cardiovascular aging, but underlying mechanisms remain incompletely understood. This study investigated the role of leukocyte telomere length (LTL), a marker of cellular aging and genomic instability, in the association of premature menopause with cardiovascular disease. METHODS Participants from the UK Biobank and Women's Health Initiative with complete reproductive history and LTL measurements were included. Primary analyses tested the association between age at menopause and LTL using multivariable-adjusted linear regression. Secondary analyses stratified women by history of gynecologic surgery. Mendelian randomization was used to infer causal relationships between LTL and age at natural menopause. Multivariable-adjusted Cox regression and mediation analyses tested the joint associations of premature menopause and LTL with incident coronary artery disease. RESULTS This study included 130 254 postmenopausal women (UK Biobank: n=122 224; Women's Health Initiative: n=8030), of whom 4809 (3.7%) had experienced menopause before age 40. Earlier menopause was associated with shorter LTL (meta-analyzed ß=-0.02 SD/5 years of earlier menopause [95% CI, -0.02 to -0.01]; P=7.2×10-12). This association was stronger and significant in both cohorts for women with natural/spontaneous menopause (meta-analyzed ß=-0.04 SD/5 years of earlier menopause [95% CI, -0.04 to -0.03]; P<2.2×10-16) and was independent of hormone therapy use. Mendelian randomization supported a causal association of shorter genetically predicted LTL with earlier age at natural menopause. LTL and age at menopause were independently associated with incident coronary artery disease, and mediation analyses indicated small but significant mediation effects of LTL in the association of menopausal age with coronary artery disease. CONCLUSIONS Earlier age at menopause is associated with shorter LTL, especially among women with natural menopause. Accelerated telomere shortening may contribute to the heightened cardiovascular risk associated with premature menopause.
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Affiliation(s)
- Art Schuermans
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Tetsushi Nakao
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Md Mesbah Uddin
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Whitney Hornsby
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shriie Ganesh
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Simin Liu
- Department of Epidemiology and Brown Center for Global Cardiometabolic Health, Brown University, Providence, RI, USA
| | - Bernhard Haring
- Department of Medicine III, Saarland University Medical Center, Homburg, Saarland, Germany
- Department of Medicine I, University of Wuerzburg, Bavaria, Germany
| | - Chrisandra L. Shufelt
- Division of Internal Medicine, Women’s Health Research Center, Mayo Clinic, Jacksonville, Florida
| | - Margaret A. Taub
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rasika A. Mathias
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Alexander P. Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Alexander G. Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pradeep Natarajan
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael C. Honigberg
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Solomon DH, Santacroce L, Shadyab A, Haring B, Burnett-Bowie SAM, Karvonen-Gutierrez C, Colvin A, Jackson R, LeBoff MS, Ruppert K, Valencia CI, Avis NE, Manson JE. Derivation and external validation of a risk score for clinically important declines in health and function among two longitudinal cohorts of women in the mid-life. BMJ Open 2023; 13:e069149. [PMID: 37558437 PMCID: PMC10414087 DOI: 10.1136/bmjopen-2022-069149] [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: 10/14/2022] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Women in mid-life often develop chronic conditions and experience declines in physical health and function. Identifying factors associated with declines provides opportunity for targeted interventions. We derived and externally validated a risk score for clinically important declines over 10 years among women ages 55-65 using the Physical Component Summary Score (PCS) of the SF-36. DESIGN Derivation and validation of a risk score. SETTING Two longitudinal cohorts from sites in the USA were used. PARTICIPANTS Women from the Study of Women's Health Across the Nation (SWAN) and women from the Women's Health Initiative (WHI) Observational Study and/or clinical trials. OUTCOME MEASURES A clinically important decline over 10 years among women ages 55-65 using the PCS of the SF-36 predictors was measured at the beginning of the 10 years of follow-up. RESULTS Seven factors-lower educational attainment, smoking, higher body mass index, history of cardiovascular disease, history of osteoarthritis, depressive symptoms and baseline PCS level-were found to be significant predictors of PCS decline among women in SWAN with an area under the curve (AUC)=0.71 and a Brier Score=0.14. The same factors were associated with a decline in PCS in WHI with an AUC=0.64 and a Brier Score=0.18. Regression coefficients from the SWAN analysis were used to estimate risk scores for PCS decline in both cohorts. Using a threshold of a 30% probability of a significant decline, the risk score created a binary test with a specificity between 89%-93% and an accuracy of 73%-79%. CONCLUSIONS Seven clinical variables were used to create a valid risk score for PCS declines that was replicated in an external cohort. The risk score provides a method for identifying women at high risk for a significant mid-life PCS decline.
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Affiliation(s)
- Daniel H Solomon
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leah Santacroce
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aladdin Shadyab
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Bernhard Haring
- Department of Medicine III, Saarland University Medical Center, Saarbrücken, Germany
| | | | | | - Alicia Colvin
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Jackson
- Department of Human Nutrition, The Ohio State University, Columbus, Ohio, USA
| | - Meryl S LeBoff
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristine Ruppert
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Celina I Valencia
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Nancy E Avis
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Böhm M, Butler J, Krawczyk M, Mahfoud F, Haring B, Filippatos G, Ferreira JP, Pocock SJ, Brueckmann M, Ofstad AP, Schüler E, Wanner C, Verma S, Packer M, Anker SD. Liver tests, cardiovascular outcomes and effects of empagliflozin in patients with heart failure and preserved ejection fraction: The EMPEROR-Preserved trial. Eur J Heart Fail 2023; 25:1375-1383. [PMID: 37278451 DOI: 10.1002/ejhf.2922] [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: 01/27/2023] [Revised: 04/17/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
AIM The prognostic implication of elevated liver tests in heart failure with preserved ejection fraction (HFpEF) is uncertain. This analysis investigates the association of liver markers with hospitalization for heart failure (HHF) and cardiovascular death (CVD), and the treatment effect of empagliflozin across the range of liver marker levels. METHODS AND RESULTS The double-blind, placebo-controlled EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure with Preserved Ejection Fraction) enrolled 5988 patients with HFpEF (ejection fraction >40%). Patients in New York Heart Association class II-IV and elevated N-terminal pro-B-type natriuretic peptide were randomized to receive empagliflozin 10 mg daily or placebo in addition to usual therapy. Patients with significant liver disease were excluded. The primary endpoint was time to first adjudicated HHF or CVD. We explored the association of liver function abnormalities with heart failure outcomes in patients on placebo, the effects of empagliflozin on liver tests and the treatment effects of empagliflozin on heart failure outcomes across categories of liver laboratory values. High alkaline phosphatase (p trend < 0.0001), low albumin (p trend < 0.0001) and high bilirubin (p = 0.02) were associated with poorer outcomes for HHF or CVD, while high aspartate aminotransferase was not, and high alanine aminotransferase was associated with better outcomes. Empagliflozin had no significant effects on liver tests compared to placebo except for albumin which was significantly increased. The treatment effect of empagliflozin on outcomes was not modified by liver tests. CONCLUSION Abnormalities of liver function tests are associated differently with heart failure outcomes. Salutary effects of empagliflozin on liver tests were not observed although albumin increased. The treatment benefits of empagliflozin were not affected by baseline values of liver parameters.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
- Cape Heart Institute, Cape Town, South Africa
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Marcin Krawczyk
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Bernhard Haring
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
- Cape Heart Institute, Cape Town, South Africa
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - João Pedro Ferreira
- Université de Lorraine, Centre d'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Nancy, France
- Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
- Cardiovascular R&D Centre - UnIC@RISE, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Martina Brueckmann
- Boehringer Ingelheim International, Ingelheim, Germany
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anne Pernille Ofstad
- Medical Department, Boehringer Ingelheim Norway KS, Asker, Norway
- Oslo Diabetes Research Center, Oslo, Norway
| | | | - Christoph Wanner
- Medizinische Klinik und Poliklinik 1, Schwerpunkt Nephrologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, and Departments of Surgery, and Pharmacology and Toxicology, University of Toronto, Toronto, ONT, Canada
| | - Milton Packer
- Baylor University Medical Center, Dallas, TX, USA
- Imperial College, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
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16
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Zeymer U, Lober C, Richter S, Olivier CB, Huber K, Haring B, Schwimmbeck P, Andrassy M, Akin I, Cuneo A, Desch S, Thiele H, Geisler T. Cangrelor in patients with percutaneous coronary intervention for acute myocardial infarction after cardiac arrest and/or with cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2023; 12:462-463. [PMID: 37042356 DOI: 10.1093/ehjacc/zuad041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/05/2023] [Accepted: 03/30/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany
- Stiftung, Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany
| | - Christiane Lober
- Stiftung, Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany
| | | | | | | | - Bernhard Haring
- Kardiologie, Universitätsklinikum Homburg-Saar, Homburg/Saar, Germany
| | | | | | - Ibrahim Akin
- Kardiologie, Universitätsklinikum Mannheim, Kardiologie, Mannheim, Germany
| | | | - Steffen Desch
- Kardiologie: Innere Medizin III, Universitäres Herzzentrum Leipzig, Leipzig, Germany
| | - Holger Thiele
- Kardiologie: Innere Medizin III, Universitäres Herzzentrum Leipzig, Leipzig, Germany
| | - Tobias Geisler
- Universitätsklnikum Tübingen, Innere Medizin III, Tübingen, Germany
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17
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Haring B, Andrews CA, Hovey K, Shadyab AH, LaCroix A, Martin LW, Rosal MC, Kuller LH, Salmoirago-Blotcher E, Saquib N, Koo P, Laddu D, Stefanick ML, Manson JE, Wassertheil-Smoller S, LaMonte MJ. Systolic Blood Pressure and Survival to Very Old Age. Results from the Women's Health Initiative. medRxiv 2023:2023.06.22.23291783. [PMID: 37425845 PMCID: PMC10327241 DOI: 10.1101/2023.06.22.23291783] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background The association between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine survival probabilities to age 90 for various SBP levels among women aged ≥ 65 years with or without BP medication. Methods We analyzed blood pressure data from participants in the Women's Health Initiative (n=16,570) who were aged 65 or older and without history of cardiovascular disease, diabetes or cancer. Blood pressure was measured at baseline (1993-1998) and then annually through 2005. The outcome was defined as survival to age 90 with follow-up until February 28, 2020. Results During a follow-up of 18 years, 9,723 (59%) of 16,570 women survived to age 90. The SBP associated with the highest probability of survival was about 120mmHg regardless of age. Compared to an SBP between 110 and 130 mmHg, women with uncontrolled SBP had a lower survival probability across all age groups and with or without BP medication. A 65-year-old women on BP medication with an interpolated SBP between 110 and 130 mmHg in 80% of the first 5 years of follow-up had a 31% (95% confidence interval, 24%, 38%) absolute survival probability. For those with 20% time in range, the probability was 21% (95% confidence interval, 16%, 26%). Conclusions An SBP level below 130 mmHg was found to be associated with longevity among older women. The longer SBP was controlled at a level between 110 and 130 mmHg, the higher the survival probability to age 90. Preventing age-related rises in SBP and increasing the time with controlled BP levels constitute important measures for achieving longevity.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chris A. Andrews
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Kathleen Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Andrea LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Lisa Warsinger Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh, PA, USA
| | | | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia
| | - Patrick Koo
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baroness Erlanger Hospital, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Marcia L. Stefanick
- Department of Medicine Stanford University Medical Center Palo Alto CA. Departments of Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
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18
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Peila R, Xue X, Qi Q, Dannenberg AJ, Allison MA, Johnson KC, LaMonte MJ, Wild RA, Haring B, Pan K, Tindle HA, Foraker R, Saquib N, Barac A, Rohan TE. Healthy Lifestyle Index and Risk of Cardiovascular Disease Among Postmenopausal Women With Normal Body Mass Index. J Am Heart Assoc 2023:e029111. [PMID: 37306150 DOI: 10.1161/jaha.122.029111] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background A lifestyle comprising a healthy diet, light alcohol consumption, no smoking, and moderate or intense physical activity has been associated with reduced risk of cardiovascular disease (CVD). We examined the association of a healthy lifestyle index (HLI), derived from scores for each of these components plus waist circumference, with the risk of incident CVD and CVD subtypes in postmenopausal women with normal body mass index (18.5-<25.0 kg/m2). Methods and Results We studied 40 118 participants in the Women's Health Initiative, aged 50 to 79 years at enrollment, with a normal body mass index and no history of CVD. The HLI score was categorized into quintiles. We estimated multivariable adjusted hazard ratios (HR) and 95% CIs for the association of HLI with risk of CVD and CVD subtypes using Cox regression models. A total of 3821 cases of incident CVD were ascertained during a median follow-up of 20.1 years. Compared with the lowest quintile (unhealthiest lifestyle), higher HLI quintiles showed inverse associations with the risk of CVD (HRquintile-2=0.74 [95% CI, 0.67-0.81]; HRquintile-3=0.66 [95% CI, 0.60-0.72]; HRquintile-4=0.57 [95% CI, 0.51-0.63]; and HRquintile-5=0.48 [95% CI, 0.43-0.54], P-trend=<0.001). HLI was also inversely associated with risks of stroke, coronary heart disease, myocardial infarction, angina, and coronary revascularization. Subgroup analyses, stratified by age (≤63 years vs >63 years), body mass index (</≥ 22.0 kg/m2), and general health status (absence/presence of hypertension, diabetes, or lipid-lowering drug use) also showed inverse associations between HLI and risk of CVD. Conclusions Among postmenopausal women with a normal body mass index, adherence to a healthy lifestyle is associated with a reduced risk of clinical CVD and CVD subtypes, underscoring the cardiovascular benefits of maintaining a healthy lifestyle, even for women with a healthy weight.
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Affiliation(s)
- Rita Peila
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
| | - Qibin Qi
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
| | | | - Matthew A Allison
- Family Medicine and Public Health University of California CA San Diego USA
| | - Karen C Johnson
- Department of Preventive Medicine The University of Tennessee TN Memphis USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health University of Buffalo NY USA
| | - Robert A Wild
- Department of Obstetrics and Gynecology and Biostatistics and Epidemiology University of Oklahoma Health Sciences Center OK Oklahoma City USA
| | - Bernhard Haring
- Department of Cardiology University Heart Center Graz, Medical University of Graz Graz Austria
| | - Kathy Pan
- Department of Hematology/Oncology Kaiser Permanente Southern California CA Downey USA
| | - Hilary A Tindle
- Department of Medicine Vanderbilt University Medical Center TN Nashville USA
| | - Randi Foraker
- Department of Medicine Washington University at St. Louis MO St. Louis USA
| | - Nazmus Saquib
- College of Medicine at Sulaiman Al Rajhi University Bukariyah Saudi Arabia
| | - Ana Barac
- MedStar Heart and Vascular Institute Georgetown University DC Washington USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
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Bancks M, Gaussoin SA, Beavers D, Bress AS, Gillette C, Haring B, Liu L, Maron DJ, Reynolds LM, Shadyab AH, Vitolins MZ. Abstract P432: Statin Initiation for Primary Prevention and Dose Intensity According to Age in the Women’s Health Initiative. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p432] [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: 03/18/2023]
Abstract
Introduction:
Over 50% of US adults older than 75 live free of atherosclerotic cardiovascular disease (ASCVD) and diabetes (DM), yet data on incident statin use among this population are lacking. Our objective was to assess statin initiation by age among the Women’s Health Initiative cohort free of ASCVD and DM at baseline (1993).
Hypothesis:
Statin initiation is higher at older ages and differs by race/ethnicity.
Methods:
Exclusions were statin use at baseline, known ASCVD, DM, and no follow-up after baseline. Self-reported medication use was assessed in 1996 and 2008. Specific statin and dose prescribed at the time of initiation were identified using National Drug Codes and determined statin intensity, defined by the ACC/AHA guidelines. We estimated the adjusted association between age group (<65, 65-74, and ≥75) and statin initiation and assessed for heterogeneity by race/ethnicity. We also assessed statin dose at the time of initiation.
Results:
Over 12 years of follow-up, 27% of 99,631 women free of ASCVD and DM at baseline initiated a statin; initiation was lower with older age (Table). This association remained after adjustment for ASCVD risk factors and did not differ by race/ethnicity (p for interaction >0.5). Moderate intensity dose was most common at statin initiation overall, and moderate and high intensity dose were both lower with older age.
Conclusion:
Of women free of ASCVD and DM, women older than 75 were least likely to start a statin and most likely to start low intensity statin therapy at initiation than younger women. We identified a potential clinical gap for investigation: whether lower overall use of statins and lower intensity statin therapy among older women are associated with preventable ASCVD.
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Affiliation(s)
| | | | | | - Adam S Bress
- Univ of Utah Sch of Medicine, Salt Lake City, UT
| | | | | | | | | | | | - Aladdin H Shadyab
- Univ of California, San Diego Herbert Wertheim Sch of Public Health and Human Longevity Science, San Diego, CA
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20
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Neuhouser ML, Pettinger M, Tinker LF, Thomson C, Van Horn L, Haring B, Shikany JM, Stefanick ML, Prentice RL, Manson JE, Mossavar-Rahmani Y, Lampe JW. Associations of Biomarker-Calibrated Healthy Eating Index-2010 Scores with Chronic Disease Risk and Their Dependency on Energy Intake and Body Mass Index in Postmenopausal Women. J Nutr 2023; 152:2808-2817. [PMID: 36040344 PMCID: PMC9839987 DOI: 10.1093/jn/nxac199] [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] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prior studies examined associations between the Healthy Eating Index (HEI) and chronic disease risk based on self-reported diet without measurement error correction. OBJECTIVE Our objective was to test associations between biomarker calibration of the food-frequency questionnaire (FFQ)-derived HEI-2010 with incident cardiovascular disease (CVD), cancer, and type 2 diabetes (T2D) among Women's Health Initiative (WHI) participants. METHODS Data were derived from WHI postmenopausal women (n = 100,374) aged 50-79 y at enrollment (1993-1998) at 40 US clinical centers, linked to nutritional biomarker substudies and outcomes over subsequent decades of follow-up. Baseline or year 1 FFQ-derived HEI-2010 scores were calibrated with nutritional biomarkers and participant characteristics (e.g., BMI) for systematic measurement error correction. Calibrated data were then used in HR models examining associations with incidence of CVD (total, subtypes, mortality), cancer (total, subtypes, mortality), and T2D in WHI participants with approximately 2 decades of follow-up. Models were multivariable-adjusted with further adjustment for BMI and doubly labeled water (DLW)-calibrated energy. RESULTS Multivariable-adjusted HRs modeled a 20% increment in HEI-2010 score in relation to outcomes. HRs were modest using uncalibrated HEI-2010 scores (HRs = 0.91-1.09). Using biomarker-calibrated HEI-2010, 20% increments in scores yielded multivariable-adjusted HRs (95% CIs) of 0.75 (0.60, 0.93) for coronary heart disease; 0.75 (0.61, 0.91) for myocardial infarction; 0.96 (0.92, 1.01) for stroke; 0.88 (0.75, 1.02) for CVD mortality; 0.81 (0.70, 0.94) for colorectal cancer; 0.81 (0.74, 0.88) for breast cancer; 0.79 (0.73, 0.87) for cancer mortality; and 0.45 (0.36-0.55) for T2D. Except for cancer mortality and T2D incidence, results became null when adjusted for DLW-calibrated energy intake and BMI. CONCLUSIONS Biomarker calibration of FFQ-derived HEI-2010 was associated with lower CVD and cancer incidence and mortality and lower T2D incidence in postmenopausal women. Attenuation after adjustment with BMI and DLW-calibrated energy suggests that energy intake and/or obesity are strong drivers of diet-related chronic disease risk in postmenopausal women. The Women's Health Initiative is registered at clinicaltrials.gov at NCT00000611.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cynthia Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Linda Van Horn
- Department of Prevention Medicine, Northwestern University, Chicago, IL, USA
| | - Bernhard Haring
- Department of Medicine III, Saarland University Medical Center, Homburg, Saarland, Germany
| | - James M Shikany
- Department of Medicine, Division of Prevention Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcia L Stefanick
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
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21
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Chou EL, Pettinger M, Haring B, Allison MA, Mell MW, Hlatky MA, Wactawski-Wende J, Wild RA, Shadyab AH, Wallace RB, Snetselaar LG, Madsen TE, Eagleton MJ, Conrad MF, Liu S. Association of Premature Menopause With Risk of Abdominal Aortic Aneurysm in the Women's Health Initiative. Ann Surg 2022; 276:e1008-e1016. [PMID: 33156064 DOI: 10.1097/sla.0000000000004581] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if premature menopause and early menarche are associated with increased risk of AAA, and to explore potential effect modification by smoking history. SUMMARY OF BACKGROUND DATA Despite worse outcomes for women with AAA, no studies have prospectively examined sex-specific risk factors, such as premature menopause and early menarche, with risk of AAA in a large, ethnically diverse cohort of women. METHODS This was a post-hoc analysis of Women's Health Initiative participants who were beneficiaries of Medicare Parts A&B fee-for-service. AAA cases and interventions were identified from claims data. Follow-up period included Medicare coverage until death, end of follow-up or end of coverage inclusive of 2017. RESULTS Of 101,119 participants included in the analysis, the mean age was 63 years and median follow-up was 11.3 years. Just under 10,000 (9.4%) women experienced premature menopause and 22,240 (22%) experienced early men-arche. Women with premature menopause were more likely to be overweight, Black, have >20 pack years of smoking, history of cardiovascular disease, hypertension, and early menarche. During 1,091,840 person-years of follow-up, 1125 women were diagnosed with AAA, 134 had premature menopause (11.9%), 93 underwent surgical intervention and 45 (48%) required intervention for ruptured AAA. Premature menopause was associated with increased risk of AAA [hazard ratio 1.37 (1.14, 1.66)], but the association was no longer significant after multivariable adjustment for demographics and cardiovascular disease risk factors. Amongst women with ≥20 pack year smoking history (n = 19,286), 2148 (11.1%) had premature menopause, which was associated with greater risk of AAA in all models [hazard ratio 1.63 (1.24, 2.23)]. Early menarche was not associated with increased risk of AAA. CONCLUSIONS This study finds that premature menopause may be an important risk factor for AAA in women with significant smoking history. There was no significant association between premature menopause and risk of AAA amongst women who have never smoked. These results suggest an opportunity to develop strategies for better screening, risk reduction and stratification, and outcome improvement in the comprehensive vascular care of women.
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Affiliation(s)
- Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bernhard Haring
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Matthew W Mell
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, California
| | - Mark A Hlatky
- Department of Health Research and Policy, Campus Drive, Stanford University School of Medicine, Stanford, California
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, California
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Tracy E Madsen
- Department of Emergency Medicine, Division of Sex and Gender, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Simin Liu
- Departments of Epidemiology, Surgery, and Medicine, Brown University, Providence, Rhode Island
- Department of Internal Medicine, University of Würzburg, Würzburg, Germany
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22
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Kolesnik E, Stangl V, Haring B, Scherr D, Rainer PP. Cardiac relapse of extranodal NK/T-cell lymphoma manifesting as incessant ventricular tachycardia: a case report. Eur Heart J Case Rep 2022; 6:ytac363. [PMID: 36111075 PMCID: PMC9470109 DOI: 10.1093/ehjcr/ytac363] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/05/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022]
Abstract
Background Cardiac tumours are rare but affected patients may present with symptoms mimicking other cardiac diseases. The most frequent symptoms include heart failure, arrhythmias, or embolic phenomena. Case summary A 39-year-old man with a history of extranodal NK/T-cell lymphoma of the nasal type (ENKTL-NT) in clinical remission presented at our department with incessant ventricular tachycardia. The arrhythmia could only be controlled with a combination of intravenously administered beta-blockers, ajmaline, and amiodarone. Diagnostic workup excluded ischaemia, but imaging revealed a tumour located in the apex of the left ventricle. Endomyocardial biopsy confirmed the diagnosis of cardiac relapse of ENKTL-NT. Upon chemotherapy no further arrhythmias developed. Discussion Many malignancies can metastasize into the heart. Multimodal imaging including echocardiography, cardiac magnetic resonance imaging, and a positron-emission tomography computed tomography paved the way to the diagnosis that was finally established by endomyocardial biopsy. In the present case, a cardiac metastasis from an ENKTL-NT presented with incessant ventricular tachycardia.
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Affiliation(s)
- Ewald Kolesnik
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz , Graz , Austria
| | - Bernhard Haring
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
| | - Daniel Scherr
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
| | - Peter P Rainer
- Division of Cardiology, University Heart Center, Medical University of Graz , Auenbruggerplatz 15, Graz 8036 , Austria
- BioTechMed Graz , Graz , Austria
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Haring B, McGinn AP, Kamensky V, Allison M, Stefanick ML, Schnatz PF, Kuller LH, Berger JS, Johnson KC, Saquib N, Garcia L, Richey PA, Manson JE, Alderman M, Wassertheil-Smoller S. Low Diastolic Blood Pressure and Mortality in Older Women. Results From the Women's Health Initiative Long Life Study. Am J Hypertens 2022; 35:795-802. [PMID: 35522983 PMCID: PMC9434234 DOI: 10.1093/ajh/hpac056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/13/2022] [Revised: 03/17/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recommended systolic blood pressure targets often do not consider the relationship of low diastolic blood pressure (DBP) levels with cardiovascular disease (CVD) and all-cause mortality risk, which is especially relevant for older people with concurrent comorbidities. We examined the relationship of DBP levels to CVD and all-cause mortality in older women in the Women's Health Initiative Long Life Study (WHI-LLS). METHODS The study sample included 7,875 women (mean age: 79 years) who underwent a blood pressure measurement at an in-person home visit conducted in 2012-2013. CVD and all-cause mortality were centrally adjudicated. Hazard ratios (HRs) were obtained from adjusted Cox proportional hazards models. RESULTS After 5 years follow-up, all-cause mortality occurred in 18.4% of women. Compared with a DBP of 80 mm Hg, the fully adjusted HR for mortality was 1.33 (95% confidence interval [CI]: 1.04-1.71) for a DBP of 50 mm Hg and 1.67 (95% CI: 1.29-2.16) for a DBP of 100 mm Hg. The HRs for CVD were 1.14 (95% CI: 0.78-1.67) for a DBP of 50 mm Hg and HR 1.50 (95% CI: 1.03-2.17) for a DBP of 100 mm Hg. The nadir DBP associated with lowest mortality risk was 72 mm Hg overall. CONCLUSIONS In older women, consideration should be given to the potential adverse effects of low and high DBP. Low DBP may serve as a risk marker. DBP target levels between 68 and 75 mm Hg may avoid higher mortality risk.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Germany
- Department of Medicine I, University of Würzburg, Würzburg, Germany
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aileen P McGinn
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Victor Kamensky
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew Allison
- Department of Family Medicine, University of California San Diego, La Jolla, California, USA
| | - Marcia L Stefanick
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Peter F Schnatz
- Department of Obstetrics/Gynecology and Internal Medicine, Reading Hospital/Tower Health, West Reading, Pennsylvania, USA
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey S Berger
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, New York, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Saudi Arabia
| | - Lorena Garcia
- Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, California, USA
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - JoAnn E Manson
- Department of Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Alderman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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Abstract
Purpose of Review Clonal hematopoiesis of indeterminate potential (CHIP) has been identified as a novel cardiovascular risk factor. Here we review the relationship of lifestyle and environmental risk factors predisposing to somatic mutations and CHIP and provide an overview on age-related cardiovascular outcomes. Recent Findings CHIP has been associated with accelerated atherosclerosis and cardiovascular disease in both epidemiological and experimental studies. The most commonly mutated candidate driver genes are DNMT3A, TET2, JAK2, and ASXL1. The underlying mechanisms appear predominantly related to inflammatory pathways. Although age is the dominant risk factor for developing CHIP, emerging evidence suggests that other factors such as smoking, obesity/type 2 diabetes, or an unhealthy diet play a role in the occurrence of somatic mutations. Summary Evidence suggests a strong link between vascular risk factors, somatic hematopoietic mutations, and age-related cardiovascular disease. Further studies on CHIP biology are required to identify targeted interventions for risk reduction in patients with CHIP and inform the utility of screening strategies.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany. .,Department of Medicine I, University of Würzburg, Würzburg, Bavaria, Germany. .,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Stephanie Wissel
- Department of Medicine I, University of Würzburg, Würzburg, Bavaria, Germany
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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25
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Haring B, Hovey K, LaMonte M, Andrews C, Saquib N, Manson JE, Shimbo D, Ritch R, De Moraes CG, Wassertheil-Smoller S. Blood pressure control and glaucoma risk in postmenopausal women: an analysis from the Women's Health Initiative. Menopause 2022; 29:531-536. [PMID: 35486945 PMCID: PMC9060363 DOI: 10.1097/gme.0000000000001952] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to glaucoma risk in a large cohort of postmenopausal women. METHODS Prospective follow-up of 101,447 postmenopausal women without prior history of glaucoma enrolled in the Women's Health Initiative Study. BP was measured in-clinic at baseline and after 3 years using standardized procedures. Antihypertensive medication use was determined by drug inventory at baseline and year 3. Women self-reported incident newly diagnosed glaucoma annually. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards analyses adjusting for demographic, medical history, and lifestyle covariates. RESULTS During a mean follow-up of 4.7 years, we documented 7,514 glaucoma cases. Among women not on antihypertensive treatment, those with systolic BP ≥ 140 mm Hg or diastolic BP ≥80 mm Hg were not at higher risk of developing glaucoma (HR 0.97, 95% confidence intervals 0.88-1.08 and HR 1.00 [0.93-1.08], respectively), compared with women with a systolic BP < 120 mm Hg or a diastolic BP 60 to <80 mm Hg. Among women on antihypertensive treatment, neither systolic BP ≥ 140 mm Hg nor diastolic BP ≥80 mm Hg was associated with an increased glaucoma risk (HR 0.89 [0.79-1.00] and HR 0.97 [0.90-1.05], respectively). A diastolic BP <60 mm Hg was not associated with a higher risk compared with a diastolic BP 60 to <80 mm Hg. CONCLUSIONS BP control is not associated with an increased or decreased glaucoma risk in postmenopausal women.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
- Department of Medicine I, University of Würzburg, Würzburg, Bavaria, Germany
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathleen Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Mike LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Chris Andrews
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, NYC, NY, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye & Ear Infirmary New York, NYC, NY USA
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26
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Larson SR, Vasbinder AL, Reding KW, Leary PJ, Branch KR, Shadyab AH, Johnson KC, Haring B, Wallace R, Manson JE, Anderson G, Cheng RK. Histamine H 2 Receptor Antagonists and Heart Failure Risk in Postmenopausal Women: The Women's Health Initiative. J Am Heart Assoc 2022; 11:e024270. [PMID: 35191329 PMCID: PMC9075064 DOI: 10.1161/jaha.121.024270] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Prior studies suggested lower risk of heart failure (HF) in individuals taking H2 receptor antagonists (H2RA) compared with H2RA nonusers in relatively small studies. We evaluated the association of H2RA use and incident HF in postmenopausal women in the large‐scale WHI (Women’s Health Initiative) study. Methods and Results This study included postmenopausal women from the WHI without a history of HF at baseline. HF was defined as first incident hospitalization for HF and physician adjudicated. Multivariable Cox proportional hazards regression models evaluated the association of H2RA use as a time‐varying exposure with HF risk, after adjustment for demographic, lifestyle, and medical history variables. Sensitivity analyses examined (1) risk of HF stratified by the ARIC (Atherosclerosis Risk in Communities) score, (2) propensity score matching on H2RA use, (3) use of proton pump inhibitors rather than H2RA nonuse as the referent, and (4) exclusion of those taking diuretics at baseline. The primary analysis included 158 854 women after exclusion criteria, of whom 9757 (6.1%) were H2RA users. During median 8.2 years of follow‐up, 376 H2RA users (4.9 events/1000 person‐years) and 3206 nonusers (2.7 events/1000 person‐years) developed incident HF. After multivariable adjustment, there was no association between H2RA use and HF in the primary analysis (hazard ratio, 1.07; 95% CI, 0.94–1.22; P=0.31) or in any of the sensitivity analyses. Conclusions Clinical H2RA use was not associated with incident HF among postmenopausal women. Future studies are needed to evaluate potential effect modification by sex, HF severity, or patterns of use on H2RA exposure and HF risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000611.
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Affiliation(s)
- Sophia R Larson
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Alexi L Vasbinder
- Department of Health Informatics School of Nursing University of Washington Seattle WA
| | - Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics School of Nursing University of Washington Seattle WA
| | - Peter J Leary
- Division of Pulmonology and Critical Care Medicine Department of Medicine University of Washington Seattle WA
| | - Kelley R Branch
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science University of California, San Diego La Jolla CA
| | - Karen C Johnson
- Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN
| | - Bernhard Haring
- Department of Internal Medicine Saarland University Homburg Germany
| | - Robert Wallace
- Departments of Epidemiology and Medicine University of Iowa Iowa City IA
| | - JoAnn E Manson
- Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Garnet Anderson
- Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle WA
| | - Richard K Cheng
- Division of Cardiology Department of Medicine University of Washington Seattle WA
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27
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Liu L, Hayden KM, May NS, Haring B, Liu Z, Henderson VW, Chen JC, Gracely EJ, Wassertheil-Smoller S, Rapp SR. Association between blood pressure levels and cognitive impairment in older women: a prospective analysis of the Women's Health Initiative Memory Study. Lancet Healthy Longev 2022; 3:e42-e53. [PMID: 35112096 PMCID: PMC8804967 DOI: 10.1016/s2666-7568(21)00283-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Whether blood pressure (BP), and at what level of controlled BP, reduces risk of cognitive impairment remains uncertain. We investigated the association of BP and hypertension treatment status with mild cognitive impairment and dementia in older women. METHODS We prospectively analysed a sample of 7207 community-dwelling women aged 65-79 years participating in the Women's Health Initiative Memory Study (WHIMS). Participants were recruited between May 28, 1996, and Dec 13, 1999, at 39 US clinical centres, and they were followed up until Dec 31, 2019. Cognitive function was assessed annually. Mild cognitive impairment and probable dementia were defined through a centralised adjudication process. BP was measured by trained and certified staff at baseline. Pulse pressure (PP) was calculated as systolic BP (SBP) minus diastolic BP. Hypertension was defined using the American Heart Association 2017 Guideline for High BP in Adults. Outcomes were (1) mild cognitive impairment, (2) probable dementia, and (3) cognitive loss (the combined endpoint of either mild cognitive impairment or probable dementia, or both). We estimated hazard ratios (HRs) to assess the association between hypertension, SBP, and PP with the risk of study outcomes using Cox proportional hazards regression models, with adjustment for key covariates. FINDINGS During a median follow-up of 9 years (IQR 6-15), 1132 (15·7%) participants were classified as mild cognitive impairment, 739 (10·3%) as probable dementia, and 1533 (21·3%) as cognitive loss. The incidence rates per 1000 person-years were 15·3 cases (95% CI 14·4-16·2) for mild cognitive impairment, 9·7 cases (9·0-10·4) for probable dementia, and 20·3 (19·3-21·3) for cognitive loss. Elevated SBP and PP were significantly associated with increased risk of mild cognitive impairment and cognitive loss (test for trends across SBP and PP strata, p<0·01). Individuals with hypertension, but with controlled SBP of less than 120 mm Hg did not have a significantly increased risk of mild cognitive impairment (HR 1·33, 95% CI 0·98-1·82, p=0·071), and of cognitive loss (1·09, 0·82-1·44, p=0·57) compared with normotension. Individuals on anti-hypertensive treatment with PP of less than 50 mm Hg did not have a significantly higher risk of mild cognitive impairment (1·26, 0·98-1·62, p=0·07) and of cognitive loss (1·17, 0·94-1·46, p=0·16). There were no significant associations between hypertension, SBP, or PP and probable dementia. INTERPRETATION Results of our study show significant associations of hypertension and elevated SBP and PP levels with risk of mild cognitive impairment and the combined endpoint of either mild cognitive impairment or probable dementia, suggesting that intensive control of hypertension, SBP, and PP can preserve cognitive health in older women. FUNDING National Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services.
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28
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Yi SY, Steffen LM, Haring B, Rebholz CM, Mosley TH, Shah AM. Associations of the Dietary Approaches to Stop Hypertension dietary pattern with cardiac structure and function. Nutr Metab Cardiovasc Dis 2021; 31:3345-3351. [PMID: 34635365 PMCID: PMC8605993 DOI: 10.1016/j.numecd.2021.08.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/12/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Various food groups have been associated with measures of left ventricular geometry and function. Whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern in mid-life is associated with a favorable cardiac structure and function later in life is unknown. METHODS AND RESULTS The study population consisted of the Atherosclerosis Risk in Communities study participants free of cardiovascular disease at study visit 3 in 1993-1995. Dietary intake was assessed by food frequency questionnaire at study visits 1 (1987-1989) and 3 (1993-1995). Participants who underwent transthoracic echocardiograms at the Jackson field center at visit 3 (n = 1974) and at all field centers at study visit 5 (2011-2013; n = 4651) were included in this study. General linear regression was used to evaluate associations between dietary intake and markers of cardiac structure and function adjusting for potential confounders. Higher DASH score was associated with lower left ventricle mean wall thickness and higher absolute value of longitudinal strain at visit 5 (ptrend = 0.004 and < 0.001, respectively). CONCLUSION The DASH dietary pattern in midlife was favorably associated with left ventricle structure and systolic function later in life. These results emphasize the importance of adhering to a healthy eating plan as one lifestyle measure to preserve cardiac structure and function.
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Affiliation(s)
- So-Yun Yi
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | - Bernhard Haring
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas H Mosley
- MIND Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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29
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Haring B, Schmidt A, Frantz S. [Acute Chest Pain: A Stepwise Approach to Management]. Pneumologie 2021; 75:901-909. [PMID: 34788891 DOI: 10.1055/a-1238-5254] [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: 10/19/2022]
Abstract
Acute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.
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30
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Haring B, Hovey K, La Monte M, Andrews C, Saquib N, Manson J, Shimbo D, Ritch R, De Moraes CG, Wassertheil-Smoller S. Abstract P188: Blood Pressure Control And Glaucoma Risk In Older Women. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.p188] [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: 11/16/2022]
Abstract
Objective:
Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to risk of incident glaucoma in a large cohort of elderly women.
Methods:
Prospective follow-up of 101,447 postmenopausal women without prior history of glaucoma enrolled in the Women’s Health Initiative Study (WHI). Blood pressure was measured in-clinic at baseline and after 3 years using standardized procedures and average BP was calculated. Antihypertensive medication use was determined by drug inventory at baseline and year 3. Women self-reported incident newly diagnosed glaucoma annually. Hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards analyses adjusting for demographic, medical history, and lifestyle covariates.
Results:
During a mean follow-up of 4.7 years, we documented 7,514 glaucoma cases. Among women not on antihypertensive treatment, those with systolic BP ≥140 mmHg or diastolic BP ≥80 mmHg were not at higher risk of developing glaucoma (HR 0.97, 95% CI 0.88-1.08 and HR 1.00 [0.93-1.08], respectively), compared to women with a systolic BP <120 mmHg or a diastolic BP 60-<80 mmHg. Among women on antihypertensive treatment, neither systolic BP ≥140 mmHg nor diastolic BP ≥80 mmHg was associated with an increased risk of glaucoma (HR 0.91 [0.82-1.01] and HR 0.97 [0.90-1.05], respectively). A diastolic BP <60 mmHg was not associated with a higher risk compared to a diastolic BP 60-<80 mmHg.
Conclusions:
BP control is not associated with an increased or decreased glaucoma risk in elderly women.
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Affiliation(s)
| | | | | | | | | | | | | | - Robert Ritch
- New York Eye and Ear Infirmary New York, New York City, NY
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31
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Chen GC, Arthur R, Mossavar-Rahmani Y, Xue X, Haring B, Shadyab AH, Allison MA, Liu S, Tinker LF, Saquib N, Coday M, Shikany JM, Neuhouser ML, Snetselaar LG, Van Horn L, Rohan TE, Wassertheil-Smoller S, Kaplan RC, Qi Q. Adherence to Recommended Eating Patterns Is Associated With Lower Risk of Peripheral Arterial Disease: Results From the Women's Health Initiative. Hypertension 2021; 78:447-455. [PMID: 34176290 DOI: 10.1161/hypertensionaha.121.17432] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Guo-Chong Chen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (G.-C.C., R.A., Y.M.-R., X.X., T.E.R., S.W.-S., R.C.K., Q.Q.)
| | - Rhonda Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (G.-C.C., R.A., Y.M.-R., X.X., T.E.R., S.W.-S., R.C.K., Q.Q.)
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (G.-C.C., R.A., Y.M.-R., X.X., T.E.R., S.W.-S., R.C.K., Q.Q.)
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (G.-C.C., R.A., Y.M.-R., X.X., T.E.R., S.W.-S., R.C.K., Q.Q.)
| | - Bernhard Haring
- Department of Cardiology, University Heart Center Graz, Medical University of Graz, Austria (B.H.)
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla (A.H.S., M.A.A.)
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla (A.H.S., M.A.A.)
| | - Simin Liu
- Center for Global Cardiometabolic Health and Departments of Epidemiology, Medicine, and Surgery, Brown University, Providence, RI (S.L.)
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (L.F.T., M.L.N.)
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukayriah, Saudi Arabia (N.S.)
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (M.C.)
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham (J.M.S.)
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (L.F.T., M.L.N.)
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa (L.G.S.)
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (G.-C.C., R.A., Y.M.-R., X.X., T.E.R., S.W.-S., R.C.K., Q.Q.)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (G.-C.C., R.A., Y.M.-R., X.X., T.E.R., S.W.-S., R.C.K., Q.Q.)
| | - Robert C Kaplan
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (R.C.K.)
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (G.-C.C., R.A., Y.M.-R., X.X., T.E.R., S.W.-S., R.C.K., Q.Q.).,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (Q.Q.)
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Haring B, Hunt R, Manson J, Lamonte MJ, Klein L, Allison MA, Wild RA, Wallace RB, Shadyab A, Breathett K, Eaton CB, Wassertheil-smoller SW, Shimbo D. Abstract MP60: Blood Pressure Variability And Risk Of Heart Failure In Postmenopausal Women. Results From The Women's Health Initiative. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
Introduction:
Little is known about the relationships between visit-to-visit BPV and HF sub-phenotypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). The aim of this analysis was to investigate the relationship of visit-to-visit systolic and diastolic BPV and risk of HF subtypes HFrEF and HFpEF in a large cohort of postmenopausal women.
Hypothesis:
We hypothesized that greater systolic and diastolic BPV would be associated with a higher risk for HFrEF and HFpEF.
Methods:
This study consisted of 23,918 postmenopausal women aged 50-79 enrolled in the Women’s Health Initiative Hormone Therapy Trials. Blood pressure (BP) was measured at baseline (1993-1998) and then annually through 2005 by trained clinical staff. Variability was defined as the standard deviation of the mean BP across visits (SDm). The outcome was first HF hospitalization, which was adjudicated by physician review of medical records. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for HF endpoints with adjustments for demographic, medical history, lifestyle factors, antihypertensive medication use, mean systolic and diastolic BPs, and time-varying coronary events interim to HF hospitalization.
Results:
During a mean follow-up of 15.8 years, 913 incident cases of HFpEF and 421 cases of HFrEF were identified. In fully adjusted models, women in the highest quartile of SDm for systolic blood pressure were at higher risk of HFpEF [HR (95% CI): 1.61, 95% confidence interval: 1.12, 2.31)], but not HFrEF [1.18 (0.70,1.96)] compared to women in the lowest quartile of SDm. Higher SDm for diastolic blood pressure was not related to HFpEF [1.19 (0.85,1.65)] or HFrEF [1.56 (0.89,2.74)].
Conclusions:
Greater systolic BPV was associated with a higher risk of HFpEF independent of mean blood pressure and coronary events interim to HF hospitalization. These findings suggest that control of BPV may be a relevant target for the prevention of HFpEF in postmenopausal women.
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Abstract
Taxines are the active, poisonous constituents in yew plants (Taxus spp.) and can result in life-threatening cardiac toxicity. Rapid elimination of yew plant material and administration of active charcoal can limit absorption of toxins. Treatment is confined to supportive care. Therapeutic interventions such as utilization of digoxin immune fab, hemodialysis and temporary cardiac pacing may be utilized. Extracorporeal life support should be considered for severe cases.
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Affiliation(s)
- B Haring
- Medizinische Klinik und Poliklinik I, Schwerpunkt Internistische Notfall- und Intensivmedizin, Universitätsklinikum Würzburg
| | - D Weismann
- Medizinische Klinik und Poliklinik I, Schwerpunkt Internistische Notfall- und Intensivmedizin, Universitätsklinikum Würzburg
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Sun Y, Liu B, Snetselaar LG, Wallace RB, Shadyab AH, Kroenke CH, Haring B, Howard BV, Shikany JM, Valdiviezo C, Bao W. Association of Major Dietary Protein Sources With All-Cause and Cause-Specific Mortality: Prospective Cohort Study. J Am Heart Assoc 2021; 10:e015553. [PMID: 33624505 PMCID: PMC8174240 DOI: 10.1161/jaha.119.015553] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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] [Indexed: 12/21/2022]
Abstract
Background Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient. Methods and Results We included 102 521 postmenopausal women enrolled in the Women’s Health Initiative between 1993 and 1998, and followed them through February 2017. During 1 876 205 person‐years of follow‐up, 25 976 deaths occurred. Comparing the highest with the lowest quintile, plant protein intake was inversely associated with all‐cause mortality (hazard ratio [HR], 0.91 [0.86, 0.96]), cardiovascular disease mortality (HR, 0.88 [0.79, 0.97]), and dementia mortality (HR, 0.79 [0.67, 0.94]). Among major protein sources, comparing the highest with the lowest quintile of consumption, processed red meat (HR, 1.06 [1.01, 1.10]) or eggs (HR, 1.14 [1.10, 1.19]) was associated with higher risk of all‐cause mortality. Unprocessed red meat (HR, 1.12 [1.02, 1.23]), eggs (HR, 1.24 [1.14, 1.34]), or dairy products (HR, 1.11 [1.02, 1.22]) was associated with higher risk of cardiovascular disease mortality. Egg consumption was associated with higher risk of cancer mortality (HR, 1.10 [1.02, 1.19]). Processed red meat consumption was associated with higher risk of dementia mortality (HR, 1.20 [1.05, 1.32]), while consumption of poultry (HR, 0.85 [0.75, 0.97]) or eggs (HR, 0.86 [0.75, 0.98]) was associated with lower risk of dementia mortality. In substitution analysis, substituting of animal protein with plant protein was associated with a lower risk of all‐cause mortality, cardiovascular disease mortality, and dementia mortality, and substitution of total red meat, eggs, or dairy products with nuts was associated with a lower risk of all‐cause mortality. Conclusions Different dietary protein sources have varying associations with all‐cause mortality, cardiovascular disease mortality, and dementia mortality. Our findings support the need for consideration of protein sources in future dietary guidelines.
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Affiliation(s)
- Yangbo Sun
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Buyun Liu
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Linda G Snetselaar
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Robert B Wallace
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health School of Medicine University of California, San Diego La Jolla CA
| | - Candyce H Kroenke
- Division of Research Kaiser Permanente Northern California Oakland CA
| | - Bernhard Haring
- Department of Medicine I/Cardiology University of Würzburg Germany
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Science Washington DC
| | - James M Shikany
- Division of Preventive Medicine School of Medicine University of Alabama at Birmingham Birmingham AL
| | - Carolina Valdiviezo
- Medstar Washington Hospital Center and Georgetown University School of Medicine Washington DC
| | - Wei Bao
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA.,Obesity Research and Education Initiative University of Iowa Iowa City IA.,Fraternal Order of Eagles Diabetes Research Center University of Iowa Iowa City IA
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Haring B, Reiner AP, Liu J, Tobias DK, Whitsel E, Berger JS, Desai P, Wassertheil-Smoller S, LaMonte MJ, Hayden KM, Bick AG, Natarajan P, Weinstock JS, Nguyen PK, Stefanick M, Simon MS, Eaton CB, Kooperberg C, Manson JE. Healthy Lifestyle and Clonal Hematopoiesis of Indeterminate Potential: Results From the Women's Health Initiative. J Am Heart Assoc 2021; 10:e018789. [PMID: 33619969 PMCID: PMC8174283 DOI: 10.1161/jaha.120.018789] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 01/31/2023]
Abstract
Background Presence of clonal hematopoiesis of indeterminate potential (CHIP) is associated with a higher risk of atherosclerotic cardiovascular disease, cancer, and mortality. The relationship between a healthy lifestyle and CHIP is unknown. Methods and Results This analysis included 8709 postmenopausal women (mean age, 66.5 years) enrolled in the WHI (Women's Health Initiative), free of cancer or cardiovascular disease, with deep‐coverage whole genome sequencing data available. Information on lifestyle factors (body mass index, smoking, physical activity, and diet quality) was obtained, and a healthy lifestyle score was created on the basis of healthy criteria met (0 point [least healthy] to 4 points [most healthy]). CHIP was derived on the basis of a prespecified list of leukemogenic driver mutations. The prevalence of CHIP was 8.6%. A higher healthy lifestyle score was not associated with CHIP (multivariable‐adjusted odds ratio [OR] [95% CI], 0.99 [0.80–1.23] and 1.13 [0.93–1.37]) for the upper (3 or 4 points) and middle category (2 points), respectively, versus referent (0 or 1 point). Across score components, a normal and overweight body mass index compared with obese was significantly associated with a lower odds for CHIP (OR, 0.71 [95% CI, 0.57–0.88] and 0.83 [95% CI, 0.68–1.01], respectively; P‐trend 0.0015). Having never smoked compared with being a current smoker tended to be associated with lower odds for CHIP. Conclusions A healthy lifestyle, based on a composite score, was not related to CHIP among postmenopausal women. However, across individual lifestyle factors, having a normal body mass index was strongly associated with a lower prevalence of CHIP. These findings support the idea that certain healthy lifestyle factors are associated with a lower frequency of CHIP.
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Affiliation(s)
- Bernhard Haring
- Department of Internal Medicine I University of Würzburg Bavaria Germany
| | - Alexander P Reiner
- Division of Public Health Sciences Department of Epidemiology Fred Hutchinson Cancer Research CenterUniversity of Washington Seattle WA
| | | | - Deirdre K Tobias
- Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA.,Division of Preventive Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Eric Whitsel
- Department of Epidemiology and Medicine University of North Carolina Chapel Hill NC
| | - Jeffrey S Berger
- Department of Medicine Center for the Prevention of Cardiovascular Disease New York University School of Medicine New York City NY
| | - Pinkal Desai
- Division of Hematology and Oncology Weill Cornell Medical College New York NY
| | | | - Michael J LaMonte
- Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo-SUNY Buffalo NY
| | - Kathleen M Hayden
- Division of Public Health Sciences Department of Social Sciences and Health Policy Wake Forest School of Medicine Winston-Salem NC
| | - Alexander G Bick
- Department of Medicine Program in Medical and Population Genetics Harvard Medical SchoolBroad Institute of Harvard and MIT Cambridge MA
| | - Pradeep Natarajan
- Department of Medicine Program in Medical and Population Genetics Harvard Medical SchoolBroad Institute of Harvard and MIT Cambridge MA
| | - Joshua S Weinstock
- Department of Biostatistics and Center for Statistical Genetics University of Michigan School of Public Health Ann Arbor MI
| | - Patricia K Nguyen
- Department of Medicine Stanford University Medical Center Palo Alto CA
| | - Marcia Stefanick
- Department of Medicine Stanford University Medical Center Palo Alto CA.,Departments of Obstetrics and Gynecology Stanford University Palo Alto CA
| | - Michael S Simon
- Department of Oncology Karmanos Cancer Institute at Wayne State University Detroit MI
| | - Charles B Eaton
- Department of Epidemiology Center for Primary Care and Prevention Brown University Providence RI
| | | | - JoAnn E Manson
- Division of Preventive Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
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36
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Chen GC, Chen LH, Mossavar-Rahmani Y, Kamensky V, Shadyab AH, Haring B, Wild RA, Silver B, Kuller LH, Sun Y, Saquib N, Howard B, Snetselaar LG, Neuhouser ML, Allison MA, Van Horn L, Manson JE, Wassertheil-Smoller S, Qi Q. Dietary cholesterol and egg intake in relation to incident cardiovascular disease and all-cause and cause-specific mortality in postmenopausal women. Am J Clin Nutr 2020; 113:948-959. [PMID: 33330926 PMCID: PMC8023834 DOI: 10.1093/ajcn/nqaa353] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The potential cardiovascular impact of dietary cholesterol intake has been actively debated for decades. OBJECTIVES We aimed to evaluate associations of dietary cholesterol and egg intakes with incident cardiovascular disease (CVD) and all-cause and cause-specific mortality. METHODS We included 96,831 US postmenopausal women aged 50-79 y without known CVD or cancer during baseline enrollment (1993-1998) of the Women's Health Initiative. Dietary information was collected using a validated FFQ. Incident CVD [i.e., ischemic heart disease (IHD) and stroke] and all-cause and cause-specific mortality were ascertained and adjudicated through February 2018. RESULTS A total of 9808 incident CVD cases and 19,508 all-cause deaths occurred during a median follow-up of 17.8 y and 18.9 y, respectively. After multivariable adjustment for traditional risk factors and key dietary nutrients including dietary saturated fat, there were modest associations of dietary cholesterol intake with incident CVD (HRQ5versusQ1: 1.12; 95% CI: 1.03, 1.21; P-trend < 0.001) and all-cause mortality (HRQ5versusQ1: 1.09; 95% CI: 1.02, 1.15; P-trend < 0.001). Significant positive associations were also observed between dietary cholesterol and incident IHD (P-trend = 0.007), incident ischemic stroke (P-trend = 0.002), and CVD mortality (P-trend = 0.002), whereas there was an inverse association for incident hemorrhagic stroke (P-trend = 0.037) and no association for mortality from cancer, Alzheimer disease/dementia, respiratory diseases, or other causes (P-trend > 0.05). Higher egg consumption was also associated with modestly higher risk of incident CVD (P-trend = 0.004) and all-cause mortality (P-trend < 0.001), with HRs of 1.14 (95% CI: 1.04, 1.25) and 1.14 (95% CI: 1.07, 1.22), respectively, when comparing ≥1 egg/d with <1 egg/wk. CONCLUSIONS Both higher dietary cholesterol intake and higher egg consumption appeared to be associated with modestly elevated risk of incident CVD and all-cause mortality in US postmenopausal women.
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Affiliation(s)
- Guo-Chong Chen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Li-Hua Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Victor Kamensky
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Bernhard Haring
- Department of Medicine I, University of Würzburg, Würzburg, Germany
| | - Robert A Wild
- Clinical Epidemiology and Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Brian Silver
- UMass Memorial Medical Center, Worcester, MA, USA
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa, IA, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukayriah, Saudi Arabia
| | - Barbara Howard
- MedStar Health Research Institute Georgetown University, Washington, DC, USA,Georgetown University School of Medicine, Washington, DC, USA
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa, IA, USA
| | - Marian L Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Qibin Qi
- Address correspondence to QQ (e-mail: )
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37
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Miller CR, Wactawski-Wende J, Manson JE, Haring B, Hovey KM, Laddu D, Shadyab AH, Wild RA, Bea JW, Tinker LF, Martin LW, Nguyen PK, Garcia L, Andrews CA, Eaton CB, Stefanick ML, LaMonte MJ. Walking Volume and Speed Are Inversely Associated With Incidence of Treated Hypertension in Postmenopausal Women. Hypertension 2020; 76:1435-1443. [PMID: 32981366 DOI: 10.1161/hypertensionaha.120.15839] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Few studies have evaluated hypertension incidence in relation to walking, which is a common physical activity among adults. We examined the association between walking and hypertension incidence in 83 435 postmenopausal women who at baseline were aged 50 to 79 years, without known hypertension, heart failure, coronary heart disease, or stroke, and reported the ability to walk at least one block without assistance. Walking volume (metabolic equivalent hours per week) and speed (miles per hour) were assessed by questionnaire. Incident physician-diagnosed hypertension treated with medication was ascertained through annual questionnaires. During a mean 11-year follow-up, 38 230 hypertension cases were identified. After adjustment for covariates including nonwalking activities, a significant inverse association with hypertension was observed across categories of baseline walking volume (0 [referent], >0-3.5, 3.6-7.5, and >7.5 metabolic equivalent hours per week), hazard ratio: 1.00 (referent), 0.98, 0.95, 0.89; trend P<0.001. Faster walking speeds (<2, 2-3, 3-4, and >4 miles per hour) also were associated with lower hypertension risk, hazard ratio: 1.00 (referent), 1.07, 0.95, 0.86, 0.79; trend P<0.001. Further adjustment for walking duration (h/wk) had little impact on the association for walking speed (hazard ratio: 1.00 [referent], 1.08, 0.96, 0.86, 0.77; trend P<0.001). Significant inverse associations for walking volume and speed persisted after additional control for baseline blood pressure. Results for time-varying walking were comparable to those for baseline exposures. This study showed that walking at guideline-recommended volumes (>7.5 metabolic equivalent hours per week) and at faster speeds (≥2 miles per hour) is associated with lower hypertension risk in postmenopausal women. Walking should be encouraged as part of hypertension prevention in older adults.
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Affiliation(s)
- Connor R Miller
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
| | - Jean Wactawski-Wende
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard University Medical School, Boston, MA (J.E.M.)
| | - Bernhard Haring
- Department of Internal Medicine I, University of Würzburg, Bavaria, Germany (B.H.)
| | - Kathleen M Hovey
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois-Chicago (D.L.)
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego (A.H.S.)
| | - Robert A Wild
- Departments of Obstetrics and Gynecology and Clinical Epidemiology, University of Oklahoma Health Sciences Center (R.A.W.)
| | - Jennifer W Bea
- Departments of Medicine and Nutritional Sciences, College of Medicine, University of Arizona, Tucson (J.W.B.)
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (L.F.T.)
| | - Lisa W Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.)
| | - Patricia K Nguyen
- Department of Medicine (P.K.N., M.L.S.), Stanford University School of Medicine, Palo Alto, CA
| | - Lorena Garcia
- Division of Epidemiology, Department of Public Health Sciences, School of Medicine, University of California, Davis (L.G.)
| | - Christopher A Andrews
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor (C.A.A.)
| | - Charles B Eaton
- Departments of Family Medicine and Epidemiology, Alpert Medical School, Brown University, Providence, RI (C.B.E.)
| | - Marcia L Stefanick
- Department of Medicine (P.K.N., M.L.S.), Stanford University School of Medicine, Palo Alto, CA.,Departments of Medicine and Obstetrics and Gynecology (M.L.S.), Stanford University School of Medicine, Palo Alto, CA
| | - Michael J LaMonte
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
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38
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Shadyab AH, Manson JE, Luo J, Haring B, Saquib N, Snetselaar LG, Chen JC, Groessl EJ, Wassertheil-Smoller S, Sun Y, Hale L, LeBoff MS, LaCroix AZ. Associations of Coffee and Tea Consumption With Survival to Age 90 Years Among Older Women. J Am Geriatr Soc 2020; 68:1970-1978. [PMID: 32329900 PMCID: PMC8580285 DOI: 10.1111/jgs.16467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/08/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age. OBJECTIVE To examine associations of coffee and tea consumption with survival to age 90 years. DESIGN Prospective cohort study among participants from the Women's Health Initiative, recruited during 1993 to 1998 and followed up until March 31, 2018. SETTING The setting included 40 US clinical centers. PARTICIPANTS A racially and ethnically diverse cohort of 27,480 older women, aged 65 to 81 years at baseline. MEASUREMENTS Women were classified as having either survived to age 90 years or died before this age. Consumption of caffeinated and decaffeinated coffee and caffeinated tea was assessed at baseline and categorized as 0, 1, 2 to 3, or 4 or more cups/day. Associations of coffee and tea consumption with survival to age 90 years were examined using logistic regression models adjusted for sociodemographic characteristics, lifestyle behaviors, dietary quality, and chronic disease history. RESULTS A total of 14,659 (53.3%) women survived to age 90 years during follow-up. Caffeinated coffee, decaffeinated coffee, or caffeinated tea consumption was not significantly associated with survival to age 90 years after adjusting for confounders. Findings did not significantly vary by smoking, body mass index, or race/ethnicity. CONCLUSION No amount of coffee or tea consumption was associated with late-age survival among older women. These findings may be reassuring to older women who consume coffee and tea as part of their daily diets but do not support drinking these beverages to achieve longevity.
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Affiliation(s)
- Aladdin H. Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Bernhard Haring
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukayriyah, Saudi Arabia
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Jiu-Chiuan Chen
- Departments of Preventive Medicine and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Erik J. Groessl
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | | | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Lauren Hale
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Meryl S. LeBoff
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Woman's Hospital, Harvard Medical School, Boston, MA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
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39
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Chou EL, Pettinger M, Haring B, Mell MW, Hlatky MA, Wactawski-Wende J, Allison MA, Wild RA, Shadyab AH, Wallace RB, Snetselaar LG, Eagleton MJ, Conrad MF, Liu S. Lipoprotein(a) levels and risk of abdominal aortic aneurysm in the Women's Health Initiative. J Vasc Surg 2020; 73:1245-1252.e3. [PMID: 32882349 DOI: 10.1016/j.jvs.2020.07.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/13/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Few studies have prospectively examined the associations of lipoprotein(a) [Lp(a)] levels with the risk of abdominal aortic aneurysm (AAA), especially in women. Accounting for commonly recognized risk factors, we investigated the baseline Lp(a) levels and the risk of AAA among postmenopausal women participating in the ongoing national Women's Health Initiative. METHODS Women's Health Initiative participants with baseline Lp(a) levels available who were beneficiaries of Medicare parts A and B fee-for-service at study enrollment or who had aged into Medicare at any point were included. Participants with missing covariate data or known AAA at baseline were excluded. Thoracic aneurysms were excluded owing to the different pathophysiology. The AAA cases and interventions were identified using the International Classification of Diseases, 9th and 10th revision, codes and Current Procedural Terminology codes from claims data. Hazard ratios were computed using Cox proportional hazard models according to the quintiles of Lp(a). RESULTS The mean age of the 6615 participants included in the analysis was 65.3 years. Of the 6615 participants, 66.6% were non-Hispanic white, 18.9% were black, 7% were Hispanic and 4.7% were Asian/Pacific Islander. Compared with the participants in the lowest Lp(a) quintile, those in higher quintiles were more likely to be overweight, black, and former or current smokers, to have hypertension, hyperlipidemia, and a history of cardiovascular disease, and to use menopausal hormone therapy and statins. During 65,476 person-years of follow-up, with a median of 10.4 years, 415 women had been diagnosed with an AAA and 36 had required intervention. More than one half had required intervention for a ruptured AAA. We failed to find a statistically significant association between Lp(a) levels and incident AAA. Additional sensitivity analyses stratified by race, with exclusion of statin users and alternative categorizations of Lp(a) using log-transformed levels, tertiles, and a cutoff of >50 mg/dL, were conducted, which did not reveal any significant associations. CONCLUSIONS We found no statistically significant association between Lp(a) levels and the risk of AAA in a large and well-phenotyped sample of postmenopausal women. Women with high Lp(a) levels were more likely to be overweight, black, and former or current smokers, and to have hypertension, hyperlipidemia, and a history of cardiovascular disease, or to use hormone therapy and statins compared with those with lower Lp(a) levels. These findings differ from previous prospective, case-control, and meta-analysis studies that had supported a significant relationship between higher Lp(a) levels and an increased risk of AAA. Differences in the association could have resulted from study limitations or sex differences.
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Affiliation(s)
- Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Wash
| | - Bernhard Haring
- Department of Internal Medicine, University of Würzburg, Würzburg, Germany
| | - Matthew W Mell
- Division of Vascular Surgery, University of California, Davis, Medical Center, Sacramento, Calif
| | - Mark A Hlatky
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, Calif
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, Calif
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, Calif
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Simin Liu
- Department of Epidemiology and Medicine, Brown University, Providence, RI
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40
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Chen G, Mossavar-Rahmani Y, Xue X, Haring B, Shadyab A, Allison M, Liu S, Tinker L, Saquib N, Coday M, Shikany J, Neuhouser M, Snetselaar L, Horn LV, Rohan T, Wassertheil-Smoller S, Kaplan R, Qi Q. Dietary Pattern Indices and Incident Peripheral Arterial Disease in Women: A Prospective Cohort Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa046_013] [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: 11/14/2022] Open
Abstract
Abstract
Objectives
We aimed to evaluate diet quality as reflected by multiple a priori dietary pattern indices in relation to incident PAD.
Methods
We included 138,506 US postmenopausal women aged 50–79 years without known PAD at baseline (1993–1998) of the Women's Health Initiative. Score of 4 dietary pattern indices, including the alternate Mediterranean diet (aMED) index, the alternate Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet index, and the Healthy Eating Index (HEI)-2015, were derived using data collected by a validated food frequency questionnaire. Incident cases of symptomatic PAD in the lower extremities were ascertained and adjudicated through March 2019 by reviewing medical record. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models, with adjustment for multiple potential confounders including known risk factors for PAD (i.e., smoking, high blood pressure, dyslipidemia, and diabetes).
Results
During a median 18.6 years of follow-up, 1036 incident cases of PAD were identified. All 4 dietary pattern indices were inversely associated with risk of PAD. The multivariable-adjusted HRs (95% CI) comparing the highest with the lowest score quartiles were 0.74 (0.61–0.91) for aMED index (P-trend across quartile = 0.010), 0.79 (0.65–0.95) for AHEI-2010 (P-trend < 0.001), 0.66 (0.55–0.80) for DASH index (P-trend < 0.001), and 0.68 (0.56–0.82) for HEI-2015 (P-trend < 0.001). Among major foods/nutrients contributing to these dietary patterns, intakes of whole grains (top vs. bottom quartile, HR = 0.81; P-trend = 0.01), legumes (HR = 0.77; P-trend = 0.004), dietary fiber (HR = 0.78; P-trend = 0.01), and vegetable protein (HR = 0.76; P-trend = 0.006) were associated with lower risk of PAD, whereas intakes of red meat (HR = 1.38; P-trend = 0.003), processed meat (HR = 1.36; P-trend = 0.004), and regular soft drinks (HR = 1.26; P-trend = 0.01) were associated with higher risk.
Conclusions
Adherence to various recommended dietary patterns is associated with lower risk of PAD in a nationwide cohort of US postmenopausal women. Our findings may extend the range of cardiovascular diseases that are potentially preventable by adopting a healthy dietary pattern.
Funding Sources
National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
| | | | | | | | | | | | - Simin Liu
- Department of Epidemiology, Brown University
| | - Lesley Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center
| | | | - Mace Coday
- University of Tennessee Health Science Center
| | - James Shikany
- Depatment of Medicine, University of Alabama Birmingham
| | | | | | | | | | | | | | - Qibin Qi
- Albert Einstein College of Medicine
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Gerber DA, Stefanick M, Hlatky M, Yang J, Hedlin H, Haring B, Perez M. DIETARY PROTEIN INTAKE AND INCIDENT ATRIAL FIBRILLATION IN POSTMENOPAUSAL WOMEN FROM THE WOMEN's HEALTH INITIATIVE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30551-9] [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: 10/24/2022]
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Haring B, Selvin E, He X, Coresh J, Steffen LM, Folsom AR, Tang W, Rebholz CM. Adherence to the Dietary Approaches to Stop Hypertension Dietary Pattern and Risk of Abdominal Aortic Aneurysm: Results From the ARIC Study. J Am Heart Assoc 2019; 7:e009340. [PMID: 30571386 PMCID: PMC6404186 DOI: 10.1161/jaha.118.009340] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 02/07/2023]
Abstract
Background The role of a healthy dietary pattern in the prevention of abdominal aortic aneurysms (AAA) is unknown. We aimed to evaluate the relationship between adherence to a Dietary Approaches To Stop Hypertension‐style dietary pattern and the risk of incident AAAs. Methods and Results Dietary intake was assessed via a 66‐item food frequency questionnaire at baseline (1987–1989) and at visit 3 (1993–1995) in 13 496 participants enrolled in the ARIC (Atherosclerosis Risk in Communities) study without clinical AAA (mean age, 54 years). A dietary scoring index based on food times was constructed to assess self‐reported adherence to a dietary approaches to stop hypertension‐style dietary pattern. Participants were followed for incident clinical AAAs using hospital discharge diagnoses, Medicare inpatient and outpatient diagnoses, or death certificates through December 31, 2011. Cox proportional hazards models with covariate adjustment were used to estimate hazard ratios with 95% confidence intervals. During a median follow‐up of 23 years, there were 517 incident AAA cases. Individuals with a Dietary Approaches To Stop Hypertension‐style diet score in the highest quintile had a 40% lower risk of hospitalization for AAA than those in the lowest quintile (hazard ratioQ5 vs Q1: 0.60; 95% confidence intervals: 0.44, 0.83; Ptrend=0.002). In detailed analyses, higher consumption of fruits, vegetables, whole grains, low‐fat dairy, and nuts and legumes was related to a lower risk for AAA. Conclusions Greater adherence to a Dietary Approaches To Stop Hypertension‐style dietary pattern was associated with lower risk for AAA. Higher consumption of fruits, vegetables, whole grains, low‐fat dairy as well as nuts and legumes may help to decrease the burden of AAAs.
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Affiliation(s)
- Bernhard Haring
- 1 Department of Internal Medicine I University of Würzburg Bavaria Germany
| | - Elizabeth Selvin
- 2 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,4 Welch Center for Prevention Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
| | - Xintong He
- 2 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,4 Welch Center for Prevention Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
| | - Josef Coresh
- 2 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,4 Welch Center for Prevention Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
| | - Lyn M Steffen
- 3 Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis MN
| | - Aaron R Folsom
- 3 Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis MN
| | - Weihong Tang
- 3 Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis MN
| | - Casey M Rebholz
- 2 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,4 Welch Center for Prevention Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
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Mossavar-Rahmani Y, Kamensky V, Manson JE, Silver B, Rapp SR, Haring B, Beresford SAA, Snetselaar L, Wassertheil-Smoller S. Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative. Stroke 2019; 50:555-562. [PMID: 30802187 DOI: 10.1161/strokeaha.118.023100] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background and Purpose- We examine the association between self-reported consumption of artificially sweetened beverages (ASB) and stroke and its subtypes, coronary heart disease, and all-cause mortality in a cohort of postmenopausal US women. Methods- The analytic cohort included 81 714 women from the Women's Health Initiative Observational Study, a multicenter longitudinal study of the health of 93 676 postmenopausal women of ages 50 to 79 years at baseline who enrolled in 1993 to 1998. This prospective study had a mean follow-up time of 11.9 years (SD of 5.3 years.) Participants who completed a follow-up visit 3 years after baseline were included in the study. Results- Most participants (64.1%) were infrequent consumers (never or <1/week) of ASB, with only 5.1% consuming ≥2 ASBs/day. In multivariate analyses, those consuming the highest level of ASB compared to never or rarely (<1/wk) had significantly greater likelihood of all end points (except hemorrhagic stroke), after controlling for multiple covariates. Adjusted models indicated that hazard ratios and 95% confidence intervals were 1.23 (1.02-1.47) for all stroke; 1.31 (1.06-1.63) for ischemic stroke; 1.29 (1.11-1.51) for coronary heart disease; and 1.16 (1.07-1.26) for all-cause mortality. In women with no prior history of cardiovascular disease or diabetes mellitus, high consumption of ASB was associated with more than a 2-fold increased risk of small artery occlusion ischemic stroke hazard ratio =2.44 (95% confidence interval, 1.47-4.04.) High consumption of ASBs was associated with significantly increased risk of ischemic stroke in women with body mass index ≥30; hazard ratio =2.03 (95% confidence interval, 1.38-2.98). Conclusions- Higher intake of ASB was associated with increased risk of stroke, particularly small artery occlusion subtype, coronary heart disease, and all-cause mortality. Although requiring replication, these new findings add to the potentially harmful association of consuming high quantities of ASB with these health outcomes.
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Affiliation(s)
- Yasmin Mossavar-Rahmani
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.)
| | - Victor Kamensky
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.)
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.)
| | - Brian Silver
- Department of Neurology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (B.S.)
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine Winston-Salem, NC (S.R.R.)
| | - Bernhard Haring
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.H.)
| | - Shirley A A Beresford
- School of Public Health, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, WA (S.A.A.B.)
| | - Linda Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa (L.S.)
| | - Sylvia Wassertheil-Smoller
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.)
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Carbone LD, Vasan S, Prentice RL, Harshfield G, Haring B, Cauley JA, Johnson KC. The renin-angiotensin aldosterone system and osteoporosis: findings from the Women's Health Initiative. Osteoporos Int 2019; 30:2039-2056. [PMID: 31209511 DOI: 10.1007/s00198-019-05041-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/13/2018] [Accepted: 05/30/2019] [Indexed: 01/30/2023]
Abstract
UNLABELLED New users of RAAS inhibitors, including ACE inhibitors and ARBs, have a small increased risk for fracture in the first 3 years of use, with a reduced risk of fracture with longer duration of use. INTRODUCTION Pharmacological inhibitors of the renin-angiotensin aldosterone system (RAAS) are used to treat hypertension. However, the relationship of these medications to osteoporosis is inconsistent, and no study has included simultaneous measurements of both incident fractures and bone mineral density (BMD). METHODS The association of RAAS inhibitor use (n = 131,793) with incident fractures in new users of these medications in women in the Women's Health Initiative over a minimum median follow-up of 6.5 years was assessed by Cox proportional hazard models. The association of incident fractures by a cumulative duration of use of these medications (< 3 years.) and (> 3 years.) was also estimated. Subgroup analysis of fracture risk by RAAS inhibitor use confined to women with hypertension was also performed (n = 33,820). The association of RAAS inhibitor use with changes in BMD of the hip was estimated by linear regression in 8940 women with dual energy X-ray absorptiometry measurements. RESULTS There was no significant association between RAAS inhibitor use and all fractures in the final adjusted multivariable models including hip BMD (HR 0.86 (0.59, 1.24)). However, among users of RAAS inhibitors, including ACE inhibitors and angiotensin receptor blockers (ARBs), hazard ratios for all incident fracture sites in final multivariable models including hip BMD showed dramatic differences by duration of use, with short duration of use (3 years or less) associated with a marked increased risk for fracture (HR 3.28 (1.66, 6.48)) to (HR 6.23 (3.11, 12.46)) and use for more than 3 years associated with a reduced fracture risk (HR 0.40 (0.24, 0.68) to (HR 0.44 (0.20, 0.97)) . Findings were similar in the subgroup of women with a history of hypertension. There was no significant change in BMD of the hip by RAAS inhibitor use. CONCLUSIONS In postmenopausal women, use of RAAS inhibitors, including ACE inhibitors and ARBs, is associated with an increased risk for fracture among new users of these medications in the first 3 years of use. However, long-term use (> 3 years) is associated with a reduced risk. Consideration for fracture risk may be part of the decision-making process for initiation of these medications for other disease states.
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Affiliation(s)
- L D Carbone
- Department of Medicine, Division of Rheumatology, J. Harold Harrison MD, Distinguished University Chair in Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
| | - S Vasan
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R L Prentice
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - G Harshfield
- Georgia Prevention Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - B Haring
- Department of Medicine, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Bavaria, Germany
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - K C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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45
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Haring B, Schmidt A, Frantz S. [Acute Chest Pain: A Stepwise Approach To Diagnosis]. Dtsch Med Wochenschr 2019; 144:1223-1228. [PMID: 31454846 DOI: 10.1055/a-0741-0917] [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: 10/26/2022]
Abstract
Acute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.
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Gu X, Koch M, Tabung FK, Marchand N, Harrington LB, Shadyab AH, Zaslavsky O, Sachs BC, Li W, Johnson KC, Snetselaar LG, Wactawski-Wende J, Rapp SR, Resnick SM, Haring B, Hayden KM, Mukamal KJ, Eaton CB, Manson JE, Jensen MK. P1‐010: THE EMPIRICAL INFLAMMATORY DIETARY PATTERN IN RELATION TO COGNITIVE FUNCTION AND RISK OF MILD COGNITIVE IMPAIRMENT AND DEMENTIA IN THE WOMEN'S HEALTH INITIATIVE MEMORY STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Xiao Gu
- Harvard T.H. Chan School of Public Health Boston MA USA
| | - Manja Koch
- Harvard T.H. Chan School of Public Health Boston MA USA
| | - Fred K. Tabung
- Ohio State University Columbus OH USA
- Harvard TH Chan School of Public Health Boston MA USA
| | | | - Laura B. Harrington
- Harvard T.H. Chan School of Public Health Boston MA USA
- Kaiser Permanente Washington Health Research Institute Seattle WA USA
| | | | - Oleg Zaslavsky
- University of Washington School of Nursing Seattle WA USA
| | | | - Wenjun Li
- University of Massachusetts Medical School Worcester MA USA
| | | | | | - Jean Wactawski-Wende
- University at Buffalo School of Public Health and Health Professions Buffalo NY USA
| | | | | | | | | | | | | | - JoAnn E. Manson
- Brigham and Women's Hospital Harvard Medical School Boston MA USA
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Haring B, Crandall CJ, Carbone L, Liu S, Li W, Johnson KC, Wactawski-Wende J, Shadyab AH, Gass ML, Kamensky V, Cauley JA, Wassertheil-Smoller S. Lipoprotein(a) plasma levels, bone mineral density and risk of hip fracture: a post hoc analysis of the Women's Health Initiative, USA. BMJ Open 2019; 9:e027257. [PMID: 31023762 PMCID: PMC6501983 DOI: 10.1136/bmjopen-2018-027257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Elevated Lipoprotein(a) (Lp[a]) is a well-known risk factor for cardiovascular disease. However, its roles in bone metabolism and fracture risk are unclear. We therefore investigated whether plasma Lp(a) levels were associated with bone mineral density (BMD) and incident hip fractures in a large cohort of postmenopausal women. DESIGN Post hoc analysis of data from the Women's Health Initiative (WHI), USA. SETTING 40 clinical centres in the USA. PARTICIPANTS The current analytical cohort consisted of 9698 white, postmenopausal women enrolled in the WHI, a national prospective study investigating determinants of chronic diseases including heart disease, breast and colorectal cancers and osteoporotic fractures among postmenopausal women. Recruitment for WHI took place from 1 October 1993 to 31 December 1998. EXPOSURES Plasma Lp(a) levels were measured at baseline. OUTCOME MEASURES Incident hip fractures were ascertained annually and confirmed by medical records with follow-up through 29 August 2014. BMD at the femoral neck was measured by dual X-ray absorptiometry in a subset of participants at baseline. STATISTICAL ANALYSES Cox proportional hazards and logistic regression models were used to evaluate associations of quartiles of plasma Lp(a) levels with hip fracture events and hip BMD T-score, respectively. RESULTS During a mean follow-up of 13.8 years, 454 incident cases of hip fracture were observed. In analyses adjusting for confounding variables including age, body mass index, history of hysterectomy, smoking, physical activity, diabetes mellitus, general health status, cardiovascular disease, use of menopausal hormone therapy, use of bisphosphonates, calcitonin or selective-oestrogen receptor modulators, baseline dietary and supplemental calcium and vitamin D intake and history of fracture, no significant association of plasma Lp(a) levels with low hip BMD T-score or hip fracture risk was detected. CONCLUSIONS These findings suggest that plasma Lp(a) levels are not related to hip BMD T-score or hip fracture events in postmenopausal women. TRIAL REGISTRATION NUMBER NCT00000611; Post-results.
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Affiliation(s)
- Bernhard Haring
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Carolyn J Crandall
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Laura Carbone
- Department of Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Simin Liu
- Department of Epidemiology and Medicine, Brown University, Providence, Rhode Island, USA
| | - Wenjun Li
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | | | - Victor Kamensky
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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Jiménez MC, Manson JE, Cook NR, Kawachi I, Wassertheil-Smoller S, Haring B, Nassir R, Rhee JJ, Sealy-Jefferson S, Rexrode KM. Racial Variation in Stroke Risk Among Women by Stroke Risk Factors. Stroke 2019; 50:797-804. [PMID: 30869565 PMCID: PMC6433502 DOI: 10.1161/strokeaha.117.017759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Indexed: 12/25/2022]
Abstract
Background and Purpose- In the United States, black Americans exhibit a greater risk of stroke and burden of stroke risk factors than whites; however, it is unclear whether these stroke risk factors influence stroke risk differently across racial groups. Methods- In total, 126 018 participants of the Women's Health Initiative (11 389 black and 114 629 white women), free of stroke and coronary heart disease at baseline (1994-1998), were followed through 2010. Participants completed baseline clinical exams with standardized measurements of blood pressure and anthropometrics, medication inventory and self-reported questionnaires on sociodemographics, behaviors/lifestyle, and medical history. Incident total, ischemic and hemorrhagic strokes were updated annually through questionnaires with medical record confirmation. Rate differences (per 100 000 person-years) and hazard ratios (HR) based on multivariable Cox models and were estimated. Results- Over a median of 13 years, 4344 stroke events were observed. Absolute incidence rates were higher in black than white women in each age group. In age-adjusted analyses, the risk of stroke was significantly higher among black compared with white women (HR=1.47, 95% CI, 1.33-1.63); adjustment for stroke risk factors, which may be on the causal pathway, attenuated the estimate. Racial disparities were greatest among women 50 to <60 years (HR=3.48; 95% CI, 2.31-5.26; rate difference =99) and diminished with increasing age (60 to <70 HR=1.80; 95% CI, 1.50-2.16; rate difference =107; ≥70 years: HR=1.26; 95% CI, 1.10-1.43; rate difference =87; Pinteraction <0.001). Black women 50 to <60 years remained at significantly higher risk than white women after adjustment for stroke risk factors (HR=1.76; 95% CI, 1.09-2.83). Conclusions- There was a moderately greater risk of total stroke among black compared with white women; however, racial disparities were greatest among women aged 50 to <60 years. Interventions targeted at younger black women may provide the greatest benefit in reducing disparities.
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Affiliation(s)
- Monik C. Jiménez
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - JoAnn E. Manson
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nancy R. Cook
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Health, Harvard School of Public Health, Boston MA USA
| | | | - Bernhard Haring
- Department of Medicine, University of Würzburg, Würzburg, Bavaria, Germany
| | - Rami Nassir
- Department of Biochemistry and Molecular Medicine, University of California, Davis, California
| | - Jinnie J. Rhee
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, MA USA
| | - Shawnita Sealy-Jefferson
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA
| | - Kathryn M. Rexrode
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
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Haring B, Kickuth R, Fluck F. [Aortic Intramural Hematoma: a Challenging Diagnosis]. Dtsch Med Wochenschr 2019; 144:484-488. [PMID: 30925605 DOI: 10.1055/a-0851-2226] [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: 10/27/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 75-year-old woman was admitted to our institution for acute abdominal pain. She had a history of atrial fibrillation, pacemaker implantation and diastolic heart failure. At time of admission, she was under oral anticoagulation therapy with apixaban. EXAMINATIONS AND DIAGNOSIS The X-ray of the chest showed a reduction in transparency surrounding the calcification of the aortic arch. CT angiography revealed evidence of an intramural hematoma of the aorta ranging from the left subclavian artery to the inferior mesenteric artery with presence of localized ulcer-like projections. THERAPY AND COURSE Since the IMH was limited to the descending aorta, we first chose a conservative strategy with tight blood pressure control. Unfortunately, the patients' clinical symptoms did not improve. Her pain persisted despite medical treatment. After joint discussion with surgery and radiology, an endovascular aortic repair was successfully performed. The patient recovered well and could be discharged from the hospital. CONCLUSIONS Acute aortic syndrome describes a life-threatening condition, including acute aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer. Rapid and correct diagnosis is imperative for adequate management. Once the definitive diagnosis of an aortic syndrome is made, prompt and appropriate therapeutic interventions should be undertaken. Urgent surgery for acute aortic syndromes involving the ascending aorta (Stanford Type A) and medical therapy alone for uncomplicated cases involving the descending aorta (Stanford Type B) are typically recommended. In complicated Stanford Type B situations, endovascular aortic repair (TEVAR) should be considered.
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Affiliation(s)
- Bernhard Haring
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg
| | - Ralph Kickuth
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg
| | - Friederika Fluck
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg
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50
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Haring B, Liu J, Salmoirago-Blotcher E, Hayden KM, Sarto G, Roussouw J, Kuller LH, Rapp SR, Wassertheil-Smoller S. Blood pressure variability and brain morphology in elderly women without cardiovascular disease. Neurology 2019; 92:e1284-e1297. [PMID: 30814325 DOI: 10.1212/wnl.0000000000007135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/08/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To examine the relationship between blood pressure (BP) variability (BPV), brain volumes, and cognitive functioning in postmenopausal women with few modifiable cardiovascular risk factors. METHODS Study participants consisted of postmenopausal women enrolled in the Women's Health Initiative Memory MRI study (WHIMS-MRI) without cardiovascular disease, diabetes mellitus, hypertension, or current smoking at baseline (1996-1999). BP readings were taken at baseline and each annual follow-up visit. BPV was defined as the SD associated with a participant's mean BP across visits and the SD associated with the participant's regression line with BP regressed across visits. Brain MRI scans were performed between 2004 and 2006. Cognitive functioning was assessed at baseline and annually thereafter with the Modified Mini-Mental State Examination (3MSE) scoring until 2008. The final sample consisted of 558 women (mean age 69 years, median follow-up time [interquartile range] 8 [0.8] years). RESULTS In adjusted models including mean systolic BP, women in the highest tertile of systolic BPV had lower hippocampal volumes and higher lesion volumes compared to women in the lowest tertile. No relationship between BPV and 3MSE scoring was detected. CONCLUSIONS In postmenopausal women with few modifiable cardiovascular risk factors, greater visit-to-visit systolic BPV was associated with reductions in hippocampal volume and increases in lesion volumes at later life. These data add evidence to the emerging importance of BPV as a prognostic indicator even in the absence of documented cardiovascular risk factors.
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Affiliation(s)
- Bernhard Haring
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY.
| | - Jingmin Liu
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Elena Salmoirago-Blotcher
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Kathleen M Hayden
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Gloria Sarto
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Jacques Roussouw
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Lew H Kuller
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Steve R Rapp
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Sylvia Wassertheil-Smoller
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
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