1
|
Rajendran A, Minhas AS, Kazzi B, Varma B, Choi E, Thakkar A, Michos ED. Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women. Atherosclerosis 2023; 384:117269. [PMID: 37752027 PMCID: PMC10841060 DOI: 10.1016/j.atherosclerosis.2023.117269] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/01/2023] [Revised: 05/13/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality for women globally. Sex differences exist in the relative risks conferred by traditional CVD risk factors, including diabetes, hypertension, obesity, and smoking. Additionally, there are female-specific risk factors, including age of menarche and menopause, polycystic ovary syndrome, infertility and the use of assisted reproductive technology, spontaneous pregnancy loss, parity, and adverse pregnancy outcomes, as well as female-predominant conditions such as autoimmune diseases, migraines, and depression, that enhance women's cardiovascular risk across the lifespan. Along with measurement of traditional risk factors, these female-specific factors should also be ascertained as a part of cardiovascular risk assessment to allow for a more comprehensive overview of the risk for developing cardiometabolic disorders and CVD. When present, these factors can identify women at elevated cardiovascular risk, who may benefit from more intensive preventive interventions, including lifestyle changes and/or pharmacotherapy such as statins. This review describes sex differences in traditional risk factors and female-specific/female-predominant risk factors for CVD and examines the role of coronary artery calcium scores and certain biomarkers that can help further risk stratify patients and guide preventive recommendations.
Collapse
Affiliation(s)
- Aardra Rajendran
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anum S Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhavya Varma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eunjung Choi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarti Thakkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
2
|
Rodriguez CP, Ogunmoroti O, Minhas AS, Vaidya D, Kazzi B, Osibogun O, Whelton S, Kovell LC, Harrington CM, Honigberg MC, Thamman R, Stein JH, Shapiro MD, Michos ED. Female-specific risk factors of parity and menopause age and risk of carotid plaque: the multi-ethnic study of atherosclerosis. Am J Cardiovasc Dis 2023; 13:222-234. [PMID: 37736349 PMCID: PMC10509453] [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] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/21/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Female-specific factors of grand multiparity (≥5 births) and early menopause age are associated with an increased risk of cardiovascular disease (CVD). However, mechanisms are incompletely understood. Carotid plaque is a marker of subclinical atherosclerosis and associated with increased CVD risk. We evaluated the association of female-specific factors with plaque burden. METHODS We included 2,313 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis, free of clinical CVD, whose parity and menopause age were ascertained by questionnaires and carotid plaque measured by ultrasound at baseline and 10 years later. Parity was categorized as nulliparity (reference), 1-2, 3-4 and ≥5 live births. Menopause age was categorized as <45, 45-49, 50-54 (reference) and ≥55 years. Multivariable regression was performed to evaluate the association of parity and menopause age with carotid plaque presence (yes/no) and extent [carotid plaque score (CPS)]. RESULTS The mean age was 64±9 years; 52.3% had prevalent carotid plaque at baseline. Compared to nulliparity, grand multiparity was significantly associated with prevalent carotid plaque after adjustment for CVD risk factors (prevalence ratio 1.17 (95% CI 1.03-1.35)) and progression of CPS over 10 years [percent difference 13% (95% CI 3-23)]. There was not any significant association of menopause age with carotid plaque presence or progression in fully-adjusted models. CONCLUSION In a multiethnic cohort, grand multiparity was independently associated with carotid plaque presence and progression. Early menopause, a known risk factor for CVD, was not captured by carotid plaque in this study. These findings may have implications for refining CVD risk assessment in women.
Collapse
Affiliation(s)
- Carla P Rodriguez
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Anum S Minhas
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Dhananjay Vaidya
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Brigitte Kazzi
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International UniversityMiami, FL, USA
| | - Seamus Whelton
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Lara C Kovell
- Division of Cardiology, University of Massachusetts Chan School of MedicineWorchester, MA, USA
| | - Colleen M Harrington
- Cardiology Division, Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - Ritu Thamman
- Division of Cardiology, University of PittsburghPittsburgh, PA, USA
| | - James H Stein
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of MedicineWinston-Salem, NC, USA
| | - Erin D Michos
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| |
Collapse
|
3
|
Kazzi B, Shankar B, Elder-Odame P, Tokgözoğlu LS, Sierra-Galan LM, Michos ED. A Woman's Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations. Int J Womens Health 2023; 15:1171-1183. [PMID: 37520181 PMCID: PMC10377626 DOI: 10.2147/ijwh.s328441] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population.
Collapse
Affiliation(s)
- Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bairavi Shankar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Petal Elder-Odame
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lale S Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Lilia M Sierra-Galan
- Cardiology Department of the Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
Lewis MJ, Hsieh A, Qiao L, Tan R, Kazzi B, Channing A, Griffin EL, Jobanputra V, Su J, Shahryar C, Kochilas L, Gaynor JW, Lee T, Goldmuntz E, Russell M, Mital S, Tristani M, Brueckner M, Newburger J, Shen Y, Chung WK. Association of Predicted Damaging De Novo Variants on Ventricular Function in Individuals With Congenital Heart Disease. Circ Genom Precis Med 2023; 16:e003900. [PMID: 36866680 PMCID: PMC10121832 DOI: 10.1161/circgen.122.003900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Matthew J Lewis
- Department of Medicine (M.J.L., B.K., W.K.C.), Columbia University Irving Medical Center, New York
| | - Alexander Hsieh
- Departmens of Systems Biology and Biomedical Informatics (A.H., R.T., Y.S.), Columbia University Irving Medical Center, New York
| | - Lu Qiao
- Department of Pediatrics (L.Q., A.C., E.L.G., V.J., T.L., W.K.C.), Columbia University Irving Medical Center, New York
| | - Renjie Tan
- Departmens of Systems Biology and Biomedical Informatics (A.H., R.T., Y.S.), Columbia University Irving Medical Center, New York
| | - Brigitte Kazzi
- Department of Medicine (M.J.L., B.K., W.K.C.), Columbia University Irving Medical Center, New York
| | - Alexandra Channing
- Department of Pediatrics (L.Q., A.C., E.L.G., V.J., T.L., W.K.C.), Columbia University Irving Medical Center, New York
| | - Emily L Griffin
- Department of Pediatrics (L.Q., A.C., E.L.G., V.J., T.L., W.K.C.), Columbia University Irving Medical Center, New York
- Department of Pediatrics (E.L.G.), The Children's Hospital of Philadelphia, PA
| | - Vaidehi Jobanputra
- Department of Pediatrics (L.Q., A.C., E.L.G., V.J., T.L., W.K.C.), Columbia University Irving Medical Center, New York
| | - Jennifer Su
- Department of Pediatrics, Children's Hospital Los Angles, CA (J.S.)
| | - Chowdhury Shahryar
- Department of Pediatrics, Medical University of South Carolina, Charleston (C.S.)
| | | | - J William Gaynor
- Department of Pediatric Cardiac Surgery (J.W.G.), The Children's Hospital of Philadelphia, PA
| | - Teresa Lee
- Department of Pediatrics (L.Q., A.C., E.L.G., V.J., T.L., W.K.C.), Columbia University Irving Medical Center, New York
| | | | - Mark Russell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor (M.R.)
| | - Seema Mital
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada (S.M.)
| | - Martin Tristani
- Department of Pediatrics, University of Utah, Salt Lake City (M.T.)
| | | | - Jane Newburger
- Department of Cardiology, Boston Children's Hospital, MA (J.N.)
| | - Yufeng Shen
- Departmens of Systems Biology and Biomedical Informatics (A.H., R.T., Y.S.), Columbia University Irving Medical Center, New York
| | - Wendy K Chung
- Department of Medicine (M.J.L., B.K., W.K.C.), Columbia University Irving Medical Center, New York
- Department of Pediatrics (L.Q., A.C., E.L.G., V.J., T.L., W.K.C.), Columbia University Irving Medical Center, New York
| |
Collapse
|
5
|
Kazzi B, Ogunmoroti O, Rodriguez CP, Zhao D, Minhas AS, Osibogun O, Subramanya V, Allison MA, Ouyang P, Michos ED. Parity History and Later Life Sex Hormone Levels in the Multi-Ethnic Study of Atherosclerosis (MESA). Can J Cardiol 2022; 38:1893-1900. [PMID: 36087657 DOI: 10.1016/j.cjca.2022.09.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/14/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiparity is a risk factor for cardiovascular disease (CVD). A more androgenic sex hormone profile, with a higher testosterone (T)/estradiol (E2) ratio, is associated with worse CVD outcomes in women and might be one mechanism linking multiparity to increased CVD risk. We investigated the relationship between parity and sex hormones at mid-to-older age. METHODS We performed a cross-sectional analysis of 2979 women with data on parity and endogenous sex hormone levels from the Multi-Ethnic Study of Atherosclerosis (MESA), a community-based cohort. Parity and gravidity (our exposures) were categorized as 0 (reference), 1-2, 3-4, or ≥ 5. Our outcome measures were T, E2, sex hormone binding globulin, dehydroepiandrosterone, and T/E2 ratio. Progressively adjusted linear regression was used to evaluate the association of parity/gravidity with sex hormones. RESULTS In multivariable adjusted models, there were no significant associations of parity with E2, dehydroepiandrosterone, and sex hormone binding globulin. Compared with nulliparity, after adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher T, but this was not significant for grand multiparity (≥ 5 live births). However, grand multigravidity (≥ 5 pregnancies) was associated with 10% (95% confidence interval [CI], 1%-20%) higher T and 14% (95% CI, 1%-29%) higher T/E2, compared with null gravidity. Grand multiparity was associated with an 18% (95% CI, 4%-34%) higher T/E2 ratio compared with nulliparity, after adjustment for CVD risk factors. CONCLUSIONS In this multiethnic cohort, women with grand multigravidity and grand multiparity had higher T/E2 levels, reflecting a more androgenic sex hormone profile. Longitudinal studies on sex hormones' influence on the relationship between multiparity and CVD are warranted.
Collapse
Affiliation(s)
- Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carla P Rodriguez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, San Diego, California, USA
| | - Pamela Ouyang
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
6
|
Kazzi B, Chino F, Kazzi B, Jain B, Tian S, Paguio JA, Yao JS, Muralidhar V, Mahal BA, Nguyen PL, Sanford NN, Dee EC. Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA. Support Care Cancer 2022; 30:8905-8917. [PMID: 35877007 DOI: 10.1007/s00520-022-07234-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/14/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE There has been little research on the healthcare cost-related coping mechanisms of families of patients with cancer. Therefore, we assessed the association between a cancer diagnosis and the healthcare cost-related coping mechanisms of participant family members through their decision to forego or delay seeking medical care, one of the manifestations of financial toxicity. METHODS Using data from the National Health Interview Survey (NHIS) between 2000 and 2018, sample weight-adjusted prevalence was calculated and multivariable logistic regressions defined adjusted odds ratios (aORs) for participant family members who needed but did not get medical care or who delayed seeking medical care due to cost in the past 12 months, adjusting for relevant sociodemographic covariates, including participant history of cancer (yes vs. no) and participant age (18-45 vs. 46-64 years old). The analysis of family members foregoing or delaying medical care was repeated using a cancer diagnosis * age interaction term. RESULTS Participants with cancer were more likely than those without a history of cancer to report family members delaying (19.63% vs. 16.31%, P < 0.001) or foregoing (14.53% vs. 12.35%, P = 0.001) medical care. Participants with cancer in the 18 to 45 years old age range were more likely to report family members delaying (pinteraction = 0.028) or foregoing (pinteraction < 0.001) medical care. Other factors associated with cost-related coping mechanisms undertaken by the participants' family members included female sex, non-married status, poorer health status, lack of health insurance coverage, and lower household income. CONCLUSION A cancer diagnosis may be associated with familial healthcare cost-related coping mechanisms, one of the manifestations of financial toxicity. This is seen through delayed/omitted medical care of family members of people with a history of cancer, an association that may be stronger among young adult cancer survivors. These findings underscore the need to further explore how financial toxicity associated with a cancer diagnosis can affect patients' family members and to design interventions to mitigate healthcare cost-related coping mechanisms.
Collapse
Affiliation(s)
- Bahaa Kazzi
- Department of Biology, Emory University, Atlanta, GA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 02446, USA
| | - Brigitte Kazzi
- Department of Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bhav Jain
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sibo Tian
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph A Paguio
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - J Seth Yao
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75235, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 02446, USA.
| |
Collapse
|
7
|
Choi E, Kazzi B, Varma B, Ortengren AR, Minhas AS, Vaught AJ, Bennett WL, Lewey J, Michos ED. The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care. Curr Cardiovasc Risk Rep 2022; 16:219-229. [PMID: 36159207 PMCID: PMC9490714 DOI: 10.1007/s12170-022-00706-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/26/2023]
Abstract
Purpose of Review The "fourth trimester" concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women's cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester. Recent Findings A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness. Summary Development of a comprehensive postpartum care plan with careful consideration of each patient's risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.
Collapse
Affiliation(s)
- Eunjung Choi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | - Bhavya Varma
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | | | - Anum S. Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287 USA
| | - Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- Division of Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD 21287 USA
| |
Collapse
|
8
|
Ezeigwe A, Ogunmoroti O, Minhas AS, Rodriguez CP, Kazzi B, Fashanu OE, Osibogun O, Kovell LC, Harrington CM, Michos ED. Association between parity and markers of inflammation: The multi-ethnic study of atherosclerosis. Front Cardiovasc Med 2022; 9:922367. [PMID: 36186982 PMCID: PMC9515387 DOI: 10.3389/fcvm.2022.922367] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Multiparity has been associated with increased risk of cardiovascular disease (CVD). Inflammation may be a mechanism linking parity to CVD. We investigated the association between parity and later-life markers of inflammation. Methods We studied 3,454 female MESA participants aged 45–84, free of CVD, who had data on parity and inflammatory markers. Parity was categorized as 0 (reference), 1–2, 3–4, or ≥5. Linear regression was used to evaluate the association between parity and natural log-transformed levels of fibrinogen, D-dimer, GlycA, high sensitivity C-reactive protein (hsCRP), and interleukin-6 (IL-6). Results Mean age was 62 ± 10 years. The proportion of women with nulliparity, 1–2, 3–4, and ≥5 live births were 18, 39, 29, and 14%, respectively. There was no association between parity and fibrinogen. Women with grand multiparity (≥5 live births) had 28, 10, and 18% higher levels of hsCRP, IL-6 and D-dimer, respectively, compared to nulliparous women, after adjustment for demographic factors. After additional adjustment for CVD risk factors, women with 1–2 and 3–4 live births had higher hsCRP and women with 1–2 live births had higher GlycA. Conclusion In this diverse cohort of middle-to-older aged women, we found that higher parity was associated with some inflammatory markers; however, these associations were largely attenuated after adjustment for CVD risk factors. There was no clear dose-response relationship between parity and these inflammatory markers. Future studies are needed to evaluate how inflammation may influence the link between parity and CVD and whether healthy lifestyle/pharmacotherapies targeting inflammation can reduce CVD risk among multiparous women. Clinical trial registration The MESA cohort design is registered at clinicaltrials.gov as follows: https://clinicaltrials.gov/ct2/show/NCT00005487.
Collapse
Affiliation(s)
- Angelica Ezeigwe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anum S. Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carla P. Rodriguez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun E. Fashanu
- Division of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, United States
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Lara C. Kovell
- Division of Cardiology, University of Massachusetts Chan School of Medicine, Worchester, MA, United States
| | - Colleen M. Harrington
- Corrigan's Women's Heart Health Program, Massachusetts General Hospital, Boston, MA, United States
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- *Correspondence: Erin D. Michos
| |
Collapse
|
9
|
Hassan HJ, Naranjo M, Kazzi B, Housten-Harris T, Hsu S, Balasubramanian A, Simpson CE, Damico RL, Kolb TM, Mathai SC, Hassoun PM. Risk assessment of systemic sclerosis-associated pulmonary arterial hypertension: cardiac index versus stroke volume index. Eur Respir J 2022; 60:13993003.00801-2022. [PMID: 35896206 DOI: 10.1183/13993003.00801-2022] [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] [Received: 04/20/2022] [Accepted: 07/06/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Hussein J Hassan
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mario Naranjo
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brigitte Kazzi
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Traci Housten-Harris
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aparna Balasubramanian
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catherine E Simpson
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachel L Damico
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Todd M Kolb
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen C Mathai
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Hassoun
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
10
|
Quispe R, Alfaddagh A, Kazzi B, Zghyer F, Marvel FA, Blumenthal RS, Sharma G, Martin SS. Correction to: Controversies on the Use of Omega-3 Fatty Acids to Prevent Atherosclerosis. Curr Atheroscler Rep 2022; 24:583. [PMID: 35624392 DOI: 10.1007/s11883-022-01043-5] [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: 11/24/2022]
Affiliation(s)
- Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Abdulhamied Alfaddagh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Brigitte Kazzi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Fawzi Zghyer
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Francoise A Marvel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA.
| |
Collapse
|
11
|
Quispe R, Alfaddagh A, Kazzi B, Zghyer F, Marvel FA, Blumenthal RS, Sharma G, Martin SS. Controversies in the Use of Omega-3 Fatty Acids to Prevent Atherosclerosis. Curr Atheroscler Rep 2022; 24:571-581. [PMID: 35499805 DOI: 10.1007/s11883-022-01031-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We discuss current controversies in the clinical use of omega-3 fatty acids (FA), primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and examine discrepancies between recent trials. Furthermore, we discuss potential side effects reported in these studies and the role of mixed omega-3 FA dietary supplements and concerns about their use. RECENT FINDINGS REDUCE-IT showed that addition of icosapent ethyl, a highly purified form of EPA, can reduce risk of cardiovascular events among statin-treated individuals with high triglycerides. Additional supportive evidence for EPA has come from other trials and meta-analyses of omega-3 FA therapy. In contrast, trials of mixed EPA/DHA products have consistently failed to improve cardiovascular outcomes. Discrepancies in results reported in RCTs could be explained by differences in omega-3 FA products, dosing, study populations, and study designs including the placebo control formulation. Evidence obtained from highly purified forms should not be extrapolated to other mixed formulations, including "over-the-counter" omega-3 supplements. Targeting TG-rich lipoproteins represents a new frontier for mitigating ASCVD risk. Clinical and basic research evidence suggests that the use of omega-3 FA, specifically EPA, appears to slow atherosclerosis by reducing triglyceride-rich lipoproteins and/or inflammation, therefore addressing residual risk of clinical ASCVD.
Collapse
Affiliation(s)
- Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Abdulhamied Alfaddagh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Brigitte Kazzi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Fawzi Zghyer
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Francoise A Marvel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA.
| |
Collapse
|
12
|
Kazzi B, Gudenkauf B, Fine D, Monroy-Trujillo JM, Azar A, Giannini G, Timlin H. Adalimumab-Induced Lupus Nephritis: Case Report and Review of the Literature. Eur J Rheumatol 2022; 9:108-110. [PMID: 35546334 PMCID: PMC10176219 DOI: 10.5152/eurjrheum.2022.21059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tumor necrosis factor-alpha inhibitors are known causative agents of systemic lupus erythemato- sus but have rarely been implicated in lupus nephritis. A patient with Crohn's disease on long-term adalimumab treatment presented with new-onset Raynaud's phenomenon and was found to have hematuria and proteinuria. Elevated antinuclear, anti-dsDNA, and MPO antibodies were found. A renal biopsy confirmed the diagnosis of lupus nephritis. Adalimumab was discontinued ensuing improvement in urine studies and resolution of dsDNA and MPO antibodies. Adalimumab can induce systemic lupus erythematosus and lupus nephritis.
Collapse
|
13
|
Abstract
A dysregulated immune response plays a critical role in systemic lupus erythematosus (SLE) pathogenesis. Environmental factors such as viruses, including coronavirus 2 (COVID-19), have been described to play a role in SLE presentation and exacerbation. These viruses trigger a host's humoral and cellular immunities typically essential in elimination of the viral infection. We present a case of a Hispanic male who developed new-onset lupus nephritis class II after a COVID-19 infection.
Collapse
Affiliation(s)
| | - Derek Fine
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Melody Chung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | |
Collapse
|
14
|
Varma B, Ogunmoroti O, Ndumele CE, Kazzi B, Rodriquez CP, Osibogun O, Allison MA, Bertoni AG, Michos ED. Associations between endogenous sex hormone levels and adipokine levels in the Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2022; 9:1062460. [PMID: 36712262 PMCID: PMC9880051 DOI: 10.3389/fcvm.2022.1062460] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023] Open
Abstract
Background Differences in sex hormone levels contribute to differences in cardiovascular disease (CVD) risk. Adipokines play a role in cardiometabolic pathways and have differing associations with CVD. Adipokine levels differ by sex; however, the association between sex hormone profiles and adipokines is not well established. We hypothesized that a more androgenic sex hormone profile would be associated with higher leptin and resistin and lower adiponectin levels among postmenopausal women, with the opposite associations in men. Methods We performed an analysis of 1,811 adults in the Multi-Ethnic Study of Atherosclerosis who had both sex hormones and adipokines measured an average of 2.6 years apart. Sex hormones [Testosterone (T), estradiol (E2), sex hormone binding globulin (SHBG), and dehydroepiandrosterone (DHEA)] were measured at exam 1; free T was estimated. Serum adipokines (leptin, resistin, adiponectin) were measured at exams 2 or 3. We used multivariable linear regression to examine the cross-sectional associations between sex hormones and adipokines. Results The mean (SD) age was 63 (10) years, 48% were women; 59% non-White participants. For leptin, after adjusting for demographics only, higher free T and lower SHBG, were associated with higher leptin in women; this association was attenuated after further covariate adjustment. However in men, higher free T and lower SHBG were associated with greater leptin levels in fully adjusted models. For adiponectin, lower free T and higher SHBG were associated with greater adiponectin in both women and men after adjustment for CVD risk factors. For resistin, no significant association was found women, but an inverse association with total T and bioT was seen in men. Conclusion Overall, these results further suggest a more androgenic sex profile (higher free T and lower SHBG) is associated with a less favorable adipokine pattern. These findings may provide mechanistic insight into the interplay between sex hormones, adipokines, and CVD risk.
Collapse
Affiliation(s)
- Bhavya Varma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Carla P Rodriquez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Matthew A Allison
- Department of Family Medicine, University of California, San Diego, San Diego, CA, United States
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| |
Collapse
|
15
|
Tian S, Kazzi B, Mccook A, Switchenko J, Stokes W, Shelton J, Kahn S, Carlisle J, Steuer C, Owonikoko T, Ramalingam S, Bradley J, Higgins K. FP08.01 Lung Stereotactic Body Radiation Therapy for Treatment of Oligoprogressive and Oligorecurrent Metastatic Disease: A Multi-Center Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.231] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Dagher GA, Lewandowski C, Ali SS, Barsky C, Kazzi B, Cheaito MA, Lotfipour S, Kazzi A, Kazzi Z. The International Medical Graduate and Emergency Medicine. J Emerg Med 2020; 58:e99-e104. [PMID: 31812453 DOI: 10.1016/j.jemermed.2019.10.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
International medical graduates (IMGs) are medical graduates who have received their degree from international medical schools. IMGs must undertake a 3-step process to apply to the National Residency Matching Program match. First, they must obtain a valid standard certificate from the Educational Commission for Foreign Medical Graduates. Following certification, they must apply for and secure a position in a residency training program. Third, they must obtain a visa that would enable them to commence their training. In this article, we delve thoroughly into these stepladders to provide IMGs with a clear roadmap of the process as well as contacts to key agencies that may provide more comprehensive assistance.
Collapse
Affiliation(s)
| | - Christopher Lewandowski
- Department of Emergency Medicine, Henry Ford Hospital and Wayne State University, Detroit, Michigan
| | - Syed S Ali
- Memorial Hermann Memorial City Hospital, Houston, Texas
| | - Carol Barsky
- Department of Emergency Medicine, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Brigitte Kazzi
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | | | - Amin Kazzi
- American University of Beirut, Beirut, Lebanon; University of California, Irvine, Rivine, California
| | - Ziad Kazzi
- American University of Beirut, Beirut, Lebanon; Department of Emergency Medicine, Emory University, Atlanta, Georgia
| |
Collapse
|