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Szaló G, Hellgren MI, Allison M, Li Y, Råstam L, Rådholm K, Bollano E, Duprez DA, Jacobs DR, Lindblad U, Daka B. Impaired artery elasticity predicts cardiovascular morbidity and mortality- A longitudinal study in the Vara-Skövde Cohort. J Hum Hypertens 2024; 38:140-145. [PMID: 37794130 PMCID: PMC10844075 DOI: 10.1038/s41371-023-00867-1] [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: 02/22/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
It is still debated whether arterial elasticity provides prognostic information for cardiovascular risk beyond blood pressure measurements in a healthy population. To investigate the association between arterial elasticity obtained by radial artery pulse wave analysis and risk for cardiovascular diseases (CVD) in men and women. In 2002-2005, 2362 individuals (men=1186, 50.2%) not taking antihypertensive medication were included. C2 (small artery elasticity) was measured using the HDI/Pulse Wave CR2000. Data on acute myocardial infarction or stroke, fatal or non-fatal, was obtained between 2002-2019. Cox- regression was used to investigate associations between C2 and future CVD, adjusting for confounding factors such as age, sex, systolic blood pressure, heart rate, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LDL- cholesterol, CRP (C-Reactive Protein), alcohol consumption, smoking and physical activity. At baseline, the mean age of 46 ± 10.6 years and over the follow-up period, we observed 108 events 70 events in men [event rate: 5.9%], 38 in women [event rate: 3.2%]. In the fully adjusted model, and for each quartile decrease in C2, there was a significant increase in the risk for incident CVD by 36%. (HR = 1.36, 95% CI: 1.01-1.82, p = 0.041). The results were accentuated for all men (HR = 1.74, 95% CI: 1.21-2.50, p = 0.003) and women over the age of 50 years (HR = 1.70, 95% CI: 0.69-4.20). We showed a strong and independent association between C2 and CVD in men. In women after menopause, similar tendencies and effect sizes were observed.
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Affiliation(s)
- Gábor Szaló
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Margareta I Hellgren
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Skaraborg Institute, Skövde, Sweden
| | - Matthew Allison
- Division of Preventive Medicine, Department of Family Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ying Li
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Råstam
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ulf Lindblad
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bledar Daka
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Duprez DA, Jacobs DR. Time to Routinely Measure eGFR and Albuminuria in Young and Middle-Aged Adults. J Am Coll Cardiol 2023; 82:1328-1330. [PMID: 37730289 DOI: 10.1016/j.jacc.2023.07.013] [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: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Duprez DA, Jacobs DR. The Reply. Am J Med 2023; 136:e185. [PMID: 37612025 DOI: 10.1016/j.amjmed.2023.04.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Medical School, eliminate Medical School, Minneapolis
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Choi Y, Jacobs Jr DR, Kramer HJ, Shroff GR, Chang AR, Duprez DA. Racial Differences and Contributory Cardiovascular and Non-Cardiovascular Risk Factors Towards Chronic Kidney Disease Progression. Vasc Health Risk Manag 2023; 19:433-445. [PMID: 37465230 PMCID: PMC10350429 DOI: 10.2147/vhrm.s416395] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Background The prevalence of advanced chronic kidney disease (CKD) is higher in Black than in White Americans. We evaluated CKD progression in Black and White participants and the contribution of biological risk factors. We included the study of lung function (measured by forced vital capacity [FVC]), which is part of the emerging notion of interorgan cross-talk with the kidneys to racial differences in CKD progression. Methods This longitudinal study included 2175 Black and 2207 White adult Coronary Artery Risk Development in Young Adults (CARDIA) participants. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were measured at study year 10 (age 27-41y) and every five years for 20 years. The outcome was CKD progression through no CKD, low, moderate, high, or very high-risk categories based on eGFR and UACR in combination. The association between race and CKD progression as well as the contribution of risk factors to racial differences were assessed in multivariable-adjusted Cox models. Results Black participants had higher CKD transition probabilities than White participants and more prevalent risk factors during the 20-year period studied. Hazard ratios for CKD transition for Black (vs White participants) were 1.38 from No CKD into ≥ low risk, 2.25 from ≤ low risk into ≥ moderate risk, and 4.49 from ≤ moderate risk into ≥ high risk. Racial differences in CKD progression from No CKD into ≥ low risk were primarily explained by FVC (54.8%), hypertension (30.9%), and obesity (20.8%). In contrast, racial differences were less explained in more severe transitions. Conclusion Black participants had a higher risk of CKD progression, and this discrepancy may be partly explained by FVC and conventional risk factors.
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Affiliation(s)
- Yuni Choi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - David R Jacobs Jr
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Holly J Kramer
- Departments of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Gautam R Shroff
- Division of Cardiology and Department of Medicine, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Alexander R Chang
- Departments of Population of Health Sciences and Nephrology, Geisinger, Danville, PA, USA
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Brumback LC, Andrews LIB, Jacobs DR, Duprez DA, Thepaksorn EH, Kaufman JD, Denenberg JO, Allison MA. The association between arterial compliance, as assessed by PTC1 and PTC2 from radial artery waveforms, and age, sex, and race/ethnicity. J Hypertens 2023; 41:1117-1126. [PMID: 37071438 PMCID: PMC10238654 DOI: 10.1097/hjh.0000000000003441] [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: 04/19/2023]
Abstract
BACKGROUND There is limited literature on differences in arterial compliance, as assessed from arterial pressure waveforms, with age, sex, and race/ethnicity. PTC1 and PTC2 are indices of arterial compliance, which are derived from a Windkessel model of the waveform, relatively easy to obtain, and associated with cardiovascular disease. METHOD PTC1 and PTC2 were computed from radial artery waveforms from participants of the Multi-Ethnic Study of Atherosclerosis at baseline and again 10 years later. We evaluated the association of PTC1, PTC2, and 10-year change in PTC1 and PTC2 with age, sex, and race/ethnicity. RESULTS Among 6245 participants in 2000-2002 (mean ± SD of age was 62 ± 10 years; 52% female; 38% White, 12% Chinese, 27% Black, and 23% Hispanic/Latino), means ± SDs for PTC1 and PTC2 were 394 ± 334 and 94 ± 46 ms. After adjustment for cardiovascular disease risk factors, mean PTC2 was 1.1 ms (95% confidence interval: 1.0, 1.2) lower (arterial stiffness was greater) per year older age, was 22 ms (19, 24) lower for females, and varied by race/ethnicity ( P < 0.001; e.g., 5 ms lower for Blacks compared with Whites), although the differences were smaller at older ages ( P < 0.001 for age-sex, P < 0.001 for age-race/ethnicity interactions). Among 3701 participants with repeat measurements in 2010-2012, arteries had stiffened (mean ± SD 10-year decrease in PTC2: 13 ± 46 ms) consistent with cross-sectional age-trend and tended to stiffen less for females and Blacks consistent with cross-sectional age-interactions. CONCLUSION Differences in arterial compliance by age, sex, and race/ethnicity lend support to identify and act on societal factors that may drive health disparities.
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Affiliation(s)
- Lyndia C Brumback
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Leah I B Andrews
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth Hom Thepaksorn
- Sirindhorn College of Public Health, Trang, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Thailand
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington
| | - Julie O Denenberg
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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Choi Y, Jacobs DR, Kramer HJ, Shroff GR, Chang AR, Duprez DA. Nontraditional Risk Factors for Progression Through Chronic Kidney Disease Risk Categories: The Coronary Artery Risk Development in Young Adults Study. Am J Med 2023; 136:380-389.e10. [PMID: 36565799 PMCID: PMC10038875 DOI: 10.1016/j.amjmed.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND There may be nontraditional pathways of chronic kidney disease (CKD) progression that are complementary to classical pathways. Therefore, we aimed to examine nontraditional risk factors for incident CKD and its progression. METHODS We used the generally healthy population (n = 4382) starting at age 27-41 years in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, which is an observational longitudinal study. Nontraditional risk factors included forced vital capacity, inflammation, serum urate, and serum carotenoids. CKD risk category was classified using the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) measured in 1995-1996 and repeated every 5 years for 20 years: No CKD, low risk, moderate risk, high risk, and very high risk. RESULTS At baseline, 84.8% had no CKD (eGFR ≥60 mL/min/1.73 m2 and UACR <10 mg/g), 10.3% were in the low risk (eGFR ≥60 and UACR 10-29), and 4.9% had CKD (eGFR <60 and/or UACR ≥ 30). Nontraditional risk factors were significantly associated with the progression of CKD to higher categories. Hazard ratios per standard deviation of the predictor for incident CKD and its progression from the No CKD and low and moderate risk into CKD were inverse for forced vital capacity and serum carotenoids and positive for serum urate, GlycA, and C-reactive protein, the first 3 even after adjustment for conventional risk factors. CONCLUSION Several nontraditional markers were significantly associated with an increased risk of progression to higher CKD categories in generally healthy young to middle-aged adults.
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Affiliation(s)
- Yuni Choi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Holly J Kramer
- Departments of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, Ill
| | - Gautam R Shroff
- Division of Cardiology and Department of Medicine, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis
| | - Alexander R Chang
- Department of Population of Health Sciences, Kidney Health Research Institute, Department of Nephrology, Geisinger Medical Center, Danville, Penn
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis.
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Duprez DA, Van't Hof J, Florea ND, Duval S, Cohn JN. EARLY CARDIOVASCULAR FUNCTIONAL AND STRUCTURAL ABNORMALITIES SCORE IN ASYMPTOMATIC ADULTS AS A GUIDE TO MAJOR ADVERSE CARDIOVASCULAR EVENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bhatia H, Allen TS, McClelland R, Denenberg J, Budoff MJ, Duprez DA, Allison MA, Blaha MJ, Criqui MH. THE DENSITY ADJUSTED VOLUME SCORE: A NOVEL CORONARY ARTERY CALCIUM SCORE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01786-2] [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: 03/06/2023]
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Watanabe KA, Shrout Allen T, Andrews LI, Brumback LC, Cornelissen Guillaume GG, Duprez DA, Jacobs DR, Criqui MH, Allison MA. Abstract P665: Thoracic Aorta Calcification and Left Ventricular Structure and Function Relevant to Heart Failure: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p665] [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
Background:
Aortic stiffness promotes left ventricular (LV) remodeling and dysfunction. Thoracic aorta calcification (TAC) contributes to aortic stiffness, but it remains unclear how TAC presence, volume, and density impact LV structure and function. We tested the hypothesis that TAC presence and higher volume is associated with increased LV mass index, decreased LV end-diastolic volume (LVEDV) index, and impaired mid-wall circumferential strain (Ecc).
Methods:
We evaluated 1,693 participants from the MESA who underwent chest CT and cardiac MRI from 2010 to 2012. We used linear regression models to determine cross-sectional associations between the presence, volume, and density of TAC with LV mass index, LVEDV index, and Ecc. Each pair of predictor and outcome variables underwent three model adjustments: (1) age, gender, and race/ethnicity; (2) Model 1 plus education level, height, weight, physical activity, sedentary behavior, smoking status, eGFR, SBP, DBP, anti-HTN medication use, total cholesterol/HDL ratio, statin use, and diabetes; (3) Model 2 plus coronary artery calcium (CAC) presence and volume. TAC volume and density were evaluated separately, then jointly in the same models.
Results:
The mean age was 69 years (SD 9) and 53% were female, while 39% were White, 26% Black, 21% Hispanic/Latino, 15% Chinese. TAC was present in 1,518 (90%) participants. TAC volume and density were highly correlated (r=0.75) with respective median 213 (25%ile, 75%ile: 36, 800) mm
3
and mean 350 (SD 110) Hounsfield Units. LV mass index, LVEDV index, and Ecc had respective means of 65 g/m
2
(SD 14), 120 mL/m
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(SD 31), and -18.2% (SD 2.8). After full adjustment (Model 3 without density), a 10% increase in TAC volume was associated with a 1.8% multiplicative higher Ecc (i.e., less negative Ecc) (95% CI 0.2-3.4%, p=0.04) reflecting reduced LV systolic and diastolic function. Higher TAC volume was marginally associated with higher LV mass index: a 10% increase in TAC volume was associated with a 5.6% increase (-0.6-11.7%, p=0.08) in Model 2 without density, 13.9% (2.1-25.7%, p=0.03) in Model 2 with density, 3.9% (-2.5-10.4%, p=0.23) in Model 3 without density, and 11.3% (-1.0-23.7%, p=0.08) in Model 3 with density. After adjustments in Models 2 or 3, there were no other significant associations between TAC presence, volume, or density with the outcomes.
Conclusions:
Higher TAC volume is associated with impaired Ecc independent of CAC and marginally associated with higher LV mass index. These results suggest that the extent of TAC may influence LV remodeling and thus reduced function.
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Full KM, Huang T, Shah NA, Allison MA, Michos ED, Duprez DA, Redline S, Lutsey PL. Sleep Irregularity and Subclinical Markers of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e027361. [PMID: 36789869 PMCID: PMC10111477 DOI: 10.1161/jaha.122.027361] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 09/07/2022] [Accepted: 12/02/2022] [Indexed: 02/16/2023]
Abstract
Background Sleep irregularity has been linked to incident cardiovascular disease. Less is known about associations of sleep regularity with atherosclerosis. We examined cross-sectional associations of actigraphy-assessed sleep duration and sleep timing regularity with subclinical atherosclerosis in the community-based MESA (Multi-Ethnic Study of Atherosclerosis). Methods and Results MESA Sleep Ancillary Study participants (N=2032; mean age, 68.6±9.2 years; 37.9% White) completed 7-day wrist actigraphy. Participants underwent assessments of coronary artery calcium, carotid plaque presence, carotid intima-media thickness, and the ankle-brachial index. Sleep regularity was quantified by the 7-day with-in person SD of sleep duration and sleep onset timing. Relative risk regression models were used to calculate prevalence ratios and 95% CIs. Models are adjusted for demographics, cardiovascular disease risk factors, and other objectively assessed sleep characteristics including obstructive sleep apnea, sleep duration, and sleep fragmentation. After adjustment, compared with participants with more regular sleep durations (SD ≤60 minutes), participants with greater sleep duration irregularity (SD >120 minutes) were more likely to have high coronary artery calcium burden (>300; prevalence ratio, 1.33 [95% CI, 1.03-1.71]) and abnormal ankle-brachial index (<0.9; prevalence ratio, 1.75 [95% CI, 1.03-2.95]). Compared with participants with more regular sleep timing (SD ≤30 minutes), participants with irregular sleep timing (SD >90 minutes) were more likely to have high coronary artery calcium burden (prevalence ratio, 1.39 [95% CI, 1.07-1.82]). Associations persisted after adjustment for cardiovascular disease risk factors and average sleep duration, obstructive sleep apnea, and sleep fragmentation. Conclusions Sleep irregularity, particularly sleep duration irregularity, was associated with several measures of subclinical atherosclerosis. Sleep regularity may be a modifiable target for reducing atherosclerosis risk. Future investigation into cardiovascular risk reduction interventions targeting sleep irregularity may be warranted.
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Affiliation(s)
- Kelsie M. Full
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
| | - Tianyi Huang
- Channing Division of Network Medicine, Brigham and Women’s HospitalHarvard UniversityBostonMA
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
| | - Neomi A. Shah
- Division of Pulmonary, Critical Care and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Matthew A. Allison
- Division of Preventive MedicineUniversity of California San DiegoSan DiegoCA
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Daniel A. Duprez
- Cardiovascular DivisionUniversity of Minnesota School of MedicineMinneapolisMN
| | - Susan Redline
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
- Brigham and Women’s Hospital, Division of Sleep and Circadian DisordersHarvard Medical SchoolBostonMA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
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Choi Y, Jacobs DR, Bancks MP, Lewis CE, Cha E, Yan F, Carnethon MR, Schreiner PJ, Duprez DA. Association of Cardiovascular Health Score With Early- and Later-Onset Diabetes and With Subsequent Vascular Complications of Diabetes. J Am Heart Assoc 2023; 12:e027558. [PMID: 36565184 PMCID: PMC9973601 DOI: 10.1161/jaha.122.027558] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Little attention has been paid to how well the American Heart Association's cardiovascular health (CVH) score predicts early-onset diabetes in young adults. We investigated the association of CVH score with early- and later-onset diabetes and with subsequent complications of diabetes. METHODS AND RESULTS Our sample included 4547 Black and White adults in the CARDIA (Coronary Artery Risk Development in Young Adults) study without diabetes at baseline (1985-1986; aged 18-30 years) with complete data on the CVH score at baseline, including smoking, body mass index, physical activity, diet quality, total cholesterol, blood pressure, and fasting blood glucose. Incident diabetes was determined based on fasting glucose, 2-hour postload glucose, hemoglobin A1c, or self-reported medication use throughout 8 visits for 30 years. Multinomial logistic regression was used to assess the association between CVH score and diabetes onset at age <40 years (early onset) versus age ≥40 years (later onset). Secondary analyses assessed the association between CVH score and risk of complications (coronary artery calcium, clinical cardiovascular disease, kidney function markers, diabetic retinopathy, and diabetic neuropathy) among a subsample with diabetes. We identified 116 early- and 502 later-onset incident diabetes cases. Each 1-point higher CVH score was associated with lower odds of developing early-onset (odds ratio [OR], 0.64 [95% CI, 0.58-0.71]) and later-onset diabetes (OR, 0.78 [95% CI, 0.74-0.83]). Lower estimates of diabetic complications were observed per 1-point higher CVH score: 19% for coronary artery calcification≥100, 18% for cardiovascular disease, and 14% for diabetic neuropathy. CONCLUSIONS Higher CVH score in young adulthood was associated with lower early- and later-onset diabetes as well as diabetic complications.
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Affiliation(s)
- Yuni Choi
- Division of Epidemiology and Community Health, School of Public Health University of Minnesota Minneapolis MN
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health University of Minnesota Minneapolis MN
| | - Michael Patrick Bancks
- Department of Epidemiology and Prevention Wake Forest School of Medicine Winston-Salem NC
| | - Cora E Lewis
- Department of Epidemiology University of Alabama at Birmingham Birmingham AL
| | - EunSeok Cha
- College of Nursing Chungnam National University Daejeon South Korea.,Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Fengxia Yan
- Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health University of Minnesota Minneapolis MN
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine University of Minnesota-Twin Cities Minneapolis MN
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Choi Y, Jacobs DR, Shroff GR, Kramer H, Chang AR, Duprez DA. Progression of Chronic Kidney Disease Risk Categories and Risk of Cardiovascular Disease and Total Mortality: Coronary Artery Risk Development in Young Adults Cohort. J Am Heart Assoc 2022; 11:e026685. [PMID: 36314497 PMCID: PMC9673645 DOI: 10.1161/jaha.122.026685] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Previous studies of worsening chronic kidney disease (CKD) based on declining estimated glomerular filtration rate (eGFR) or increasing urine albumin-creatinine ratio (UACR) are limited to later middle-age and older adults. We examined associations of CKD progression and incident cardiovascular disease (CVD) and mortality in younger adults. Methods and Results We studied 4382 adults in CARDIA (Coronary Artery Risk Development in Young Adults) initially aged 27 to 41 years and prospectively over 20 years. Five-year transition probabilities across CKD risk categories were based on eGFR and UACR measured at each exam. Proportional hazards models predicted incident CVD and all-cause mortality by time-varying CKD risk category, adjusting for demographics and CVD risk factors. Progression of CKD risk categories over 20 years occurred in 28.7% (1256/4382) of participants, driven by increases in UACR, but including 5.8% (n=255) with eGFR<60 mL/min per 1.73 m2 or UACR ≥300 mg/g. Compared with eGFR ≥60 and UACR <10, demographic and smoking-adjusted hazard ratios for CVD were 1.62 (95% CI, 1.21-2.18) for low CKD risk (eGFR ≥60 with UACR 10-29) and 13.65 (95% CI, 7.52-24.79) for very high CKD risk (eGFR <30 or eGFR 30-44 with UACR 30-299; or eGFR 30-59 with UACR ≥300). Corresponding hazard ratios for all-cause mortality were 1.42 (95% CI, 1.08-1.88) and 14.75 (95% CI, 9.97-21.82). Although CVD associations were attenuated after adjustment for mediating CVD risk factors, all-cause mortality associations remained statistically significant. Conclusions Among young to middle-aged adults, progression to higher CKD risk category was common. Routine monitoring eGFR and UACR holds promise for prevention of CVD and total mortality.
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Affiliation(s)
- Yuni Choi
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - David R. Jacobs
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Gautam R. Shroff
- Division of Cardiology and Department of Medicine, Hennepin HealthcareUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Holly Kramer
- Departments of Public Health Sciences and MedicineLoyola University ChicagoMaywoodIL
| | - Alexander R. Chang
- Division of Nephrology, Geisinger Health ClinicKidney Health Research InstituteDanvillePA
| | - Daniel A. Duprez
- Cardiovascular Division, Department of MedicineUniversity of MinnesotaMinneapolisMN
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Allen TS, Andrews LI, Brumback LC, Daniels MR, Denenberg JO, Thomas IC, Cornelissen-Guillaume GG, Duprez DA, Jacobs DR, Criqui MH, Allison MA. Abstract P139: Association Of Thoracic Aorta Calcification And Aortic Arch Stiffness: The Multi-ethnic Study Of Atherosclerosis. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p139] [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
Background:
Arterial stiffness (AS) is a robust risk factor for HTN and CVD. It remains unclear how thoracic aortic calcification (TAC) presence, volume, and density relate to AS in the aortic arch. Improved understanding of central AS may provide insight to future mechanistic approaches to prevent and control CVD.
Methods:
We evaluated 1,385 participants from MESA Exam 5 with TAC data throughout the thoracic aorta via Chest CT and pulse wave velocity (PWV) as a measure of AS across the aortic arch via MRI. We used linear regression models to assess cross-sectional associations of TAC presence, volume, and density with aortic arch PWV with adjustment for 1) age, sex, and race; and 2) age, sex, race, BMI, diabetes, estimated glomerular filtration rate, HTN-medication use, SBP, DBP, total cholesterol/high-density lipoprotein ratio, smoking status, CAC volume, CAC density, education, physical activity, and sedentary behavior.
Results:
Participants were a mean age of 69 years (SD 9) [717 (52%) female; 509 (37%) White, 359 (26%) Black, 285 (21%) Hispanic/Latino, and 232 (17%) Chinese]. Calcification was present in 1,263 (91%) and 1,228 (89%) participants in the entire thoracic aorta and aortic arch, respectively, compared to 848 (61%) and 138 (10%) in the descending and ascending aorta segments. Calcium volume in the entire thoracic aorta and aortic arch were highly correlated (r=0.94) with respective means of 866 (SD 1,724) and 564 (1,014) mm
3
. Mean PWV across the aortic arch was 9 m/sec (SD 4). After full adjustment, the presence of aortic arch calcification, compared to no aortic arch calcification, was associated with a 0.76 m/sec higher mean PWV (95% CI: 0.34 - 1.18; p<0.01), while a 1,000 mm
3
increment in aortic arch calcium volume was associated with 0.36 m/sec higher mean PWV (95% CI: 0.08-0.64; p=0.01). Results were similar when calcification in the entire thoracic aorta was the primary predictor variable. Conversely, there were no significant associations between mean or maximum calcium density measures and aortic arch PWV.
Conclusion:
TAC is highly prevalent in the thoracic aorta, especially the aortic arch. Calcification presence and higher calcification volume in the thoracic aorta, as well as the aortic arch itself, are associated with greater aortic arch AS.
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Choi Y, Gallaher DD, Svendsen K, Meyer KA, Steffen LM, Schreiner PJ, Shikany JM, Rana JS, Duprez DA, Jacobs DR. Simple Nutrient-Based Rules vs. a Nutritionally Rich Plant-Centered Diet in Prediction of Future Coronary Heart Disease and Stroke: Prospective Observational Study in the US. Nutrients 2022; 14:nu14030469. [PMID: 35276828 PMCID: PMC8837984 DOI: 10.3390/nu14030469] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/14/2022] Open
Abstract
To better understand nutrition paradigm shift from nutrients to foods and dietary patterns, we compared associations of a nutrient-based blood cholesterol-lowering diet vs. a food-based plant-centered diet with risk of coronary heart disease (CHD) and stroke. Participants were 4701 adults aged 18-30 years and free of cardiovascular disease at baseline, followed for clinical events from 1985 and 86 to 2018. A plant-centered diet was represented by higher A Priori Diet Quality Score (APDQS). A blood cholesterol-lowering diet was represented by lower Keys Score. Proportional hazards regression was used to calculate hazard ratios (HR). Higher APDQS showed a nutrient-dense composition that is low in saturated fat but high in fiber, vitamins and minerals. Keys Score and APDQS changes were each inversely associated with concurrent plasma low-density lipoprotein cholesterol (LDL-C) change. Over follow-up, 116 CHD and 80 stroke events occurred. LDL-C predicted CHD, but not stroke. APDQS, but not Keys Score, predicted lower risk of CHD and of stroke. Adjusted HRs (95% CIs) for each 1-SD higher APDQS were 0.73 (0.55-0.96) for CHD and 0.70 (0.50-0.99) for stroke. Neither low dietary fat nor low dietary carbohydrate predicted these events. Our findings support the ongoing shift in diet messages for cardiovascular prevention.
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Affiliation(s)
- Yuni Choi
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN 55454, USA; (Y.C.); (L.M.S.); (P.J.S.)
| | - Daniel D. Gallaher
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, MN 55108, USA;
| | - Karianne Svendsen
- Department of Nutrition, University of Oslo, 0317 Oslo, Norway;
- The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Katie A. Meyer
- Department of Nutrition and Nutrition Research Institute, University of North Carolina—Chapel Hill, Chapel Hill, NC 28081, USA;
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN 55454, USA; (Y.C.); (L.M.S.); (P.J.S.)
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN 55454, USA; (Y.C.); (L.M.S.); (P.J.S.)
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA;
| | - Jamal S. Rana
- Divisions of Cardiology and Research, Kaiser Permanente Northern California, Department of Medicine, University of California, Oakland, CA 94612, USA;
| | - Daniel A. Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota–Twin Cities, Minneapolis, MN 55454, USA
- Correspondence: (D.A.D.); (D.R.J.J.); Tel.: +61-2624-4948 (D.A.D.); +61-2624–1818 (D.R.J.J.)
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN 55454, USA; (Y.C.); (L.M.S.); (P.J.S.)
- Correspondence: (D.A.D.); (D.R.J.J.); Tel.: +61-2624-4948 (D.A.D.); +61-2624–1818 (D.R.J.J.)
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15
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Walker M, Patel P, Kwon O, Koene RJ, Duprez DA, Kwon Y. Atrial Fibrillation and Hypertension: "Quo Vadis". Curr Hypertens Rev 2022; 18:39-53. [PMID: 35023459 DOI: 10.2174/1573402118666220112122403] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/29/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Abstract
Hypertension is one of the most well-established risk factors for atrial fibrillation. Long-standing untreated hypertension leads to structural remodeling and electrophysiologic alterations causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fibrillation. Hypertension-induced hemodynamic, inflammatory, hormonal, and autonomic changes all appear to be important contributing factors. Furthermore, hypertension is also associated with several atrial fibrillation-related comorbidities. As such, hypertension may represent an important target for therapy in atrial fibrillation. Clinicians should be aware of pitfalls of the blood pressure measurement in atrial fibrillation. While the auscultatory method is preferred, the use of automated devices appears to be an acceptable method in the ambulatory setting. There are pathophysiologic bases and emerging clinical evidence suggesting the benefit of renin-angiotensin system inhibition in risk reduction of atrial fibrillation development particularly in patients with left ventricular hypertrophy or left ventricular dysfunction. A better understanding of hypertension's pathophysiologic link to atrial fibrillation may lead to the development of novel therapies for the primary prevention of atrial fibrillation. Finally, future studies are needed to address optimal blood pressure goal to minimize the risk of atrial fibrillation-related complications.
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Affiliation(s)
- McCall Walker
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, USA
| | - Paras Patel
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, USA
| | - Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Uslan College of Medicine, Seoul, Korea
| | - Ryan J Koene
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Daniel A Duprez
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Younghoon Kwon
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, USA
- Department of Medicine, University of Minnesota, Minneapolis, USA
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16
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Jurgens PT, Carr JJ, Terry JG, Rana JS, Jacobs DR, Duprez DA. Association of Abdominal Aorta Calcium and Coronary Artery Calcium with Incident Cardiovascular and Coronary Heart Disease Events in Black and White Middle-Aged People: The Coronary Artery Risk Development in Young Adults Study. J Am Heart Assoc 2021; 10:e023037. [PMID: 34873926 PMCID: PMC9075251 DOI: 10.1161/jaha.121.023037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
Background Assessing coronary artery calcium (CAC) is among AHA/ACC prevention guidelines for people at least 40 years old at intermediate risk for coronary heart disease (CHD). To study enhanced risk stratification, we investigated the predictive value of abdominal aorta calcium (AAC) relative to CAC for cardiovascular disease (CVD) and CHD events in Black and White early middle-aged participants, initially free of overt CVD. Methods and Results In the CARDIA (Coronary Artery Risk Development in Young Adults) study, a multi-center, community-based, longitudinal cohort study of CVD risk, the CAC and AAC scores were assessed in 3011 participants in 2010-2011 with follow-up until 2019 for incident CVD and CHD events. Distributions and predictions, overall and by race, were computed. During the 8-year follow-up, 106 incident CVD events (55 were CHD) occurred. AAC scores tended to be much higher than CAC scores. AAC scores were higher in Black women than in White women. CAC predicted CVD with HR 1.77 (1.52-2.06) and similarly for AAC, while only CAC predicted CHD. After adjustment for risk factors and calcium in the other arterial bed, the association of CAC with CVD was independent of risk factors and AAC, while the association of AAC with CVD was greatly attenuated. However, AAC predicted incident CVD when CAC was 0. Prediction did not vary by race. Conclusions AAC predicted CVD nearly as strongly as CAC and could be especially useful as a diagnostic tool when it is an incidental finding or when no CAC is found.
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Affiliation(s)
- Paul T. Jurgens
- Division of CardiologyDepartment of MedicineUniversity of MinnesotaMinneapolisMN
| | - John J. Carr
- Division of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTN
| | - James G. Terry
- Division of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTN
| | - Jamal S. Rana
- Division of Cardiology and ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - David R. Jacobs
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Daniel A. Duprez
- Division of CardiologyDepartment of MedicineUniversity of MinnesotaMinneapolisMN
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17
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Morikawa N, Bancks MP, Yano Y, Kuwabara M, Gaffo AL, Duprez DA, Gross MD, Jacobs DR. Serum Urate Trajectory in Young Adulthood and Incident Cardiovascular Disease Events by Middle Age: CARDIA Study. Hypertension 2021; 78:1211-1218. [PMID: 34092118 PMCID: PMC8516664 DOI: 10.1161/hypertensionaha.121.17555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/03/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Nagisa Morikawa
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Masanari Kuwabara
- Intensive Care Unit and Department of Cardiology, Toranomon Hospital, Tokyo, Japan
| | - Angelo L. Gaffo
- Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Daniel A. Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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18
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Duprez DA, Duval S, Hoke L, Florea N, Grandits G, Carlson C, Lee J, Cohn JN. Early cardiovascular structural and functional abnormalities as a guide to future morbid events. Eur J Prev Cardiol 2021. [PMID: 34551082 DOI: 10.3760/cma.j.cn114453-20201010-00526] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS Our aim was to evaluate the predictive value of a battery of 10 non-invasive tests of cardiovascular structural and functional health on the future risk of cardiovascular morbid events. METHODS AND RESULTS A total of 1900 asymptomatic adults concerned about their risk for cardiovascular disease underwent non-invasive assessment with 10 tests of vascular and cardiac structure and function. A disease score (DS) was calculated for each individual based on these 10 tests. Follow-up (mean 9.2 years) for cardiovascular morbidity and mortality was available for 1442 individuals (mean age 53.2 years, 48.2% women). Those in the lowest DS tertile (0-2) experienced 0.16 cardiovascular events per 100 patient-years (PY), those in the middle tertile (3-5) experienced 0.86 events per 100 PY, and those in the highest tertile (6+) experienced 1.3 events per 100 PY (p < .001). Sensitivity analysis, assuming a neutral effect of DS on projected events in subjects not followed, did not alter statistical significance. Risk assessment using the Framingham risk score (FRS) also predicted morbid events but the two methods differed in identifying individuals at high risk. The net reclassification index was improved by 0.11 (p = 0.01) when DS was added to FRS. CONCLUSIONS Assessing the biological disease process in the arteries and heart of asymptomatic adults provides a guide to the risk of a future cardiovascular morbid event. Larger and longer studies are needed to determine whether risk factor algorithms, the severity of the biological process or some combination is the optimal method for identifying individuals in need of intervention to delay morbid events.
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Affiliation(s)
- Daniel A Duprez
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sue Duval
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lynn Hoke
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalia Florea
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Gregory Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Claire Carlson
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joy Lee
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jay N Cohn
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
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19
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Choi Y, Larson N, Steffen LM, Schreiner PJ, Gallaher DD, Duprez DA, Shikany JM, Rana JS, Jacobs DR. Plant-Centered Diet and Risk of Incident Cardiovascular Disease During Young to Middle Adulthood. J Am Heart Assoc 2021; 10:e020718. [PMID: 34344159 PMCID: PMC8475033 DOI: 10.1161/jaha.120.020718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/11/2022]
Abstract
Background The association between diets that focus on plant foods and restrict animal products and cardiovascular disease (CVD) is inconclusive. We investigated whether cumulative intake of a plant‐centered diet and shifting toward such a diet are associated with incident CVD. Methods and Results Participants were 4946 adults in the CARDIA (Coronary Artery Risk Development in Young Adults) prospective study. They were initially 18 to 30 years old and free of CVD (1985–1986, exam year [year 0]) and followed until 2018. Diet was assessed by an interviewer‐administered, validated diet history. Plant‐centered diet quality was assessed using the A Priori Diet Quality Score (APDQS), in which higher scores indicate higher consumption of nutritionally rich plant foods and limited consumption of high‐fat meat products and less healthy plant foods. Proportional hazards models estimated hazard ratios of CVD associated with both time‐varying average APDQS and a 13‐year change in APDQS score (difference between the year 7 and year 20 assessments). During the 32‐year follow‐up, 289 incident CVD cases were identified. Both long‐term consumption and a change toward such a diet were associated with a lower risk of CVD. Multivariable‐adjusted hazard ratio was 0.48 (95% CI, 0.28–0.81) when comparing the highest quintile of the time‐varying average ADPQS with lowest quintiles. The 13‐year change in APDQS was associated with a lower subsequent risk of CVD, with a hazard ratio of 0.39 (95% CI, 0.19–0.81) comparing the extreme quintiles. Similarly, strong inverse associations were found for coronary heart disease and hypertension‐related CVD with either the time‐varying average or change APDQS. Conclusions Consumption of a plant‐centered, high‐quality diet starting in young adulthood is associated with a lower risk of CVD by middle age.
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Affiliation(s)
- Yuni Choi
- Department of Food Science and Nutrition University of Minnesota-Twin Cities St Paul MN
| | - Nicole Larson
- Division of Epidemiology and Community Health University of Minnesota-Twin Cities Minneapolis MN
| | - Lyn M Steffen
- Division of Epidemiology and Community Health University of Minnesota-Twin Cities Minneapolis MN
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health University of Minnesota-Twin Cities Minneapolis MN
| | - Daniel D Gallaher
- Department of Food Science and Nutrition University of Minnesota-Twin Cities St Paul MN
| | - Daniel A Duprez
- Cardiovascular Division Department of Medicine University of Minnesota-Twin Cities Minneapolis MN
| | - James M Shikany
- Division of Preventive Medicine School of Medicine University of Alabama at Birmingham Birmingham AL
| | - Jamal S Rana
- Divisions of Cardiology and Research Kaiser Permanente Northern California Oakland CA.,Department of Medicine University of California San Francisco CA
| | - David R Jacobs
- Division of Epidemiology and Community Health University of Minnesota-Twin Cities Minneapolis MN
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20
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Choi Y, Steffen LM, Chu H, Duprez DA, Gallaher DD, Shikany JM, Schreiner PJ, Shroff GR, Jacobs DR. A Plant-Centered Diet and Markers of Early Chronic Kidney Disease during Young to Middle Adulthood: Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Cohort. J Nutr 2021; 151:2721-2730. [PMID: 34087933 PMCID: PMC8417917 DOI: 10.1093/jn/nxab155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/27/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few studies have evaluated whether plant-centered diets prevent progression of early stage chronic kidney disease (CKD). OBJECTIVES We examined the association between plant-centered diet quality and early CKD markers. METHODS We prospectively examined 2869 black and white men and women in the Coronary Artery Risk Development in Young Adults Study free of diagnosed kidney failure in 2005-2006 [examination year 20 (Y20); mean age: 45.3 ± 3.6 y]. CKD marker changes from Y20 to 2015-2016 (Y30) were considered, including estimated glomerular filtration rate (eGFR; serum creatinine), urinary albumin-to-creatinine ratio (ACR), and both. Diet was assessed through interviewer-administered diet histories at Y0, Y7, and Y20, and plant-centered diet quality was quantified with the A Priori Diet Quality Score (APDQS). Linear regression models were used to examine the association of APDQS and subsequent 10-y changes in CKD markers. RESULTS After adjustment for sociodemographic, behavioral, and diet factors, we found that higher APDQS was related to less adverse changes in CKD markers in the subsequent 10-y period. Compared with the lowest APDQS quintile, the highest quintile was associated with an attenuated increase in lnACR (-0.25 mg/g; 95% CI: -0.37, -0.13 mg/g; P-trend < 0.001), whereas the highest quintile was associated with an attenuated decrease in eGFR (4.45 mL·min-1·1.73 m-2; 95% CI: 2.46, 6.43 mL·min-1·1.73 m-2). There was a 0.50 lower increase in combined CKD markers [ln(ACR) z score - eGFR z score] when comparing the extreme quintiles. Associations remained similar after further adjustment for hypertension, diabetes, and obesity as potential mediating factors. The attenuated worsening CKD marker changes associated with higher APDQS strengthened across increasing initial CKD category; those with the best diet and microalbuminuria in Y10-Y20 returned to high normal albuminuria (all P-interaction < 0.001). CONCLUSIONS Individuals who consumed plant-centered, high-quality diets were less likely to experience deterioration of kidney function through midlife, especially among participants with initial stage characterized as mild CKD.
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Affiliation(s)
- Yuni Choi
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, St. Paul, MN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Haitao Chu
- Division of Biostatistics, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Daniel D Gallaher
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, St. Paul, MN, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota–Twin Cities, Minneapolis, MN, USA
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21
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Brumback LC, Andrews LIB, Jacobs DR, Duprez DA, Shah SJ, Dougherty CM, Denenberg JO, Allison MA. The association between indices of blood pressure waveforms (PTC1 and PTC2) and incident heart failure. J Hypertens 2021; 39:661-666. [PMID: 33239550 PMCID: PMC8177733 DOI: 10.1097/hjh.0000000000002707] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The radial artery pulse waveform is a continuous measure of pressure throughout the cardiac cycle, and thus can provide more information than just systolic and diastolic blood pressures. New indices based on a Windkessel model of the waveform, PTC1 and PTC2, are related to arterial compliance and add information for prediction of incident cardiovascular disease (coronary heart disease, stroke, myocardial infarction) but their association with heart failure is unknown. METHODS Among 6229 adults (mean age 62 years) from four race/ethnic groups who were initially free of clinical cardiovascular disease and heart failure in 2000-2002, we evaluated the associations of baseline PTC1 and PTC2 with incident heart failure. RESULTS Mean ± standard deviation PTC1 and PTC2 were 394 ± 334 and 94 ± 46 ms, respectively. During a median of 15.7 years follow-up, there were 357 heart failure events (148 with reduced, 150 with preserved, and 59 with unknown ejection fraction). After adjustment for traditional risk factors, the hazard ratio for heart failure per 1 standard deviation higher PTC2 was 0.73 (95% confidence interval: 0.63--0.85). Higher PTC2 was also significantly associated with lower risk of heart failure with reduced ejection fraction (hazard ratio = 0.67; 95% confidence interval: 0.56--0.80). There was no evidence of a significant association between PTC2 and heart failure with preserved ejection fraction or between PTC1 and heart failure. CONCLUSION The PTC2 measure of the radial artery pulse waveform may represent a novel phenotype related to heart failure, especially heart failure with reduced ejection fraction.
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Affiliation(s)
- Lyndia C Brumback
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Leah I B Andrews
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, and
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Julie O Denenberg
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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22
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Duprez DA, Handelsman Y, Koren M. Cardiovascular Outcomes and Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors: Current Data and Future Prospects. Vasc Health Risk Manag 2020; 16:403-418. [PMID: 33116551 PMCID: PMC7548340 DOI: 10.2147/vhrm.s261719] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular (CV) disease remains the leading cause of morbidity and mortality worldwide and poses an ongoing challenge with the aging population. Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD), and the expert consensus is the use of statin therapy (if tolerated) as first line for LDL-C reduction. However, patients with ASCVD may experience recurrent ischemic events despite receiving maximally tolerated statin therapy, including those whose on-treatment LDL-C remains ≥70 mg/dL, patients with familial hypercholesterolemia, high-risk subgroups with comorbidities such as diabetes mellitus, and those who have an intolerance to statin therapy. Optimal therapeutic strategies for this unmet need should deploy aggressive lipid lowering to minimize the contribution of dyslipidemia to their CV risk, particularly for very high-risk populations with additional risk factors beyond hypercholesterolemia and established ASCVD. To understand the current clinical climate and guidelines regarding ASCVD, we primarily searched PubMed for articles published in English regarding lipid-lowering therapies and CV risk reduction, including emerging therapies, and CV outcomes trials with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. This review discusses the findings of recent clinical trial evidence for CV risk reduction with cholesterol-lowering therapies, with a focus on CV outcomes trials with PCSK9 inhibitors, and considers the impact of the study results for secondary prevention and future strategies in patients with hypercholesterolemia and CV risk despite maximally tolerated statin therapy.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Michael Koren
- Jacksonville Center for Clinical Research, Jacksonville, FL, USA
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Shroff GR, Sanchez OA, Miedema MD, Kramer H, Ix JH, Duprez DA, Jacobs DR. Coronary artery calcium progresses rapidly and discriminates incident cardiovascular events in chronic kidney disease regardless of diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2020; 310:75-82. [PMID: 32919188 PMCID: PMC10838623 DOI: 10.1016/j.atherosclerosis.2020.07.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/05/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Chronic kidney disease (CKD) is associated with high prevalence of cardiovascular disease (CVD) events. We sought to assess the prognostic utility of coronary artery calcium (CAC) scores in discriminating incident CVD events among subpopulations of CKD, particularly those without diabetes mellitus (DM). METHODS Using the Multi-Ethnic Study of Atherosclerosis, we identified 4 groups based on present/absent CKD/diabetes (CKD-/DM-, n = 5308; CKD-/DM+, n = 586, CKD+/DM-, n = 620; CKD+/DM+, n = 266). Baseline and follow-up CAC (Agatston units) measurements, and association between CAC and incident CVD events in median follow-up of 13 years were evaluated using proportional hazards regression adjusting for demographics, clinical, biomarker variables. RESULTS Prevalence of CKD and DM in the cohort was 13% and 12.5% respectively. Annual progression in adjusted median CAC score was 24.8%, 27.9%, 26.7%, 36.8% and unadjusted cumulative incident CVD rates were 12.6%, 22.3%, 23.1%, 39.8% for CKD-/DM-, CKD-/DM+, CKD+/DM-, CKD+/DM+, respectively. After full adjustment (CKD-/DM-referent), hazard ratios (HR, 95% CI) for incident CVD events were 1.25 (1.01-1.53) CKD-/DM+, 1.10 (0.90-1.33) CKD+/DM- and 2.18 (1.73-2.76) CKD+/DM+. Using CKD-/DM-/baseline CAC = 0 referent, adjusted HRs (95% CI) for incident CVD in CKD+/DM- were 1.30 (0.81-2.07), 2.05 (1.4-2.99), and 4.15 (2.94-5.86) for baseline CAC = 0, 1-100, and >300 Agatston units respectively while for CKD+/DM+, adjusted HRs were 3.15 (2.04-4.86), 3.56 (2.26-5.62), 7.90 (5.35-11.67), respectively. CONCLUSIONS CAC provides incremental prognostic information to predict incident CVD events in CKD regardless of DM. Moreover, baseline CAC categories discriminate incident CVD among CKD without DM, which may have implications in individualizing approach to primary prevention in this high-risk population.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology and Department of Medicine, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Otto A Sanchez
- School of Kinesiology, Division of Exercise Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Michael D Miedema
- Minneapolis Heart Institute Foundation, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Holly Kramer
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Hines VA Medical Center, Hines, IL, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Daniel A Duprez
- Division of Cardiology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David R Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Brumback LC, Jacobs DR, Duprez DA. PTC1 and PTC2: New Indices of Blood Pressure Waveforms and Cardiovascular Disease. Am J Epidemiol 2020; 189:726-734. [PMID: 31907510 PMCID: PMC7608079 DOI: 10.1093/aje/kwz280] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022] Open
Abstract
Systolic and diastolic blood pressures provide information about cardiovascular disease (CVD) but are only extremes of the pressure waveform during the cardiac cycle. We developed summaries of the pressure decay, called PTC1 and PTC2, that are related to arterial compliance and to an existing proprietary summary that has been shown to predict CVD. We derived the summaries from a Windkessel model (consisting of a decaying exponential plus a dampened cosine, with an intercept so they are independent of calibration with blood pressure, unlike the proprietary measures), and we estimated them using nonlinear least squares with standard, free software. Among 6,228 adults from the Multi-Ethnic Study of Atherosclerosis, initially free of CVD in 2000-2002, mean PTC2 was 94 (standard deviation, 46) milliseconds. During median 15-year follow-up, there were 911 CVD events (including 609 incidents of coronary heart disease and 270 strokes). One-standard-deviation higher PTC2 was associated with 17% (95% confidence interval: 10, 24) lower CVD risk, after adjustment for traditional risk factors. Results were similar for PTC1. PTC1 and PTC2 are relatively straightforward to compute and add information beyond traditional risk factors for prediction of CVD. Our work enables others to replicate and extend our results with waveforms from any suitable device.
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Affiliation(s)
- Lyndia C Brumback
- Correspondence to Dr. Lyndia C. Brumback, Collaborative Health Studies Coordinating Center, Building 29, Suite 210, University of Washington, Box 354922, 6200 NE 74th Street, Seattle, WA 98115 (e-mail: )
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Nomura SO, Karger AB, Weir NL, Duprez DA, Tsai MY. Free fatty acids, cardiovascular disease, and mortality in the Multi-Ethnic Study of Atherosclerosis. J Clin Lipidol 2020; 14:531-541. [PMID: 32651087 DOI: 10.1016/j.jacl.2020.06.005] [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: 11/07/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fasting free fatty acid (FFA) levels may be associated with cardiovascular disease (CVD) and mortality, but research among generally healthy adults, females, and racially/ethnically diverse populations is lacking. OBJECTIVE The primary aim of this project was to investigate prospective associations between fasting FFAs and coronary heart disease (CHD) and CVD incidence and CVD-specific and all-cause mortality in a generally healthy age, sex, and racially/ethnically heterogeneous population. METHODS This study was conducted in the Multi-Ethnic Study of Atherosclerosis cohort using baseline (2000-2002) fasting FFAs and outcome data through 2015 (N = 6678). Cox proportional hazards regression was used to calculate hazard ratios for associations between FFAs and CHD, CVD, CVD-specific mortality, and all-cause mortality. Interactions by age, sex, race/ethnicity, and metabolic syndrome were evaluated by stratification and cross-product terms. A secondary analysis was conducted to evaluate associations between FFAs, and inflammatory and endothelial activation biomarkers were evaluated using linear regression (analytic N range: 964-6662). RESULTS FFA levels were not associated with CHD or CVD incidence. Higher FFAs were associated with CVD-specific and all-cause mortality, but associations were attenuated in fully adjusted models with a borderline significant association remaining only for all-cause mortality (fully adjusted, per standard deviation increase hazard ratio = 1.07, 95% confidence interval: 1.00-1.14). Associations did not differ by age, sex, race/ethnicity, or metabolic syndrome. CONCLUSIONS Fasting FFAs were not associated with CHD, CVD, or CVD-specific mortality and were modestly associated with all-cause mortality, regardless of age, sex, race/ethnicity, or metabolic syndrome status.
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Affiliation(s)
- Sarah O Nomura
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Natalie L Weir
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
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26
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Cainzos-Achirica M, Miedema MD, McEvoy JW, Al Rifai M, Greenland P, Dardari Z, Budoff M, Blumenthal RS, Yeboah J, Duprez DA, Mortensen MB, Dzaye O, Hong J, Nasir K, Blaha MJ. Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019: The MESA Study (Multi-Ethnic Study of Atherosclerosis). Circulation 2020; 141:1541-1553. [PMID: 32233663 DOI: 10.1161/circulationaha.119.045010] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND Recent American College of Cardiology/American Heart Association Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40 to 70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention by using 2019 aspirin meta-analysis data on cardiovascular disease relative risk reduction and bleeding risk. METHODS The study included 6470 participants from the MESA Study (Multi-Ethnic Study of Atherosclerosis). ASCVD risk was estimated using the pooled cohort equations, and 3 strata were defined: <5%, 5% to 20%, and >20%. All participants underwent CAC scoring at baseline, and CAC scores were stratified as =0, 1 to 99, ≥100, and ≥400. A 12% relative risk reduction in cardiovascular disease events was used for the 5-year number needed to treat (NNT5) calculations, and a 42% relative risk increase in major bleeding events was used for the 5-year number needed to harm (NNH5) estimations. RESULTS Only 5% of MESA participants would qualify for aspirin consideration for primary prevention according to the American College of Cardiology/American Heart Association guidelines and using >20% estimated ASCVD risk to define higher risk. Benefit/harm calculations were restricted to aspirin-naive participants <70 years of age not at high risk of bleeding (n=3540). The overall NNT5 with aspirin to prevent 1 cardiovascular disease event was 476 and the NNH5 was 355. The NNT5 was also greater than or similar to the NNH5 among estimated ASCVD risk strata. Conversely, CAC≥100 and CAC≥400 identified subgroups in which NNT5 was lower than NNH5. This was true both overall (for CAC≥100, NNT5=140 versus NNH5=518) and within ASCVD risk strata. Also, CAC=0 identified subgroups in which the NNT5 was much higher than the NNH5 (overall, NNT5=1190 versus NNH5=567). CONCLUSIONS CAC may be superior to the pooled cohort equations to inform the allocation of aspirin in primary prevention. Implementation of current 2019 American College of Cardiology/American Heart Association guideline recommendations together with the use of CAC for further risk assessment may result in a more personalized, safer allocation of aspirin in primary prevention. Confirmation of these findings in experimental settings is needed.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, MD (M.C.-A., J.W.M., Z.D., R.S.B., O.D., K.N., M.J.B.)
| | | | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, MD (M.C.-A., J.W.M., Z.D., R.S.B., O.D., K.N., M.J.B.)
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland (J.W.M.)
- National University of Ireland, Galway (J.W.M.)
- Saolta University Healthcare Group, University College Hospital Galway, Ireland (J.W.M.)
| | | | - Philip Greenland
- Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.)
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, MD (M.C.-A., J.W.M., Z.D., R.S.B., O.D., K.N., M.J.B.)
| | - Matthew Budoff
- Harbor-University of California Medical Center, Los Angeles (M.B.)
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, MD (M.C.-A., J.W.M., Z.D., R.S.B., O.D., K.N., M.J.B.)
| | - Joseph Yeboah
- Wake Forest Baptist Health, Winston-Salem, NC (J.Y.)
| | - Daniel A Duprez
- Cardiovascular Division, University of Minnesota, Minneapolis (D.A.D.)
| | | | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, MD (M.C.-A., J.W.M., Z.D., R.S.B., O.D., K.N., M.J.B.)
| | | | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, MD (M.C.-A., J.W.M., Z.D., R.S.B., O.D., K.N., M.J.B.)
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, MD (M.C.-A., J.W.M., Z.D., R.S.B., O.D., K.N., M.J.B.)
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Duprez DA, Duval S, Hoke L, Florea N, Grandits G, Carlson C, Lee J, Cohn JN. Early cardiovascular structural and functional abnormalities as a guide to future morbid events. Eur J Prev Cardiol 2020; 28:1214-1221. [PMID: 34551082 DOI: 10.1177/2047487320901416] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/16/2022]
Abstract
Abstract
Aims
Our aim was to evaluate the predictive value of a battery of 10 non-invasive tests of cardiovascular structural and functional health on the future risk of cardiovascular morbid events.
Methods and Results
A total of 1900 asymptomatic adults concerned about their risk for cardiovascular disease underwent non-invasive assessment with 10 tests of vascular and cardiac structure and function. A disease score (DS) was calculated for each individual based on these 10 tests. Follow-up (mean 9.2 years) for cardiovascular morbidity and mortality was available for 1442 individuals (mean age 53.2 years, 48.2% women). Those in the lowest DS tertile (0–2) experienced 0.16 cardiovascular events per 100 patient-years (PY), those in the middle tertile (3–5) experienced 0.86 events per 100 PY, and those in the highest tertile (6+) experienced 1.3 events per 100 PY (p < .001). Sensitivity analysis, assuming a neutral effect of DS on projected events in subjects not followed, did not alter statistical significance. Risk assessment using the Framingham risk score (FRS) also predicted morbid events but the two methods differed in identifying individuals at high risk. The net reclassification index was improved by 0.11 (p = 0.01) when DS was added to FRS.
Conclusions
Assessing the biological disease process in the arteries and heart of asymptomatic adults provides a guide to the risk of a future cardiovascular morbid event. Larger and longer studies are needed to determine whether risk factor algorithms, the severity of the biological process or some combination is the optimal method for identifying individuals in need of intervention to delay morbid events.
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Affiliation(s)
- Daniel A Duprez
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sue Duval
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lynn Hoke
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalia Florea
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Gregory Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Claire Carlson
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joy Lee
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jay N Cohn
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
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Kasiske BL, Anderson-Haag TL, Duprez DA, Kalil RS, Kimmel PL, Pesavento TE, Snyder JJ, Weir MR. A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years. Kidney Int 2020; 98:168-175. [PMID: 32331703 DOI: 10.1016/j.kint.2020.01.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 10/14/2019] [Revised: 12/06/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022]
Abstract
While there have been numerous studies of living kidney donors, most have been retrospective without suitable controls and have yielded conflicting results. To clarify this we studied 205 living donor candidates and 203 controls having no medical conditions precluding donation. Before and at six months, one, two, three, six, and nine years after donation we measured iohexol glomerular filtration rate, clinic blood pressure, urine protein excretion and metabolic parameters reported to be affected by kidney function. We measured 24 hour ambulatory blood pressure at three, six, and nine years and at six and nine years blood pressure after treadmill exercise, carotid-femoral pulse wave velocity and arterial elasticity. Between six months and nine years, the mean (95% confidence interval) change in glomerular filtration rate was significantly different among 133 donors 0·02 (-0·16-0·20) mL/min/1·73m2/year versus -1·26 (-1·52--1·00) mL/min/1·73m2/year in 113 healthy controls. Blood pressure, urine protein, urine albumin, glucose, hemoglobin A1c, insulin, and lipoproteins were not different in controls versus donors; but parathyroid hormone, homocysteine and uric acid remained higher at nine years. At six and nine years carotid-femoral pulse wave velocity was not different, but the mean small artery elasticity was significantly lower in 141 donors 6·1 mL/mmHg x100, versus 113 controls 7·1 mL/mmHg x100, and 6·1 mL/mmHg x100 in 137 donors versus 7·6 mL/mmHg x100 in 112 controls at six and nine years, respectively [significant adjusted difference of 1·1 mL/mmHg x100]. Thus, donors remain healthy with stable kidney function for the first nine years, but differences in metabolic and vascular parameters could be harbingers of adverse outcomes requiring future interventions.
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Affiliation(s)
- Bertram L Kasiske
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
| | | | - Daniel A Duprez
- Department of Medicine, Cardiology Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roberto S Kalil
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Todd E Pesavento
- Division of Nephrology, Ohio State University, Columbus, Ohio, USA
| | - Jon J Snyder
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Matthew R Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Affiliation(s)
- D A Duprez
- From the, Cardiovascular Division, Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - D R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Oluleye OW, Kronmal RA, Folsom AR, Vaidya DM, Ouyang P, Duprez DA, Dobs AS, Yarmohammadi H, Konety SH. Association Between Statin Use and Sex Hormone in the Multi-Ethnic Study of Atherosclerosis Cohort. J Clin Endocrinol Metab 2019; 104:4600-4606. [PMID: 31157875 PMCID: PMC6736052 DOI: 10.1210/jc.2019-00530] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Based on the 2018 American College of Cardiology/American Heart Association cholesterol guidelines, the number of individuals eligible for statin therapy to reduce atherosclerotic cardiovascular disease risk has greatly expanded. Statins inhibit cholesterol biosynthesis, which can impair gonadal steroidogenesis. We evaluated the effect of statins on endogenous sex hormones in a large epidemiological study. METHODS A total of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants underwent the baseline examination. Of these, 6171 had measurements of serum sex hormones available: dehydroepiandrosterone (DHEA), SHBG, estradiol, and total and bioavailable testosterone. Multivariable linear regression models were used to assess the relationship of statin use with each sex hormone. RESULTS A total of 345 women (17.4%) and 464 men (14.7%) were statin users (mean age, 67 years; 41% white, 29% black, 11% Chinese, and 19% Hispanic). Among the users vs nonusers of statins, the mean SHBG was 3.54 nmol/L (P < 0.01) lower in women and 3.37 nmol/L (P < 0.001) lower in men; the mean DHEA was 1.06 nmol/L (P < 0.05) lower in women and 0.70 nmol/L (P < 0.01) lower in men, after adjustment for potential confounders. With further propensity score adjustment, the mean DHEA and SHBG levels were 0.67 nmol/L (P < 0.05) and 3.49 nmol/L (P < 0.001) lower, respectively, for statin users vs nonusers. No statistically significant association was noted between estradiol, total testosterone, and bioavailable testosterone and statin use. CONCLUSION Statin users have lower levels of SHBG and DHEA. This is especially relevant owing to the increasing use of statin therapy.
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Affiliation(s)
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Pamela Ouyang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Adrian S Dobs
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Suma H Konety
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Correspondence and Reprint Requests: Suma H. Konety, MD, MS, Cardiovascular Division, Department of Medicine, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, Minnesota 55455. E-mail:
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Duprez DA, Heckbert SR, Alonso A, Gross MD, Ix JH, Kizer JR, Tracy RP, Kronmal R, Jacobs DR. Collagen Biomarkers and Incidence of New Onset of Atrial Fibrillation in Subjects With No Overt Cardiovascular Disease at Baseline: The Multi-Ethnic Study of Atherosclerosis. Circ Arrhythm Electrophysiol 2019; 11:e006557. [PMID: 30354407 DOI: 10.1161/circep.118.006557] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Atrial fibrosis is a hallmark of structural remodeling in atrial fibrillation (AF). Plasma procollagen type III N-terminal propeptide (PIIINP) reflects collagen synthesis and degradation while collagen type I carboxy-terminal telopeptide (ICTP) reflects collagen degradation. We aimed to study baseline plasma PIIINP and ICTP and their associations with incident AF in participants initially free of overt cardiovascular disease. METHODS In a stratified sample of the Multi-Ethnic Study of Atherosclerosis, initially aged 45-84 years, 3071 participants had both PIIINP and ICTP measured at baseline. Incident AF in 10-year follow-up was based on a hospital International Classification of Diseases code for AF or atrial flutter, in- or outpatient Medicare claims through 2011 (primarily in those aged 65-84 years), or ECG 10 years after baseline (n=357). The associations of PIIINP and ICTP with incident AF were estimated using Poisson regression with follow-up time offset. RESULTS Baseline PIIINP (5.50±1.55 µg/L) and ICTP (mean±SD, 3.41±1.37 µg/L) were positively related (both P<0.0001) to incident AF in a model adjusting for age, race/ethnicity, and sex, with an apparent threshold (relative incidence density 2.81 [1.94-4.08] for PIIINP ≥8.5 µg/L [3.5% of the sample] and 3.46 [2.36-5.07] for ICTP ≥7 µg/L [1.7% of the sample]). Findings were attenuated but remained statistically significant after further adjustment for systolic blood pressure, height, body mass index, smoking, and renal function. Additional adjustment for other risk factors and biomarkers of inflammation did not alter conclusions. CONCLUSIONS Plasma collagen biomarkers, particularly at elevated levels, were associated with excess risk for AF.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis (D.A.D.)
| | - Susan R Heckbert
- Department of Biostatistics, School of Public Health, University of Washington, Seattle (S.R.H.)
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Myron D Gross
- Laboratory Medicine, School of Medicine, University of Minnesota, Minneapolis (M.D.G.)
| | - Joachim H Ix
- Nephrology Division, University of California, San Diego School of Medicine (J.H.I.)
| | - Jorge R Kizer
- Cardiovascular Division of Cardiology, Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.)
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, and Biochemistry, University of Vermont College of Medicine, Colchester (R.P.T.)
| | - Richard Kronmal
- Department of Statistics, School of Public Health, University of Washington, Seattle (R.K.)
| | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis (D.R.J.)
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Duprez DA, Forbang NI, Allison MA, Peralta CA, Shea S, Jacobs DR. Association of C2, a derivative of the radial artery pressure waveform, with new onset of type 2 diabetes mellitus: the MESA study. Cardiovasc Diabetol 2019; 18:62. [PMID: 31101116 PMCID: PMC6524236 DOI: 10.1186/s12933-019-0868-3] [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] [Received: 03/23/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although microvascular dysfunction is known to result from diabetes, it might also lead to diabetes. Lower values of C2, a derivative of the radial artery pressure waveform, indicate microvascular dysfunction and predict hypertension and cardiovascular disease (CVD). We studied the association of C2 with incident diabetes in subjects free of overt CVD. METHODS Among multi-ethnic participants (n = 5214), aged 45-84 years with no diabetes, C2 was derived from the radial artery pressure waveform. Incident diabetes (N = 651) was diagnosed as new fasting glucose ≥ 126 mg/dL or antidiabetic medicine over ~ 10 years. The relative incidence density (RID) for incident diabetes per standard deviation (SD) of C2 was studied during ~ 10 years follow-up using four levels of adjustment. RESULTS Mean C2 at baseline was 4.58 ± 2.85 mL/mmHg × 100. The RID for incident diabetes per SD of C2 was 0.90 (95% CI 0.82-0.99, P = 0.03). After adjustment for demographics plus body size, the corresponding RID was 0.81 (95% CI 0.73-0.89, P < 0.0001); body mass index (BMI) was the dominant covariate here. After adjustment for demographics plus cardiovascular risk factors, the RID was 0.98 (95% CI 0.89, 1.07, P = 0.63). After adjustment for all the parameters in the previous models, the RID was 0.87 (95% CI 0.78, 0.96, P = 0.006). CONCLUSIONS In a multi-ethnic sample free of overt CVD and diabetes at baseline, C2 predicted incident diabetes after adjustment for demographics, BMI and CVD risk factors. Differences in arterial blood pressure wave morphology may indicate a long-term risk trajectory for diabetes, independently of body size and the classical risk factors.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, 420 Delaware St SE, MMC 508, Minneapolis, MN, 55455, USA.
| | - Nkete I Forbang
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Carmen A Peralta
- VA Medical Center, University of San Francisco, San Francisco, CA, USA
| | - Steven Shea
- Department of Medicine, Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Walker M, Patel P, Kwon O, Koene RJ, Duprez DA, Kwon Y. Withdrawal Notice: Atrial Fibrillation and Hypertension: “Quo Vadis”. Curr Hypertens Rev 2019; 15:CHYR-EPUB-98332. [PMID: 31057122 DOI: 10.2174/1573402115666190502142824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
The article has been withdrawn at the request of the editor of the journal Current Hypertension Reviews: Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused. The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php . BENTHAM SCIENCE DISCLAIMER It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript, the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.
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Affiliation(s)
- McCall Walker
- Department of Medicine, University of Virginia, Charlottesville, VA. United States
| | - Paras Patel
- Department of Medicine, University of Virginia, Charlottesville, VA. United States
| | - Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Uslan, Seoul. Korea
| | - Ryan J Koene
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio OH. United States
| | - Daniel A Duprez
- Department of Medicine, University of Minnesota, Minneapolis MN. United States
| | - Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, VA. United States
- Department of Medicine, University of Minnesota, Minneapolis MN. United States
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Yoon C, Jacobs DR, Duprez DA, Neumark-Sztainer D, Steffen LM, Mason SM. Problematic eating behaviors and attitudes predict long-term incident metabolic syndrome and diabetes: The Coronary Artery Risk Development in Young Adults Study. Int J Eat Disord 2019; 52:304-308. [PMID: 30636022 PMCID: PMC6408221 DOI: 10.1002/eat.23020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/08/2018] [Revised: 12/22/2018] [Accepted: 12/27/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Problematic relationship to eating and food (PREF) captures a broad range of unhealthy eating behaviors. We previously reported that higher BMI is associated with PREF and graded by the number of PREF endorsed. In this study, we prospectively examined the association between PREF and metabolic syndrome and diabetes. METHOD Eight PREF behaviors were assessed and summed to form the PREF score in 3800 black and white adults (age 27-41 years) in the Coronary Artery Risk Development in Young Adults Study. Diagnoses of incident metabolic syndrome and diabetes were made through 15 years of follow-up. Logistic regression estimated the association with metabolic syndrome. Proportional hazards regression estimated the association with diabetes. RESULTS The odds ratio of metabolic syndrome was 1.25 per PREF point through 5 years of follow-up (95% CI: 1.17-1.34) and 1.17 per point from 5 to 10 years of follow-up (95% CI: 1.08-1.27). Hazard of diabetes was 1.20 per PREF point through 15 years of follow-up (95% CI: 1.12-1.28). Both associations attenuated after adjustment for BMI. DISCUSSION Among participants with PREF, higher scores associate with metabolic syndrome and diabetes, with partial attenuation after adjustment for BMI. Early identification of PREF in middle-aged adults may reduce the burden of metabolic health outcomes.
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Affiliation(s)
- Cynthia Yoon
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Daniel A Duprez
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Susan M Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA
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Benson EMA, Tibuakuu M, Zhao D, Akinkuolie AO, Otvos JD, Duprez DA, Jacobs DR, Mora S, Michos ED. Associations of ideal cardiovascular health with GlycA, a novel inflammatory marker: The Multi-Ethnic Study of Atherosclerosis. Clin Cardiol 2018; 41:1439-1445. [PMID: 30452775 DOI: 10.1002/clc.23069] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Unhealthy lifestyles and inflammation contribute to cardiovascular disease (CVD). GlycA is a novel biomarker of systemic inflammation representing post-translational glycosylation of acute phase reactants and associated with increased clinical CVD risk. HYPOTHESIS We hypothesized that ideal cardiovascular health (CVH), as assessed by (higher) Life's Simple 7 (LS7) scores, would be associated with lower GlycA levels among individuals free of CVD in a multiethnic community-based population. METHODS This was a cross-sectional study of 6479 Multi-Ethnic Study of Atherosclerosis participants [53% women; mean age 62 ± 10 years] with GlycA levels measured at baseline by nuclear magnetic resonance spectroscopy. The LS7 metrics (smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose) were each scored as ideal (2), moderate (1), or poor (0). Total scores were summed and categorized as optimal (12-14), average (8-11), and inadequate (0-7). Linear regression assessed percent difference in GlycA by LS7 scores, after adjusting for age, sex, ethnicity, education, income, family history of CVD, and other inflammatory biomarkers. RESULTS GlycA levels were 403.4 ± 63.1, 374.4 ± 59.2, and 350.3 ± 56.2 micromoles per liter (μmol/L) for inadequate, average, and optimal CVH, respectively (P-trend <0.001). After multivariable adjustment, GlycA remained independently and inversely associated with CVH categories, with a lower mean GlycA level of 5 μmol/L (95% confidence interval 4.5-5.8) for each one unit increment in LS7 score. CONCLUSIONS Among this group of ethnically diverse individuals without CVD, suboptimal CVH is associated with higher GlycA levels, independent of traditional inflammatory biomarkers. Strategies aimed at improving CVH might reduce GlycA, which could be a marker of reduced risk of future CVD events.
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Affiliation(s)
- Eve-Marie A Benson
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Martin Tibuakuu
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Di Zhao
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Akintunde O Akinkuolie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Center for Lipid Metabolomics, Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, North Carolina
| | - Daniel A Duprez
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erin D Michos
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Blaes AH, Mulrooney DA, Vogel RI, Solovey A, Hebbel R, Peterson BA, Neglia JP, Biewen C, Konety SH, Duprez DA. Arterial elasticity as a risk factor for early cardiovascular disease among testicular cancer survivors treated with platinum-based chemotherapy: a cross-sectional pilot study. Vasc Health Risk Manag 2018; 14:205-211. [PMID: 30237722 PMCID: PMC6136418 DOI: 10.2147/vhrm.s151847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Testicular cancer survivors who have received platinum-based chemotherapy are at risk for premature cardiovascular disease. The etiology of this risk is not well understood. This pilot study explores the impact of platinum-based chemotherapy on endothelial function. METHODS Testicular cancer survivors <30 years old at the time of diagnosis who received platinum-based chemotherapy between 2002 and 2012, as well as 17 similarly aged male controls, were identified. Consented subjects underwent vascular assessment using the HDI/PulseWave CR-2000 Cardiovascular Profiling System and the Endo-PAT2000 system. Biomarkers and functional test markers were compared among cases, controls, and a group of historical controls using two sided two-sampled t-tests and Wilcoxon rank-sum tests. RESULTS Thirteen survivors with a median age of 30.2 years and body mass index of 27.3 were enrolled, along with 17 healthy controls with a median age of 27.1 years and body mass index of 24.8. Median time from chemotherapy was 4.7 (range: 0.8-14) years. There was no statistical difference in reactive hyperemia peripheral arterial tonometry ratio between cases and controls (p = 0.574). There was no statistical difference in small or large artery elasticity between cases and controls (p = 0.086) or between cases and historical controls (p = 0.729). There was also no statistical difference in the blood levels of circulating endothelial cells, von Willebrand factor, and vascular cell adhesion molecules. There was a trend toward increased metabolic syndrome in cases (15%) as compared to recruited controls (6%), though this difference was not statistically significant (p = 0.565). CONCLUSION Testicular cancer survivors have no clinically significant difference in endothelial function compared to controls 4 years after the completion of chemotherapy. Further research is needed to explore the secondary modifiable causes that may contribute to the risk of premature cardiovascular disease.
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Affiliation(s)
- Anne H Blaes
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA,
| | | | | | - Anna Solovey
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA,
| | - Robert Hebbel
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA,
| | - Bruce A Peterson
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA,
| | | | - Carter Biewen
- Division of Pediatrics, University of California San Francisco, CA, USA
| | - Suma H Konety
- Division of Cardiology, University of Minnesota, MN, USA
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Kwon Y, Jacobs DR, Lutsey PL, Brumback L, Chirinos JA, Mariani S, Redline S, Duprez DA. "Sleep disordered breathing and ECG R-wave to radial artery pulse delay, The Multi-Ethnic Study of Atherosclerosis". Sleep Med 2018; 48:172-179. [PMID: 29960211 PMCID: PMC6051731 DOI: 10.1016/j.sleep.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/30/2017] [Revised: 03/14/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrocardiography R-wave to radial artery pulse delay (RRD) represents pulse transit time inclusive of pre-ejection period (PEP) and arterial pulse propagation time. RRD is proposed to largely reflect arterial stiffness when PEP is accounted for (shorter RRD = higher arterial stiffness). Sleep disordered breathing (SDB) causes intermittent hypoxemia and sympathetic activation, which negatively influences vascular function. We aimed to examine the association of measures of SDB with RRD. METHODS Our sample consisted of participants in the Multi-Ethnic Study of Atherosclerosis without prevalent cardiovascular disease who underwent a daytime arterial elasticity exam, cardiac magnetic resonance imaging (MRI), and overnight polysomnography. SDB measures of interest included apnea hypopnea index (AHI) and oxygen desaturation index (ODI) (N = 1173). RRD was regressed on each measure of SDB separately, with adjustment for other cardiovascular risk factors as well as for correlates of the PEP, another component of RRD, by including cardiac MRI measures of contractility and preload. RESULTS In multivariate analysis, among measures of SDB, ODI, a marker of intermittent hypoxemia, was inversely associated with RRD (β = -60.2 msec per SD [15.5/hr], p = 0.04). No significant association was found with AHI. In gender stratified analyses, ODI and AHI were predictive of RRD in men only (β = -111.3 msec per SD [15.5/hr], p = 0.01 and β = -100.3 msec per SD [16.1/hr], p = 0.02 respectively). CONCLUSION Severity of SDB as measured by ODI was associated with RRD, a marker of arterial stiffness. Thus, association of RRD with measures of SDB appears to be gender-dependent.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Lyndia Brumback
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Sara Mariani
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA, USA
| | - Daniel A. Duprez
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Madahar P, Duprez DA, Podolanczuk AJ, Bernstein EJ, Kawut SM, Raghu G, Barr RG, Gross MD, Jacobs DR, Lederer DJ. Collagen biomarkers and subclinical interstitial lung disease: The Multi-Ethnic Study of Atherosclerosis. Respir Med 2018; 140:108-114. [PMID: 29957270 DOI: 10.1016/j.rmed.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/30/2017] [Revised: 04/02/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lung fibrosis is attributed to derangements in extracellular matrix remodeling, a process driven by collagen turnover. We examined the association of two collagen biomarkers, carboxy-terminal telopeptide of collagen type I (ICTP) and amino-terminal propeptide of type III procollagen (PIIINP), with subclinical interstitial lung disease (ILD) in adults. METHODS We performed a cross-sectional analysis of 3244 participants age 45-84 years in the Multi-Ethnic Study of Atherosclerosis. Serum ICTP and PIIINP levels were measured at baseline by radioimmunoassay. Subclinical ILD was defined as high attenuation areas (HAA) in the lung fields on baseline cardiac CT scans. Interstitial lung abnormalities (ILA) were measured in 1082 full-lung CT scans at 9.5 years median follow-up. We used generalized linear models to examine the associations of collagen biomarkers with HAA and ILA. RESULTS Median (IQR) for ICTP was 3.2 μg/L (2.6-3.9 μg/L) and for PIIINP was 5.3 μg/L (4.5-6.2 μg/L). In fully adjusted models, each SD increment in ICTP was associated with a 1.3% increment in HAA (95% CI 0.2-2.4%, p = 0.02) and each SD increment in PIIINP was associated with a 0.96% increment in HAA (95% CI 0.06-1.9%, p = 0.04). There was no association between ICTP or PIIINP and ILA. There was no evidence of effect modification by gender, race, smoking status or eGFR. CONCLUSIONS Higher levels of collagen biomarkers are associated with greater HAA independent of gender, race and smoking status. This suggests that extracellular matrix remodeling may accompany subclinical ILD prior to the onset of clinically evident disease.
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Affiliation(s)
- Purnema Madahar
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Daniel A Duprez
- Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Anna J Podolanczuk
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Steven M Kawut
- Department of Medicine and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Ganesh Raghu
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Myron D Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - David J Lederer
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
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Blaes AH, van Londen GJ, Sandhu N, Lerman A, Duprez DA. Cardiovascular Risk in Breast Cancer Patients Receiving Estrogen or Progesterone Antagonists. Curr Treat Options Cardio Med 2018; 20:48. [DOI: 10.1007/s11936-018-0637-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Duprez DA, Gross MD, Kizer JR, Ix JH, Hundley WG, Jacobs DR. Predictive Value of Collagen Biomarkers for Heart Failure With and Without Preserved Ejection Fraction: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Heart Assoc 2018; 7:JAHA.117.007885. [PMID: 29475876 PMCID: PMC5866330 DOI: 10.1161/jaha.117.007885] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Collagen biomarkers may correlate with incident heart failure (HF) and its subtypes. We hypothesized that circulating procollagen type III N-terminal propeptide (PIIINP) and collagen type I carboxy-terminal telopeptide (ICTP) predict incident HF. METHODS AND RESULTS We used a stratified sampling design in a multiethnic sample of 3187 subjects, initially aged 45 to 84 years and free of cardiovascular disease. We assayed baseline serum PIIINP and ICTP concentrations using radioimmunoassay. Incident HF was adjudicated, distinguishing reduced ejection fraction (HFrEF; EF <45%) from preserved EF (HFpEF; EF ≥45%). The incidence density for HFpEF and HFrEF was computed using Poisson regression per SD for each of PIIINP and ICTP, adjusting in model 1 for age, race, sex, and renal function or in model 2 for these variables plus blood pressure and medication. Mean (SD) ICTP was 3.38±1.77 μg/L, and mean (SD) PIIINP was 5.48±2.04 μg/L. Among the HF cases, 96 were HFrEF and 107 were HFpEF. Neither ICTP nor PIIINP significantly predicted incident HFrEF. The incidence density for HFpEF per 100 people observed for 13 years was 1.65 for low PIIINP (lower 6 octiles) versus 3.00 for higher PIIINP (P=0.002) in model 1 and correspondingly 1.45 versus 2.59 (P=0.003) in model 2. For low ICTP (lower 7 octiles) versus higher ICTP (octile 8), incidence densities were 1.79 versus 3.64 (P=0.002) in model 1 and 1.58 versus 3.12 (P=0.002) in model 2. CONCLUSIONS High levels of circulating ICTP and PIIINP as collagen biomarkers appear to be associated with incident HFpEF, but not HFrEF.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Myron D Gross
- Laboratory Medicine, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Joachim H Ix
- Nephrology Division, University of California, San Diego, CA
| | | | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis, MN
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Yoon C, Jacobs DR, Duprez DA, Dutton G, Lewis CE, Neumark-Sztainer D, Steffen LM, West DS, Mason SM. Questionnaire-based problematic relationship to eating and food is associated with 25 year body mass index trajectories during midlife: The Coronary Artery Risk Development In Young Adults (CARDIA) Study. Int J Eat Disord 2018; 51:10-17. [PMID: 29215750 DOI: 10.1002/eat.22813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Problematic eating behaviors and attitudes are of public health concern. Questionnaire-based assessment of these behaviors is important for large-scale research on eating behaviors. The questionnaire on eating and weight patterns-revised (QEWP-R) measures potential problematic behaviors and attitudes toward food (including anxieties, compensatory actions, overeating and loss of control, dieting, and shape concerns) that in aggregate may indicate diagnosable eating disorders. An important question regards the prevalence of these issues and their longitudinal associations with body mass index (BMI) in generally healthy middle aged adults. METHOD Based on eight constructs measured on QEWP-R, we created a new problematic relationship to eating and food (PREF) scale by assigning a point for each construct endorsed. Analyses were conducted in 3,892 black and white men and women participating in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) Study. The QEWP-R was administered in CARDIA year 10, when participants were aged 27-41 years. We used linear regression to model the relationship of individual constructs and the PREF scale to BMI over CARDIA follow-up. RESULTS Fifty-five percent of participants had 1-5 points and 4% had 6-8 points on the PREF scale. Each separate construct was positively associated with BMI, except concern about weight and shape. Adjusting for age, race, sex, education, and study center, mean BMI at CARDIA year 10, the time of PREF assessment, was approximately 1.0-2.5 kg/m2 higher per PREF category. CONCLUSION In middle age, problematic behaviors and attitudes toward food were common and associated with higher BMI.
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Affiliation(s)
| | | | | | | | | | | | | | - Delia S West
- University of South Carolina, Columbia, South Carolina
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Duprez DA, Florea N, Duval S, Koukol C, Cohn JN. Effect of nebivolol or atenolol vs. placebo on cardiovascular health in subjects with borderline blood pressure: the EVIDENCE study. J Hum Hypertens 2017; 32:20-25. [PMID: 29184167 DOI: 10.1038/s41371-017-0019-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/02/2017] [Accepted: 10/16/2017] [Indexed: 11/09/2022]
Abstract
Pharmacotherapy to protect the arteries may be appropriate for individuals with high-normal blood pressure who are at risk for future cardiovascular disease (CVD). Nebivolol (NEB) in contrast to atenolol (ATE) may have a beneficial effect on endothelial function and may be more effective than ATE in preventing CVD. Sixty subjects with preHTN or borderline BP and abnormal small artery elasticity (SAE) underwent evaluation with 10 tests, including large and small artery elasticity, resting and treadmill exercise BP, carotid intimal-media thickness, retinal vascular photography, micro-albuminuria, electrocardiography, echocardiography, and plasma B-type natriuretic peptide level. Each test scored as normal (0), borderline (1), or abnormal (2), and the total disease score (DS) was calculated by adding the test scores. Subjects were randomized double-blind to placebo (PLAC, n = 22), NEB 5/10 mg/day (n = 20), or ATE 25/50 mg/day (n = 18) once daily for 9 months. After 9 months, in the group receiving NEB the mean (standard deviation) DS decreased from baseline 4.3 (2.6) to 2.8 (2.4) (P < 0.007), with ATE from 5.4 (2.5) to 3.5 (1.9) (P = 0.0006), and with PLAC from 5.2 (3.0) to 4.5 (2.6) (P = 0.18). SAE increased in the NEB group from 6.0 (2.2) to 8.4 (3.4) ml/mmHg × 100 (P = 0.0001), whereas there was no significant change in the ATE and PLAC groups. Thus, nebivolol improves small artery function more than atenolol in asymptomatic subjects with preHTN or borderline BP, despite their similar BP-lowering effect.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Natalia Florea
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Catherine Koukol
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Jay N Cohn
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA.
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Marlatt KL, Steinberger J, Rudser KD, Dengel DR, Sadak KT, Lee JL, Blaes AH, Duprez DA, Perkins JL, Ross JA, Kelly AS. The Effect of Atorvastatin on Vascular Function and Structure in Young Adult Survivors of Childhood Cancer: A Randomized, Placebo-Controlled Pilot Clinical Trial. J Adolesc Young Adult Oncol 2017; 8:442-450. [PMID: 28853979 DOI: 10.1089/jayao.2017.0075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/24/2023] Open
Abstract
Purpose: Many adult survivors of childhood cancer are at high-risk of developing cardiovascular disease. Cancer therapy may cause damage to the vascular endothelium, thereby initiating atherosclerosis. Atorvastatin has been shown to improve endothelial function independent of reducing cholesterol, as well as reduce/slow arterial stiffness and thickening, yet has never been studied in childhood cancer survivors (CCS). Methods: Twenty-seven young adult (age 26.8 ± 6.2 years) survivors of childhood acute lymphoblastic leukemia or Non-Hodgkin's lymphoma were randomly assigned (1:1) 40 mg/day of atorvastatin or placebo for 6 months. Brachial artery flow-mediated dilation (FMD), small artery reactive hyperemia index (RHI), arterial stiffness, and carotid artery elasticity/thickness were assessed. Results: Fifteen participants completed the trial. No significant treatment effect for any vascular outcomes was observed at 6 months; however, a significant decrease in peak FMD (-3.0 [95% confidence interval [CI]: -5.3, -0.7]) and a trending significant decrease in RHI (-0.3 [95% CI: -0.62, 0.01]) was observed in the placebo group, resulting in a trend toward a treatment effects (p < 0.10). No effect on arterial stiffness, carotid arterial elasticity, or thickness was observed. Conclusion: Six months of atorvastatin treatment did not improve endothelial function or arterial stiffness in young adult CCS. While a trend toward an improvement in endothelial function was present, findings should be interpreted with caution owing to the small number of evaluable participants and subsequent lack of sufficient power. Further research in a larger sample size is needed to fully elucidate the effects of atorvastatin on vascular function. Trial registered at clinicaltrials.gov as NCT01733953.
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Affiliation(s)
- Kara L Marlatt
- 1Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Julia Steinberger
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kyle D Rudser
- 3Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Donald R Dengel
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.,4Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Karim T Sadak
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jill L Lee
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Anne H Blaes
- 5Cancer and Blood Disorders Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.,6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Daniel A Duprez
- 6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Joanna L Perkins
- 5Cancer and Blood Disorders Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Julie A Ross
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Aaron S Kelly
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.,6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Mulrooney DA, Soliman EZ, Ehrhardt MJ, Lu L, Duprez DA, Luepker RV, Armstrong GT, Joshi VM, Green DM, Srivastava D, Krasin MJ, Morris GS, Robison LL, Hudson MM, Ness KK. Electrocardiographic abnormalities and mortality in aging survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Am Heart J 2017. [PMID: 28625376 DOI: 10.1016/j.ahj.2017.03.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Electrocardiography (ECG), predictive of adverse outcomes in the general population, has not been studied in cancer survivors. We evaluated the prevalence of ECG abnormalities and associations with mortality among childhood cancer survivors. METHODS Major and minor abnormalities were coded per the Minnesota Classification system for participants in the St Jude Lifetime Cohort Study (n = 2,715) and community controls (n = 268). Odds ratios (ORs) and 95% CIs were calculated using multivariable logistic regression; and hazard ratios, using Cox proportional hazards regression. RESULTS Survivors were a median age of 31.3 (range 18.4-63.8) years at evaluation and 7.4 (range 0-24.8) years at diagnosis. Prior therapies included cardiac-directed radiation (29.5%), anthracycline (57.9%), and alkylating (60%) chemotherapies. The prevalence of minor ECG abnormalities was similar among survivors and controls (65.2% vs 67.5%, P = .6). Major ECG abnormalities were identified in 10.7% of survivors and 4.9% of controls (P < .001). Among survivors, the most common major abnormalities were isolated ST/T wave abnormalities (7.2%), evidence of myocardial infarction (3.7%), and left ventricular hypertrophy with strain pattern (2.8%). Anthracyclines ≥300 mg/m2 (OR 1.7 95% CI 1.1-2.5) and cardiac radiation (OR 2.1 95% CI 1.5-2.9 [1-1,999 cGy], 2.6 95% CI 1.6-3.9 [2,000-2,999 cGy], 10.5 95% CI 6.5-16.9 [≥3,000 cGy]) were associated with major abnormalities. Thirteen participants had a cardiac-related death. Major abnormalities were predictive of all-cause mortality (hazard ratio 4.0 95% CI 2.1-7.8). CONCLUSIONS Major ECG abnormalities are common among childhood cancer survivors, associated with increasing doses of anthracyclines and cardiac radiation, and predictive of both cardiac and all-cause mortality.
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Fujiyoshi A, Jacobs DR, Fitzpatrick AL, Alonso A, Duprez DA, Sharrett AR, Seeman T, Blaha MJ, Luchsinger JA, Rapp SR. Coronary Artery Calcium and Risk of Dementia in MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005349. [PMID: 28465455 DOI: 10.1161/circimaging.116.005349] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 06/30/2016] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies suggest a link between vascular injuries and dementia. Only a few studies, however, examined a longitudinal relation of subclinical vascular disease with dementia. We tested whether baseline coronary artery calcium (CAC), a biomarker of subclinical vascular disease, is associated with incident dementia independent of vascular risk factors and APOE-ε4 genotype in a community-based sample. METHODS AND RESULTS We analyzed 6293 participants of MESA (Multi-Ethnic Study of Atherosclerosis), aged 45 to 84 years at baseline (2000-2002), initially free of cardiovascular disease and noticeable cognitive deficit. Dementia cases were identified using hospital and death certificate International Statistical Classification of Diseases and Related Health Problems codes. Cox models were used to obtain hazard ratios according to CAC category, or per 1 SD log2[CAC+1], adjusted for vascular risk factor, APOE-ε4, with or without exclusion of interim stroke or cardiovascular disease. We observed 271 dementia cases in a median follow-up of 12.2 years. Baseline CAC had a graded positive association with dementia risk. Compared with no CAC, CAC score of 1 to 400, 401 to 1000, and ≥1001 had increased risk of dementia by 23%, 35%, and 71%, respectively, (Ptrend=0.026) after adjustment. 1 SD higher log2[CAC+1] was associated with 24% (95% confidence interval, 8%-41%; P=0.002) increase in dementia risk. Although the association was partially explained by interim stroke/cardiovascular disease, it remained significant even after excluding the interim events, or regardless of baseline age. CONCLUSIONS Higher baseline CAC was significantly associated with increased risk of dementia independent of vascular risk factor, APOE-ε4, and incident stroke. This is consistent with a hypothesis that vascular injuries play a role in the development of dementia.
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Affiliation(s)
- Akira Fujiyoshi
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.).
| | - David R Jacobs
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - Annette L Fitzpatrick
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - Alvaro Alonso
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - Daniel A Duprez
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - A Richey Sharrett
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - Teresa Seeman
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - Michael J Blaha
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - José A Luchsinger
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
| | - Stephen R Rapp
- From the Department of Public Health, Shiga University of Medical Science, Japan (A.F.); Division of Epidemiology and Community Health, School of Public Health (A.F., D.R.J.) and Cardiovascular Division, Department of Medicine (D.A.D.), University of Minnesota, Minneapolis; Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle (A.L.F.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); Departments of Medicine and Epidemiology, University of California, Los Angeles (T.S.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (J.A.L.); and Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.R.R.)
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Duprez DA, Gross MD, Sanchez OA, Kizer JR, Ix JH, Lima J, Tracy RP, Jacobs DR. Collagen Turnover Markers in Relation to Future Cardiovascular and Noncardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. Clin Chem 2017; 63:1237-1247. [PMID: 28515098 DOI: 10.1373/clinchem.2016.270520] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/31/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sustained remodeling of extracellular matrix can compromise organs and tissues. Procollagen type III N-terminal propeptide (PIIINP) and collagen type I carboxy-terminal telopeptide (ICTP) reflect collagen synthesis and degradation. We studied their predictive value for future death and disease. METHODS A total of 3068 men and women in the Multi-Ethnic Study of Atherosclerosis who were free of cardiovascular disease (CVD) and in generally good health had a baseline blood sample taken for ICTP and PIIINP. Median follow-up was 13.0 years. Among 4 primary outcomes, CVD events (n = 697) were adjudicated, death (n = 571) was by death certificate, and chronic inflammatory-related severe hospitalization and death (ChrIRD, n = 726) and total cancer (n = 327) were classified using International Classification of Diseases codes. We used Poisson regression to study baseline ICTP and PIIINP relative to these outcomes. RESULTS Mean (SD) PIIINP was 5.47 (1.95) μg/L and ICTP was 3.37 (1.70) μg/L. PIIINP and ICTP were highly correlated with each other and with estimated glomerular filtration rate (eGFR). Adjustment for age and eGFR attenuated relative risks, remaining 20%-30% per SD of both PIIINP and ICTP in prediction for total death and ChrIRD, and of PIIINP for cancer, with little additional attenuation by adjusting for risk factors and inflammatory biomarkers. CVD outcome was generally unrelated to PIIINP but became marginally inversely related to ICTP in the most adjusted model. CONCLUSIONS The collagen biomarkers PIIINP and ICTP, in part through pathophysiologically parallel associations with renal function, predicted ChrIRD and total death. Moreover, PIIINP predicted future cancer. These collagen markers may help differentiate healthy from unhealthy aging.
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Affiliation(s)
| | | | - Otto A Sanchez
- Nephrology Division, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Joachim H Ix
- Nephrology Division, University of California San Diego, San Diego, CA
| | - Joao Lima
- Cardiovascular Division, John Hopkins University, Baltimore, MD
| | - Russell P Tracy
- Department of Pathology & Laboratory Medicine and Department of Biochemistry, University of Vermont College of Medicine, Colchester, VT
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Affiliation(s)
- Jay N. Cohn
- From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Daniel A. Duprez
- From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Lynn Hoke
- From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Natalia Florea
- From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Sue Duval
- From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
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Hom EK, Duprez DA, Jacobs DR, Bluemke DA, Brumback LC, Polak JF, Peralta CA, Greenland P, Magzamen SL, Lima JAC, Redheuil A, Herrington DM, Stein JH, Vaidya D, Ouyang P, Kaufman JD. Comparing Arterial Function Parameters for the Prediction of Coronary Heart Disease Events: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Epidemiol 2016; 184:894-901. [PMID: 27923782 DOI: 10.1093/aje/kww113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 09/14/2016] [Indexed: 11/14/2022] Open
Abstract
Arterial dysfunction has been linked to decline in cardiac function and increased risk of cardiovascular disease events. We calculated the value of arterial function, measured at baseline (2000-2002), in predicting time to first coronary heart disease (CHD) event (median follow-up, 10.2 years) among participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Measures included the following: C1 and C2, derived from diastolic pulse contour analysis from the radial artery blood pressure waveform obtained by tonometry (n = 6,336); carotid distensibility and Young's elastic modulus at the carotid artery, derived from carotid artery ultrasonography (n = 6,531 and 6,528); and aortic distensibility, measured using cardiac magnetic resonance imaging (n = 3,677). After adjustment, the hazard ratio for a CHD event per standard-deviation increment in arterial function was 0.97 (95% confidence interval (CI): 0.86, 1.10) for C1, 0.73 (95% CI: 0.63, 0.86) for C2, 0.98 (95% CI: 0.86, 1.11) for carotid distensibility, 0.99 (95% CI: 0.90, 1.09) for Young's modulus, and 0.90 (95% CI: 0.74, 1.10) for aortic distensibility. We examined the area under the receiver operating characteristic curve for the model with full adjustment plus the addition of each measure individually. C2 provided additional discrimination for the prediction of CHD (area under the curve = 0.736 vs. 0.743; P = 0.04). Lower C2 was associated with a higher risk of future CHD events.
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Chandler PD, Akinkuolie AO, Tobias DK, Lawler PR, Li C, Moorthy MV, Wang L, Duprez DA, Jacobs DR, Glynn RJ, Otvos J, Connelly MA, Post WS, Ridker PM, Manson JE, Buring JE, Lee IM, Mora S. Association of N-Linked Glycoprotein Acetyls and Colorectal Cancer Incidence and Mortality. PLoS One 2016; 11:e0165615. [PMID: 27902713 PMCID: PMC5130185 DOI: 10.1371/journal.pone.0165615] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background Acute phase proteins highlight the dynamic interaction between inflammation and oncogenesis. GlycA, a novel nuclear magnetic resonance (NMR) inflammatory marker that identifies primarily circulating N-acetyl glycan groups attached to acute phase proteins, may be a future CRC risk biomarker. Methods We examined the association between GlycA and incident CRC and mortality in two prospective cohorts (N = 34,320); Discovery cohort: 27,495 participants from Women's Health Study (WHS); Replication cohort: 6,784 participants from Multi-Ethnic Study of Atherosclerosis (MESA). Multivariable Cox models were adjusted for clinical risk factors and compared GlycA to acute phase proteins (high-sensitivity C-reactive protein [hsCRP], fibrinogen, and soluble intercellular adhesion molecule-1 [sICAM-1]). Results In WHS (median follow-up 19 years, 337 cases, 103 deaths), adjusted HRs (95% CIs) per SD increment of GlycA for CRC incidence and mortality were 1.19 (1.06–1.35; p = 0.004) and 1.24 (1.00–1.55; p = 0.05), respectively. We replicated findings in MESA (median follow-up 11 years, 70 cases, 23 deaths); HRs (95% CIs) per SD of GlycA for CRC incidence and mortality were 1.32 (1.06–1.65; p = 0.01) and 1.54 (1.06–2.23; p = 0.02), respectively, adjusting for age, sex, and race. Pooled analysis, adjusted HR (95% CI) per SD of GlycA for CRC incidence and mortality was 1.26 (1.15–1.39; p = 1 x 10−6). Other acute phase proteins (hsCRP, fibrinogen, and sICAM-1) had weaker or no association with CRC incidence, while only fibrinogen and GlycA were associated with CRC mortality. Conclusions The clinical utility of GlycA to personalize CRC therapies or prevention warrants further study. Trial Registration ClinicalTrials.gov: WHS NCT00000479, MESA NCT00005487
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Affiliation(s)
- Paulette D. Chandler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (PDC); (SM)
| | - Akintunde O. Akinkuolie
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Deirdre K. Tobias
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Patrick R. Lawler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chungying Li
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - M. Vinayaga Moorthy
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lu Wang
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Daniel A. Duprez
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Robert J. Glynn
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - James Otvos
- LabCorp, Raleigh, North Carolina, United States of America
| | | | - Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (PDC); (SM)
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