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Strom JB, Mukherjee M, Beussink-Nelson L, Gardin JM, Freed BH, Shah SJ, Afilalo J. Reference Values for Indexed Echocardiographic Chamber Sizes in Older Adults: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2024; 13:e034029. [PMID: 38567667 DOI: 10.1161/jaha.123.034029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Normalization of echocardiographic chamber measurements for body surface area may result in misclassification of individuals with obesity or sarcopenia. Normalization for alternative measures of body size may be preferable, but there remains a dearth of information on their normative values and association with cardiovascular function metrics. METHODS AND RESULTS A total of 3032 individuals underwent comprehensive 2-dimensional echocardiography at Exam 6 in MESA (Multi-Ethnic Study of Atherosclerosis). In the subgroup of 608 individuals free of cardiopulmonary disease (69.5±7.0 years, 46% male, 48% White, 17% Chinese, 15% Black, 21% Hispanic), normative values were derived for left and right cardiac chamber measurements across a variety of ratiometric (body surface area, body mass index, height) and allometric (height1.6, height2.7) scaling parameters. Normative upper and lower reference values were provided for each scaling parameter stratified across age groups, sex, and race or ethnicity. Among scaling parameters, body surface area and height were associated with the least variability across race and ethnicity categories and height2.7 was associated with the least variability across sex categories. CONCLUSIONS In this diverse cohort of community-dwelling older adults, we provide normative values for common echocardiographic parameters across a variety of indexation methods.
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Affiliation(s)
- Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center Harvard Medical School 375 Longwood Avenue, 4th Floor Boston MA USA
| | | | | | | | - Benjamin H Freed
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine Chicago IL USA
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2
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Brankovic M, Sharma A, Gardin JM, Waller AH. Disproportionate Mitral Regurgitation and Mortality After Transcatheter Mitral Valve Edge-to-Edge Repair. Am J Cardiol 2024; 215:89-90. [PMID: 38232810 DOI: 10.1016/j.amjcard.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Milos Brankovic
- Division of Cardiology, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Alfonso H Waller
- Division of Cardiology, Department of Medicine; Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey
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3
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Liu X, Axelsson GT, Newman AB, Psaty BM, Boudreau RM, Wu C, Arnold AM, Aspelund T, Austin TR, Gardin JM, Siggeirsdottir K, Tracy RP, Gerszten RE, Launer LJ, Jennings LL, Gudnason V, Sanders JL, Odden MC. Plasma proteomic signature of human longevity. Aging Cell 2024:e14136. [PMID: 38440820 DOI: 10.1111/acel.14136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 03/06/2024] Open
Abstract
The identification of protein targets that exhibit anti-aging clinical potential could inform interventions to lengthen the human health span. Most previous proteomics research has been focused on chronological age instead of longevity. We leveraged two large population-based prospective cohorts with long follow-ups to evaluate the proteomic signature of longevity defined by survival to 90 years of age. Plasma proteomics was measured using a SOMAscan assay in 3067 participants from the Cardiovascular Health Study (discovery cohort) and 4690 participants from the Age Gene/Environment Susceptibility-Reykjavik Study (replication cohort). Logistic regression identified 211 significant proteins in the CHS cohort using a Bonferroni-adjusted threshold, of which 168 were available in the replication cohort and 105 were replicated (corrected p value <0.05). The most significant proteins were GDF-15 and N-terminal pro-BNP in both cohorts. A parsimonious protein-based prediction model was built using 33 proteins selected by LASSO with 10-fold cross-validation and validated using 27 available proteins in the validation cohort. This protein model outperformed a basic model using traditional factors (demographics, height, weight, and smoking) by improving the AUC from 0.658 to 0.748 in the discovery cohort and from 0.755 to 0.802 in the validation cohort. We also found that the associations of 169 out of 211 proteins were partially mediated by physical and/or cognitive function. These findings could contribute to the identification of biomarkers and pathways of aging and potential therapeutic targets to delay aging and age-related diseases.
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Affiliation(s)
- Xiaojuan Liu
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Gisli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Cardiovascular Health Research Unit, Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Thor Aspelund
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Thomas R Austin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, The Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Biochemistry, The Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA
| | | | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | | | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, USA
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4
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Mukherjee M, Strom JB, Afilalo J, Hu M, Beussink-Nelson L, Kim J, Addetia K, Bertoni A, Gottdiener J, Michos ED, Gardin JM, Shah SJ, Freed BH. Normative Values of Echocardiographic Chamber Size and Function in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis. medRxiv 2023:2023.12.05.23299572. [PMID: 38105976 PMCID: PMC10723504 DOI: 10.1101/2023.12.05.23299572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Echocardiographic (2DE) thresholds indicating disease or impaired functional status compared to normal physiologic aging in individuals ≥ 65 years are not clearly defined. In the present study, we sought to establish standard values for 2DE parameters related to chamber size and function in older adults without cardiopulmonary or cardiometabolic conditions. Methods In this cross-sectional study of 3032 individuals who underwent 2DE at Exam 6 in the Multi-Ethnic Study of Atherosclerosis (MESA), 608 participants fulfilled our inclusion criteria, with normative values defined as the mean value ± 1.96 standard deviations and compared across sex and race/ethnicity. Functional status measures included NT-proBNP, 6-minute walk distance [6MWD], and Kansas City Cardiomyopathy Questionnaire [KCCQ]. Prognostic performance using MESA cutoffs was compared to established guideline cutoffs using time-to-event analysis. Results Participants meeting our inclusion criteria (69.5 ± 7.0 years, 46.2% male, 47.5% White) had lower NT-proBNP, higher 6MWD, and higher (better) KCCQ summary values. Women had significantly smaller chamber sizes and better biventricular systolic function. White participants had the largest chamber dimensions, while Chinese participants had the smallest, even after adjustment for body size. Current guidelines identified 81.6% of healthy older adults in MESA as having cardiac abnormalities. Conclusions Among a large, diverse group of healthy older adults, we found significant differences in cardiac structure and function across sexes and races/ethnicities, which may signal sex-specific cardiac remodeling with advancing age. It is crucial for existing guidelines to consider the observed and clinically significant differences in cardiac structure and function associated with healthy aging. Our study highlights that existing guidelines, which grade abnormalities in echocardiographic cardiac chamber size and function based on younger individuals, may not adequately address the anticipated changes associated with normal aging.
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5
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Waller AH, Gardin JM. Does Left Ventricular Mass Have Additional Diagnostic Value in Severe Aortic Stenosis? Am J Cardiol 2023; 207:302-304. [PMID: 37782968 DOI: 10.1016/j.amjcard.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
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6
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Pearlman AS, Gardin JM. In Memoriam: Walter L. Henry, MD, FASE. J Am Soc Echocardiogr 2023; 36:1220-1222. [PMID: 37925191 DOI: 10.1016/j.echo.2023.08.014] [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: 11/06/2023]
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7
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Gottdiener JS, Buzkova P, Kahn PA, DeFilippi C, Shah S, Barasch E, Kizer JR, Psaty B, Gardin JM. Relation of Cigarette Smoking and Heart Failure in Adults ≥65 Years of Age (From the Cardiovascular Health Study). Am J Cardiol 2022; 168:90-98. [PMID: 35045935 PMCID: PMC8930705 DOI: 10.1016/j.amjcard.2021.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Cigarette smoking is associated with adverse cardiac outcomes, including incident heart failure (HF). However, key components of potential pathways from smoking to HF have not been evaluated in older adults. In a community-based study, we studied cross-sectional associations of smoking with blood and imaging biomarkers reflecting mechanisms of cardiac disease. Serial nested, multivariable Cox models were used to determine associations of smoking with HF, and to assess the influence of biochemical and functional (cardiac strain) phenotypes on these associations. Compared with never smokers, smokers had higher levels of inflammation (C-reactive protein and interleukin-6), cardiomyocyte injury (cardiac troponin T [hscTnT]), myocardial "stress"/fibrosis (soluble suppression of tumorigenicity 2 [sST2], galectin 3), and worse left ventricle systolic and diastolic function. In models adjusting for age, gender, and race (DEMO) and for clinical factors potentially in the causal pathway (CLIN), smoking exposures were associated with C-reactive protein and interleukin-6, sST2, hscTnT, and with N-terminal pro-brain natriuretic protein (in Whites). In DEMO adjusted models, the cumulative burden of smoking was associated with worse left ventricle systolic strain. Current smoking and former smoking were associated with HF in DEMO models (hazard ratio 1.41, 95% confidence interval 1.22 to 1.64 and hazard ratio 1.14, 95% confidence interval 1.03 to 1.25, respectively), and with current smoking after CLIN adjustment. Adjustment for time-varying myocardial infarction, inflammation, cardiac strain, hscTnT, sST2, and galectin 3 did not materially alter the associations. Smoking was associated with HF with preserved and decreased ejection fraction. In conclusion, in older adults, smoking is associated with multiple blood and imaging biomarker measures of pathophysiology previously linked to HF, and to incident HF even after adjustment for clinical intermediates.
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Affiliation(s)
- John S Gottdiener
- Department of Medicine (Cardiology), University of Maryland School of Medicine, Baltimore, Maryland; Departments of.
| | | | - Peter A Kahn
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Sanjiv Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eddy Barasch
- Division of Cardiology, St. Francis Hospital, Roslyn, New York
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, California; Departments of; Medicine and of; Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Bruce Psaty
- Medicine; Epidemiology, and; Health Services, University of Washington, Seattle, Washington; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; and
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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8
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Hossain A, Duverge JB, Wengrofsky P, Shin JW, Gardin JM. USE OF REMDESEVIR CAUSING SINUS BRADYCARDIA AND EVENTUALLY ASYMPTOMATIC MOBITZ TYPE 1 ATRIOVENTRICULAR BLOCK. J Am Coll Cardiol 2022. [PMCID: PMC8972510 DOI: 10.1016/s0735-1097(22)03377-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Griffith A, Wengrofsky P, Meredith A, Gardin JM, Gerula CM, Waller AH. SEVERE SECONDARY MITRAL REGURGITATION FROM ATYPICAL INFERO-POSTERIOR TRUE LEFT VENTRICULAR ANEURYSM: A CARDIAC MULTIMODALITY IMAGING DIAGNOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Kamel H, Bartz TM, Longstreth WT, Elkind MSV, Gottdiener J, Kizer JR, Gardin JM, Kim J, Shah S. Cardiac mechanics and incident ischemic stroke: the Cardiovascular Health Study. Sci Rep 2021; 11:17358. [PMID: 34462469 PMCID: PMC8405795 DOI: 10.1038/s41598-021-96702-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Recent evidence indicates that our understanding of the relationship between cardiac function and ischemic stroke remains incomplete. The Cardiovascular Health Study enrolled community-dwelling adults ≥ 65 years old. We included participants with speckle-tracking data from digitized baseline study echocardiograms. Exposures were left atrial reservoir strain (primary), left ventricular longitudinal strain, left ventricular early diastolic strain rate, septal e’ velocity, and lateral e’ velocity. The primary outcome was incident ischemic stroke. Cox proportional hazards models were adjusted for demographics, image quality, and risk factors including left ventricular ejection fraction and incident atrial fibrillation. Among 4,000 participants in our analysis, lower (worse) left atrial reservoir strain was associated with incident ischemic stroke (HR per SD absolute decrease, 1.14; 95% CI 1.04–25). All secondary exposure variables were significantly associated with the outcome. Left atrial reservoir strain was associated with cardioembolic stroke (HR per SD absolute decrease, 1.42; 95% CI 1.21–1.67) and cardioembolic stroke related to incident atrial fibrillation (HR per SD absolute decrease, 1.60; 1.32–1.95). Myocardial dysfunction that can ultimately lead to stroke may be identifiable at an early stage. This highlights opportunities to identify cerebrovascular risk earlier and improve stroke prevention via therapies for early myocardial dysfunction.
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Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, New York, NY, USA. .,Division of Neurocritical Care, Weill Cornell Medicine, 420 East 70th St, LH-413, New York, NY, 10021, USA.
| | - Traci M Bartz
- Departments of Biostatistics, University of Washington, Seattle, WA, USA
| | - W T Longstreth
- Departments of Neurology, University of Washington, Seattle, WA, USA.,Departments of Medicine, University of Washington, Seattle, WA, USA.,Departments of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - John Gottdiener
- Division of Cardiology, University of Maryland, Baltimore, MD, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Departments of Medicine, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Julius M Gardin
- Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | - Sanjiv Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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11
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Shah M, Rodriguez CJ, Bartz TM, Lyles MF, Kizer JR, Aurigemma GP, Gardin JM, Gottdiener JS. Incidence, Determinants and Mortality of Heart Failure Associated With Medical-Surgical Procedures in Patients ≥ 65 Years of Age (from the Cardiovascular Health Study). Am J Cardiol 2021; 153:71-78. [PMID: 34175107 DOI: 10.1016/j.amjcard.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/15/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) and myocardial infarction are serious complications of major noncardiac surgery in older adults. Many factors can contribute to the development of HF during the postoperative period. The incidence of, and risk factors for, procedure-associated heart failure (PHF) occurring at the time of, or shortly after, medical procedures in a population-based sample ≥ 65 years of age have not been fully characterized, particularly in comparison with HF not proximate to medical procedures. This analysis comprises 5,121 men and women free of HF at baseline from the Cardiovascular Health Study who were followed up for 12.0 years (median). HF events were documented by self-report at semi-annual contacts and confirmed by a formal adjudication committee using a review of the participants' medical records and standardized criteria for HF. Incident HF events were additionally adjudicated as either being related or unrelated to a medical procedure (PHF and non-PHF, respectively). We estimated cause-specific hazards ratios for the association of covariates with PHF and non-PHF. There were 1,728 incident HF events in the primary analysis: 168 (10%) classified as PHF, 1,526 (88%) as non-PHF, and 34 unclassified (2%). For those 1,045 participants in whom LV ejection fraction was known at the time of the HF event, it was ≥45% in 89 of 118 participants (75%) with PHF, compared to 517 of 927 participants (55%) with non-PHF (p < 0.001). Increased age, male gender, diabetes, and angina at baseline were associated with both PHF and non-PHF (range of hazard ratios (HR): 1.04-2.05]. Being Black was inversely associated with PHF [HR: 0.46, 95% confidence interval: 0.25-0.86]. Participants with increased age, without baseline angina, and with baseline LVEF<55% were at a significantly lower risk for PHF compared to non-PHF. Among those with PHF, surgical procedures-including cardiac, orthopedic, gastrointestinal, vascular, and urologic-comprised 83.3%, while percutaneous procedures comprised 8.9% (including 6.5% represented by cardiac catheterizations and pacemaker placements). Another group composed of a variety of procedures commonly requiring large fluid volume administration comprised 7.7%. There was a lower all-cause 30-day mortality in the PHF versus the non-PHF group (2.2% vs 5.7%), with a nonsignificant odds ratio of 0.39 in a minimally adjusted model. When individuals with prior myocardial infarction (MI) were excluded in a sensitivity analysis, the proportion of incident HF with concurrent MI was greater for PHF (32.9%) than for non-PHF (19.8%). In conclusion, PHF in older adults is a common entity with relatively low 30-day mortality. Baseline angina, lower age, and LVEF ≥ 55% were associated with a higher risk of PHF compared to non-PHF. Being Black was associated with a lower risk of PHF and PHF as a proportion of HF was lower in Black than in non-Black participants. Compared to non-PHF, PHF more frequently presented with concurrent MI and with preserved LV ejection fraction.
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Affiliation(s)
- Monali Shah
- Department of Medicine, Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Carlos J Rodriguez
- Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle WA, USA
| | - Mary F Lyles
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem NC, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System and Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco CA, USA
| | - Gerard P Aurigemma
- Department of Medicine, University of Massachusetts Medical School, Worcester MA, USA
| | - Julius M Gardin
- Department of Medicine, Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - John S Gottdiener
- Department of Medicine (Cardiology), University of Maryland School of Medicine, Baltimore MD, USA
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12
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Tan AX, Shah SJ, Sanders JL, Psaty BM, Wu C, Gardin JM, Peralta CA, Newman AB, Odden MC. Association Between Myocardial Strain and Frailty in CHS. Circ Cardiovasc Imaging 2021; 14:e012116. [PMID: 33993730 DOI: 10.1161/circimaging.120.012116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
BACKGROUND Myocardial strain, measured by speckle-tracking echocardiography, is a novel measure of subclinical cardiovascular disease and may reflect myocardial aging. We evaluated the association between myocardial strain and frailty-a clinical syndrome of lack of physiological reserve. METHODS Frailty was defined in participants of the CHS (Cardiovascular Health Study) as having ≥3 of the following clinical criteria: weakness, slowness, weight loss, exhaustion, and inactivity. Using speckle-tracking echocardiography data, we examined the cross-sectional (n=3206) and longitudinal (n=1431) associations with frailty among participants who had at least 1 measure of myocardial strain, left ventricular longitudinal strain (LVLS), left ventricular early diastolic strain rate and left atrial reservoir strain, and no history of cardiovascular disease or heart failure at the time of echocardiography. RESULTS In cross-sectional analyses, lower (worse) LVLS was associated with prevalent frailty; this association was robust to adjustment for left ventricular ejection fraction (adjusted odds ratio, 1.32 [95% CI, 1.07-1.61] per 1-SD lower strain; P=0.007) and left ventricular stroke volume (adjusted OR, 1.32 [95% CI, 1.08-1.61] per 1-SD lower strain; P=0.007). In longitudinal analyses, adjusted associations of LVLS and left ventricular early diastolic strain with incident frailty were 1.35 ([95% CI, 0.96-1.89] P=0.086) and 1.58 ([95% CI, 1.11-2.27] P=0.013, respectively). Participants who were frail and had the worst LVLS had a 2.2-fold increased risk of death (hazard ratio, 2.20 [95% CI, 1.81-2.66]; P<0.0001). CONCLUSIONS In community-dwelling older adults without prevalent cardiovascular disease, worse LVLS by speckle-tracking echocardiography, reflective of subclinical myocardial dysfunction, was associated with frailty. Frailty and LVLS have an additive effect on mortality risk.
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Affiliation(s)
- Annabel X Tan
- Department of Epidemiology and Population Health, Stanford University, CA (A.X.T., M.C.O.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.J.S.)
| | - Jason L Sanders
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (J.L.S.)
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services, University of Washington, Seattle (B.M.P.).,Kaiser Permanente Washington Health Research Institute, Seattle (B.M.P.)
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, China (C.W.)
| | - Julius M Gardin
- Division of Cardiology, Rutgers New Jersey Medical School (J.G.)
| | - Carmen A Peralta
- Department of Medicine, University of California San Francisco (C.A.P.).,Cricket Health, Inc, San Francisco, CA (C.A.P.)
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, CA (A.X.T., M.C.O.)
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13
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Häberle AD, Biggs ML, Cushman M, Psaty BM, Newman AB, Shlipak MG, Gottdiener J, Wu C, Gardin JM, Bansal N, Odden MC. Level and Change in N-Terminal Pro-B-Type Natriuretic Peptide and Kidney Function and Survival to Age 90. J Gerontol A Biol Sci Med Sci 2021; 76:478-484. [PMID: 32417919 DOI: 10.1093/gerona/glaa124] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many traditional cardiovascular risk factors do not predict survival to very old age. Studies have shown associations of estimated glomerular filtration rate (eGFR) and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with cardiovascular disease and mortality in older populations. This study aimed to evaluate the associations of the level and change in eGFR and NT-pro-BNP with longevity to age 90 years. METHOD The population included participants (n = 3,645) in the Cardiovascular Health Study, aged between 67 and 75 at baseline. The main exposures were eGFR, calculated with the Berlin Initiative Study (BIS) 2 equation, and NT-pro-BNP, and the main outcome was survival to age 90. Mixed models were used to estimate level and change of the main exposures. RESULTS There was an association between baseline level and change of both eGFR and NT-pro-BNP and survival to 90, and this association persisted after adjustment for covariates. Each 10 mL/min/1.73 m2 higher eGFR level was associated with an adjusted odds ratio (OR) of 1.23 (95% CI: 1.13, 1.34) of survival to 90, and a 0.5 mL/min/1.73 m2 slower decline in eGFR was associated with an OR of 1.51 (95% CI: 1.31, 1.74). A twofold higher level of NT-pro-BNP level had an adjusted OR of 0.67 (95% CI: 0.61, 0.73), and a 1.05-fold increase per year in NT-pro-BNP had an OR of 0.53 (95% CI: 0.43, 0.65) for survival to age 90. CONCLUSION eGFR and NT-pro-BNP appear to be important risk factors for longevity to age 90.
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Affiliation(s)
- Astrid D Häberle
- Department of Epidemiology and Population Health, Stanford University, California
| | - Mary L Biggs
- Department of Biostatistics, University of Washington, Seattle
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, and Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Michael G Shlipak
- Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco.,Kidney Health Research Collaborative, San Francisco VA Health Care System, California
| | | | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, China.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Julius M Gardin
- Department of Medicine, Rutgers New Jersey Medical School, Newark
| | - Nisha Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, California
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14
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Suthahar N, Lau ES, Blaha MJ, Paniagua SM, Larson MG, Psaty BM, Benjamin EJ, Allison MA, Bartz TM, Januzzi JL, Levy D, Meems LMG, Bakker SJL, Lima JAC, Cushman M, Lee DS, Wang TJ, deFilippi CR, Herrington DM, Nayor M, Vasan RS, Gardin JM, Kizer JR, Bertoni AG, Allen NB, Gansevoort RT, Shah SJ, Gottdiener JS, Ho JE, de Boer RA. Sex-Specific Associations of Cardiovascular Risk Factors and Biomarkers With Incident Heart Failure. J Am Coll Cardiol 2020; 76:1455-1465. [PMID: 32943164 PMCID: PMC7493711 DOI: 10.1016/j.jacc.2020.07.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Whether cardiovascular (CV) disease risk factors and biomarkers associate differentially with heart failure (HF) risk in men and women is unclear. OBJECTIVES The purpose of this study was to evaluate sex-specific associations of CV risk factors and biomarkers with incident HF. METHODS The analysis was performed using data from 4 community-based cohorts with 12.5 years of follow-up. Participants (recruited between 1989 and 2002) were free of HF at baseline. Biomarker measurements included natriuretic peptides, cardiac troponins, plasminogen activator inhibitor-1, D-dimer, fibrinogen, C-reactive protein, sST2, galectin-3, cystatin-C, and urinary albumin-to-creatinine ratio. RESULTS Among 22,756 participants (mean age 60 ± 13 years, 53% women), HF occurred in 2,095 participants (47% women). Age, smoking, type 2 diabetes mellitus, hypertension, body mass index, atrial fibrillation, myocardial infarction, left ventricular hypertrophy, and left bundle branch block were strongly associated with HF in both sexes (p < 0.001), and the combined clinical model had good discrimination in men (C-statistic = 0.80) and in women (C-statistic = 0.83). The majority of biomarkers were strongly and similarly associated with HF in both sexes. The clinical model improved modestly after adding natriuretic peptides in men (ΔC-statistic = 0.006; likelihood ratio chi-square = 146; p < 0.001), and after adding cardiac troponins in women (ΔC-statistic = 0.003; likelihood ratio chi-square = 73; p < 0.001). CONCLUSIONS CV risk factors are strongly and similarly associated with incident HF in both sexes, highlighting the similar importance of risk factor control in reducing HF risk in the community. There are subtle sex-related differences in the predictive value of individual biomarkers, but the overall improvement in HF risk estimation when included in a clinical HF risk prediction model is limited in both sexes.
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Affiliation(s)
- Navin Suthahar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Emily S Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins University, Baltimore, Maryland
| | - Samantha M Paniagua
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; Boston University School of Medicine and School of Public Health, and NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts
| | - Bruce M Psaty
- Departments of Medicine, Epidemiology and Health Services, University of Washington, and Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Emelia J Benjamin
- Boston University School of Medicine and School of Public Health, and NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Levy
- Boston University School of Medicine and School of Public Health, and NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts; Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Laura M G Meems
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins Medical Institutions, and Department of Cardiology, Heart and Vascular Institute, The Johns Hopkins University, Baltimore, Maryland
| | - Mary Cushman
- Department of Medicine and Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Douglas S Lee
- Department of Medicine and Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Thomas J Wang
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | | | - David M Herrington
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew Nayor
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ramachandran S Vasan
- Boston University School of Medicine and School of Public Health, and NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jorge R Kizer
- Departments of Medicine, Epidemiology and Biostatistics, San Francisco Veterans Affairs Health Care System and University of California-San Francisco, San Francisco, California
| | - Alain G Bertoni
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ron T Gansevoort
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jennifer E Ho
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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15
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Mathenge N, Fan W, Wong ND, Hirsch C, Delaney C(J, Amsterdam EA, Koch B, Calara R, Gardin JM. Pre-diabetes, diabetes and predictors of incident angina among older women and men in the Cardiovascular Health Study. Diab Vasc Dis Res 2020; 17:1479164119888476. [PMID: 31778070 PMCID: PMC7510359 DOI: 10.1177/1479164119888476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus and angina pectoris are important conditions in older persons. The utility of pre-diabetes mellitus, diabetes mellitus and other risk factors as predictors of incident angina pectoris among older adults has not been characterized. We examined incident angina pectoris rates by sex and diabetes mellitus status in 4511 adults aged ⩾65 years without coronary heart disease at baseline from the Cardiovascular Health Study. Cox regression examined predictors of incident angina pectoris, including pre-diabetes mellitus or diabetes mellitus adjusted for sociodemographic characteristics and other risk factors, over 12.2 ± 6.9 years of follow-up. Overall, 39.1% of participants had pre-diabetes mellitus, 14.0% had diabetes mellitus and 532 (11.8%) had incident angina pectoris. Incident angina pectoris rates per 1000 person-years in those with neither condition, pre-diabetes mellitus, and diabetes mellitus were 7.9, 9.0 and 12.3 in women and 10.3, 11.2 and 14.5 in men, respectively. Pre-diabetes mellitus and diabetes mellitus were not independently associated with incident AP; however, key predictors of AP were male sex, low-density lipoprotein-cholesterol, triglycerides, systolic blood pressure, antihypertensive medication and difficulty performing at least one instrumental activity of daily living (all p < 0.05 to p < 0.01). In our cohort of older adult participants, while the incidence of AP is greater in those with diabetes mellitus, neither diabetes mellitus nor pre-diabetes mellitus independently predicted incident angina pectoris.
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Affiliation(s)
- Njambi Mathenge
- Division of Cardiology, Massachusetts
General Hospital, Boston, MA, USA
| | - Wenjun Fan
- Division of Cardiology, School of
Medicine, University of California, Irvine, Irvine, CA, USA
| | - Nathan D Wong
- Division of Cardiology, School of
Medicine, University of California, Irvine, Irvine, CA, USA
| | - Calvin Hirsch
- Division of Cardiovascular Medicine,
School of Medicine, University of California, Davis, Davis, CA, USA
| | | | - Ezra A Amsterdam
- Division of Cardiovascular Medicine,
School of Medicine, University of California, Davis, Davis, CA, USA
| | - Bruce Koch
- Medical Affairs, Gilead Sciences, Foster
City, CA, USA
| | - Rico Calara
- Medical Affairs, Gilead Sciences, Foster
City, CA, USA
| | - Julius M Gardin
- Division of Cardiology, Department of
Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Julius M Gardin, Division of Cardiology,
Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange
Avenue, Room I-510, Newark, NJ 07103, USA.
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16
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de Boer RA, Nayor M, deFilippi CR, Enserro D, Bhambhani V, Kizer JR, Blaha MJ, Brouwers FP, Cushman M, Lima JAC, Bahrami H, van der Harst P, Wang TJ, Gansevoort RT, Fox CS, Gaggin HK, Kop WJ, Liu K, Vasan RS, Psaty BM, Lee DS, Hillege HL, Bartz TM, Benjamin EJ, Chan C, Allison M, Gardin JM, Januzzi JL, Shah SJ, Levy D, Herrington DM, Larson MG, van Gilst WH, Gottdiener JS, Bertoni AG, Ho JE. Association of Cardiovascular Biomarkers With Incident Heart Failure With Preserved and Reduced Ejection Fraction. JAMA Cardiol 2019; 3:215-224. [PMID: 29322198 DOI: 10.1001/jamacardio.2017.4987] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Nearly half of all patients with heart failure have preserved ejection fraction (HFpEF) as opposed to reduced ejection fraction (HFrEF), yet associations of biomarkers with future heart failure subtype are incompletely understood. Objective To evaluate the associations of 12 cardiovascular biomarkers with incident HFpEF vs HFrEF among adults from the general population. Design, Setting, and Participants This study included 4 longitudinal community-based cohorts: the Cardiovascular Health Study (1989-1990; 1992-1993 for supplemental African-American cohort), the Framingham Heart Study (1995-1998), the Multi-Ethnic Study of Atherosclerosis (2000-2002), and the Prevention of Renal and Vascular End-stage Disease study (1997-1998). Each cohort had prospective ascertainment of incident HFpEF and HFrEF. Data analysis was performed from June 25, 2015, to November 9, 2017. Exposures The following biomarkers were examined: N-terminal pro B-type natriuretic peptide or brain natriuretic peptide, high-sensitivity troponin T or I, C-reactive protein (CRP), urinary albumin to creatinine ratio (UACR), renin to aldosterone ratio, D-dimer, fibrinogen, soluble suppressor of tumorigenicity, galectin-3, cystatin C, plasminogen activator inhibitor 1, and interleukin 6. Main Outcomes and Measures Development of incident HFpEF and incident HFrEF. Results Among the 22 756 participants in these 4 cohorts (12 087 women and 10 669 men; mean [SD] age, 60 [13] years) in the study, during a median follow-up of 12 years, 633 participants developed incident HFpEF, and 841 developed HFrEF. In models adjusted for clinical risk factors of heart failure, 2 biomarkers were significantly associated with incident HFpEF: UACR (hazard ratio [HR], 1.33; 95% CI, 1.20-1.48; P < .001) and natriuretic peptides (HR, 1.27; 95% CI, 1.16-1.40; P < .001), with suggestive associations for high-sensitivity troponin (HR, 1.11; 95% CI, 1.03-1.19; P = .008), plasminogen activator inhibitor 1 (HR, 1.22; 95% CI, 1.03-1.45; P = .02), and fibrinogen (HR, 1.12; 95% CI, 1.03-1.22; P = .01). By contrast, 6 biomarkers were associated with incident HFrEF: natriuretic peptides (HR, 1.54; 95% CI, 1.41-1.68; P < .001), UACR (HR, 1.21; 95% CI, 1.11-1.32; P < .001), high-sensitivity troponin (HR, 1.37; 95% CI, 1.29-1.46; P < .001), cystatin C (HR, 1.19; 95% CI, 1.11-1.27; P < .001), D-dimer (HR, 1.22; 95% CI, 1.11-1.35; P < .001), and CRP (HR, 1.19; 95% CI, 1.11-1.28; P < .001). When directly compared, natriuretic peptides, high-sensitivity troponin, and CRP were more strongly associated with HFrEF compared with HFpEF. Conclusions and Relevance Biomarkers of renal dysfunction, endothelial dysfunction, and inflammation were associated with incident HFrEF. By contrast, only natriuretic peptides and UACR were associated with HFpEF. These findings highlight the need for future studies focused on identifying novel biomarkers of the risk of HFpEF.
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Affiliation(s)
- Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Matthew Nayor
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | | | - Danielle Enserro
- Department of Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Vijeta Bhambhani
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins University, Baltimore, Maryland
| | - Frank P Brouwers
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Mary Cushman
- Division of Hematology/Oncology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland.,Department of Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland
| | - Hossein Bahrami
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ron T Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Caroline S Fox
- Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Hanna K Gaggin
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Willem J Kop
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ramachandran S Vasan
- Framingham Heart Study, Framingham, Massachusetts.,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hans L Hillege
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle
| | - Emelia J Benjamin
- Framingham Heart Study, Framingham, Massachusetts.,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
| | - Cheeling Chan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Levy
- Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland.,Framingham Heart Study, Framingham, Massachusetts
| | - David M Herrington
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Martin G Larson
- Department of Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Wiek H van Gilst
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - Alain G Bertoni
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jennifer E Ho
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
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17
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Hammond CA, Blades NJ, Chaudhry SI, Dodson JA, Longstreth WT, Heckbert SR, Psaty BM, Arnold AM, Dublin S, Sitlani CM, Gardin JM, Thielke SM, Nanna MG, Gottesman RF, Newman AB, Thacker EL. Long-Term Cognitive Decline After Newly Diagnosed Heart Failure: Longitudinal Analysis in the CHS (Cardiovascular Health Study). Circ Heart Fail 2019. [PMID: 29523517 DOI: 10.1161/circheartfailure.117.004476] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 01/14/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction. METHODS AND RESULTS Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (P=0.084), and did not vary significantly by reduced versus preserved ejection fraction (P=0.734). CONCLUSIONS Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.
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Affiliation(s)
- Christa A Hammond
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Natalie J Blades
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Sarwat I Chaudhry
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - John A Dodson
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - W T Longstreth
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Susan R Heckbert
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Bruce M Psaty
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Alice M Arnold
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Sascha Dublin
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Colleen M Sitlani
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Julius M Gardin
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Stephen M Thielke
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Michael G Nanna
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Rebecca F Gottesman
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Anne B Newman
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Evan L Thacker
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA.
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Gardin JM. Pulsed Doppler Echocardiography: An Historical Perspective. J Am Soc Echocardiogr 2018; 31:1330-1343. [PMID: 30522606 DOI: 10.1016/j.echo.2018.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 10/27/2022]
Abstract
Over the past six decades, echocardiography has evolved into an important technique for not only imaging cardiac structures, but also, by employing the Doppler equation, for assessing cardiac blood flow and tissue velocities. This review focuses on pulsed Doppler echocardiography: its principles, early development, and clinical applications. Important clinical applications include: (1) measurement of flow velocities, stroke volumes, and regurgitant and shunt volumes; (2) assessment of time intervals, e.g., pulmonary artery acceleration time as a measure of pulmonary artery pressure and resistance or the timing of mitral regurgitation in hypertrophic cardiomyopathy; (3) detection of turbulent flow in regurgitation, stenoses, and shunts, enhanced by the implementation of color Doppler; and (4) evaluation of left ventricular diastolic function in conjunction with pulsed tissue Doppler and deformation (strain) measurements.
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Affiliation(s)
- Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
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Savji N, Meijers WC, Bartz TM, Bhambhani V, Cushman M, Nayor M, Kizer JR, Sarma A, Blaha MJ, Gansevoort RT, Gardin JM, Hillege HL, Ji F, Kop WJ, Lau ES, Lee DS, Sadreyev R, van Gilst WH, Wang TJ, Zanni MV, Vasan RS, Allen NB, Psaty BM, van der Harst P, Levy D, Larson M, Shah SJ, de Boer RA, Gottdiener JS, Ho JE. The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF. JACC Heart Fail 2018; 6:701-709. [PMID: 30007554 PMCID: PMC6076337 DOI: 10.1016/j.jchf.2018.05.018] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately. BACKGROUND Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear. METHODS We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models. RESULTS The mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI; 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18; 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34). CONCLUSIONS Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.
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Affiliation(s)
- Nazir Savji
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Wouter C Meijers
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Vijeta Bhambhani
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Cushman
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Matthew Nayor
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R Kizer
- Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Amy Sarma
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland
| | - Ron T Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Hans L Hillege
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Fei Ji
- Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Willem J Kop
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Emily S Lau
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Ruslan Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Wiek H van Gilst
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Markella V Zanni
- Division of Neuroendocrinology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ramachandran S Vasan
- Framingham Heart Study, Framingham, Massachusetts; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Norrina B Allen
- Department of Epidemiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington; Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Pim van der Harst
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Daniel Levy
- Framingham Heart Study, Framingham, Massachusetts; Center for Population Studies of the National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martin Larson
- Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rudolf A de Boer
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - Jennifer E Ho
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts.
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Bhambhani V, Kizer JR, Lima JAC, van der Harst P, Bahrami H, Nayor M, deFilippi CR, Enserro D, Blaha MJ, Cushman M, Wang TJ, Gansevoort RT, Fox CS, Gaggin HK, Kop WJ, Liu K, Vasan RS, Psaty BM, Lee DS, Brouwers FP, Hillege HL, Bartz TM, Benjamin EJ, Chan C, Allison M, Gardin JM, Januzzi JL, Levy D, Herrington DM, van Gilst WH, Bertoni AG, Larson MG, de Boer RA, Gottdiener JS, Shah SJ, Ho JE. Predictors and outcomes of heart failure with mid-range ejection fraction. Eur J Heart Fail 2018; 20:651-659. [PMID: 29226491 PMCID: PMC5899688 DOI: 10.1002/ejhf.1091] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [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: 08/24/2017] [Revised: 10/05/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
AIMS While heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) are well described, determinants and outcomes of heart failure with mid-range ejection fraction (HFmrEF) remain unclear. We sought to examine clinical and biochemical predictors of incident HFmrEF in the community. METHODS AND RESULTS We pooled data from four community-based longitudinal cohorts, with ascertainment of new heart failure (HF) classified into HFmrEF [ejection fraction (EF) 41-49%], HFpEF (EF ≥50%), and HFrEF (EF ≤40%). Predictors of incident HF subtypes were assessed using multivariable Cox models. Among 28 820 participants free of HF followed for a median of 12 years, there were 200 new HFmrEF cases, compared with 811 HFpEF and 1048 HFrEF. Clinical predictors of HFmrEF included age, male sex, systolic blood pressure, diabetes mellitus, and prior myocardial infarction (multivariable adjusted P ≤ 0.003 for all). Biomarkers that predicted HFmrEF included natriuretic peptides, cystatin-C, and high-sensitivity troponin (P ≤ 0.0004 for all). Natriuretic peptides were stronger predictors of HFrEF [hazard ratio (HR) 2.00 per 1 standard deviation increase, 95% confidence interval (CI) 1.81-2.20] than of HFmrEF (HR 1.51, 95% CI 1.20-1.90, P = 0.01 for difference), and did not differ in their association with incident HFmrEF and HFpEF (HR 1.56, 95% CI 1.41-1.73, P = 0.68 for difference). All-cause mortality following the onset of HFmrEF was worse than that of HFpEF (50 vs. 39 events per 1000 person-years, P = 0.02), but comparable to that of HFrEF (46 events per 1000 person-years, P = 0.78). CONCLUSIONS We found overlap in predictors of incident HFmrEF with other HF subtypes. In contrast, mortality risk after HFmrEF was worse than HFpEF, and similar to HFrEF.
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Affiliation(s)
- Vijeta Bhambhani
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R. Kizer
- Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Joao A. C. Lima
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Hossein Bahrami
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland. Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Matthew Nayor
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Danielle Enserro
- Department of Preventive Medicine, Boston University School of Medicine, Massachusetts
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland. Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Mary Cushman
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Thomas J. Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Hanna K Gaggin
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Willem J. Kop
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ramachandran S. Vasan
- Department of Preventive Medicine, Boston University School of Medicine, Massachusetts,Framingham Heart Study, Framingham, Massachusetts,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Douglas S. Lee
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Frank P. Brouwers
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Hans L. Hillege
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Traci M. Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Emelia J. Benjamin
- Framingham Heart Study, Framingham, Massachusetts,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Cheeling Chan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Allison
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, California
| | - Julius M. Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James L. Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel Levy
- Framingham Heart Study, Framingham, Massachusetts,Population Sciences Branch of the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David M. Herrington
- Section on Cardiovascular Medicine, Wake Forest School of Medicine Winston Salem, North Carolina
| | - Wiek H. van Gilst
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland. Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine Winston Salem, North Carolina
| | - Martin G. Larson
- Framingham Heart Study, Framingham, Massachusetts,Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Rudolf A. de Boer
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - John S. Gottdiener
- Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, Maryland
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer E. Ho
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Massera D, Xu S, Bartz TM, Bortnick AE, Joachim H, Chonchol M, Owens DS, Barasch E, Gardin JM, Gottdiener JS, Robbins JR, Siscovick DS, Kizer JR. Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study. Arch Osteoporos 2017; 12:52. [PMID: 28560501 PMCID: PMC5537624 DOI: 10.1007/s11657-017-0347-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/06/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Associations between bone mineral density and aortic valvular, aortic annular, and mitral annular calcification were investigated in a cross-sectional analysis of a population-based cohort of 1497 older adults. Although there was no association between continuous bone mineral density and outcomes, a significant association between osteoporosis and aortic valvular calcification in men was found. INTRODUCTION The process of cardiac calcification bears a resemblance to skeletal bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but epidemiologic data are sparse. METHODS We tested the hypothesis that BMD of the total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) is inversely associated with prevalence of three echocardiographic measures of cardiac calcification in a cross-sectional analysis of 1497 older adults from the Cardiovascular Health Study. The adjusted association of BMD with aortic valve calcification (AVC), aortic annular calcification (AAC), and mitral annular calcification (MAC) was assessed with relative risk (RR) regression. RESULTS Mean (SD) age was 76.2 (4.8) years; 58% were women. Cardiac calcification was highly prevalent in women and men: AVC, 59.5 and 71.0%; AAC 45.1 and 46.7%; MAC 42.8 and 39.5%, respectively. After limited and full adjustment for potential confounders, no statistically significant associations were detected between continuous BMD at either site and the three measures of calcification. Assessment of WHO BMD categories revealed a significant association between osteoporosis at the total hip and AVC in men (adjusted RR compared with normal BMD = 1.24 (1.01-1.53)). In graded sensitivity analyses, there were apparent inverse associations between femoral neck BMD and AVC with stenosis in men, and femoral neck BMD and moderate/severe MAC in women, but these were not significant. CONCLUSION These findings support further investigation of the sex-specific relationships between low BMD and cardiac calcification, and whether processes linking the two could be targeted for therapeutic ends.
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Affiliation(s)
- Daniele Massera
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Shuo Xu
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | - Anna E. Bortnick
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - H. Joachim
- University of California San Diego, San Diego, CA
| | | | | | | | | | | | | | | | - Jorge R. Kizer
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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22
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Gardin JM. Aortic Stiffness Matters: Ventricular-Arterial Interactions Over Time. JACC Cardiovasc Imaging 2017; 10:1317-1319. [DOI: 10.1016/j.jcmg.2016.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
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23
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Ho JE, Enserro D, Brouwers FP, Kizer JR, Shah SJ, Psaty BM, Bartz TM, Santhanakrishnan R, Lee DS, Chan C, Liu K, Blaha MJ, Hillege HL, van der Harst P, van Gilst WH, Kop WJ, Gansevoort RT, Vasan RS, Gardin JM, Levy D, Gottdiener JS, de Boer RA, Larson MG. Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.003116. [PMID: 27266854 DOI: 10.1161/circheartfailure.115.003116] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/12/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). METHODS AND RESULTS Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF subtype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95% confidence interval [CI], 0.78-0.82) and validation samples (internal: 0.79; 95% CI, 0.77-0.82 and external: 0.76; 95% CI: 0.71-0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95% CI, 0.80-0.84) and validation samples (internal: 0.80; 95% CI, 0.78-0.83 and external: 0.76; 95% CI, 0.71-0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02). CONCLUSIONS We describe and validate risk prediction models for HF subtypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF subtypes.
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Affiliation(s)
- Jennifer E Ho
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.). jho
| | - Danielle Enserro
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Frank P Brouwers
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Jorge R Kizer
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Sanjiv J Shah
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Bruce M Psaty
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Traci M Bartz
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Rajalakshmi Santhanakrishnan
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Douglas S Lee
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Cheeling Chan
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Kiang Liu
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Michael J Blaha
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Hans L Hillege
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Pim van der Harst
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Wiek H van Gilst
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Willem J Kop
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Ron T Gansevoort
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Ramachandran S Vasan
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Julius M Gardin
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Daniel Levy
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - John S Gottdiener
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Rudolf A de Boer
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Martin G Larson
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
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Maurer MS, Koh WJ, Bartz TM, Vullaganti S, Barasch E, Gardin JM, Gottdiener JS, Psaty BM, Kizer JR. Relation of the Myocardial Contraction Fraction, as Calculated from M-Mode Echocardiography, With Incident Heart Failure, Atherosclerotic Cardiovascular Disease and Mortality (Results from the Cardiovascular Health Study). Am J Cardiol 2017; 119:923-928. [PMID: 28073429 DOI: 10.1016/j.amjcard.2016.11.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 01/19/2023]
Abstract
We evaluated the association between 2-dimensional (2D) echocardiography (echo)-determined myocardial contraction fraction (MCF) and adverse cardiovascular outcomes including incident heart failure (HF), atherosclerotic cardiovascular disease (ASCVD), and mortality. The MCF, the ratio of left ventricular (LV) stroke volume (SV) to myocardial volume (MV), is a volumetric measure of myocardial shortening that can distinguish pathologic from physiological hypertrophy. Using 2D echo-guided M-mode data from the Cardiovascular Health Study, we calculated MCF in subjects with LV ejection fraction (EF) ≥55% and used Cox models to evaluate its association with incident HF, ASCVD, and all-cause mortality after adjusting for clinical and echo parameters. We assessed whether log2(SV) and log2(MV) were consistent with the expected 1:-1 ratio used in the definition of MCF. Among 2,147 participants (age 72 ± 5 years), average MCF was 59 ± 13%. After controlling for clinical and echo variables, each 10% absolute increment in MCF was associated with lower risk of HF (hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.82, 0.94), ASCVD (HR 0.90; 95% CI 0.85, 0.95), and death (HR 0.93; 95% CI 0.89, 0.97). Moreover, the MCF was still significantly associated with ASCVD and mortality, but not HF, after adjustment for percent-predicted LV mass. Significant departure from the 1:-1 ratio was not observed for ASCVD or death, but did occur for HF, driven by a stronger association for MV than SV. In conclusion, among older adults without CVD or low LV ejection fraction, 2D echo-guided M-mode-derived MCF was independently associated with lower risk of adverse cardiovascular outcomes, but this ratiometric index may not capture the full relation that is apparent when its components are modeled separately in the case of HF.
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Desai CS, Bartz TM, Gottdiener JS, Lloyd-Jones DM, Gardin JM. Usefulness of Left Ventricular Mass and Geometry for Determining 10-Year Prediction of Cardiovascular Disease in Adults Aged >65 Years (from the Cardiovascular Health Study). Am J Cardiol 2016; 118:684-90. [PMID: 27457431 DOI: 10.1016/j.amjcard.2016.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 01/13/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 01/19/2023]
Abstract
Left ventricular (LV) mass and geometry are associated with risk of cardiovascular disease (CVD). We sought to determine whether LV mass and geometry contribute to risk prediction for CVD in adults aged ≥65 years of the Cardiovascular Health Study. We indexed LV mass to body size, denoted as LV mass index (echo-LVMI), and we defined LV geometry as normal, concentric remodeling, and eccentric or concentric LV hypertrophy. We added echo-LVMI and LV geometry to separate 10-year risk prediction models containing traditional risk factors and determined the net reclassification improvement (NRI) for incident coronary heart disease (CHD), CVD (CHD, heart failure [HF], and stroke), and HF alone. Over 10 years of follow-up in 2,577 participants (64% women, 15% black, mean age 72 years) for CHD and CVD, the adjusted hazards ratios for a 1-SD higher echo-LVMI were 1.25 (95% CI 1.14 to 1.37), 1.24 (1.15 to 1.33), and 1.51 (1.40 to 1.62), respectively. Addition of echo-LVMI to the standard model for CHD resulted in an event NRI of -0.011 (95% CI -0.037 to 0.028) and nonevent NRI of 0.034 (95% CI 0.008 to 0.076). Addition of echo-LVMI and LV geometry to the standard model for CVD resulted in an event NRI of 0.013 (95% CI -0.0335 to 0.0311) and a nonevent NRI of 0.043 (95% CI 0.011 to 0.09). The nonevent NRI was also significant with addition of echo-LVMI for HF risk prediction (0.10, 95% CI 0.057 to 0.16). In conclusion, in adults aged ≥65 years, echo-LVMI improved risk prediction for CHD, CVD, and HF, driven primarily by improved reclassification of nonevents.
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Affiliation(s)
- Chintan S Desai
- Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Julius M Gardin
- Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
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Abstract
Noninvasive measures of atherosclerosis have emerged as adjuncts to standard cardiovascular disease (CVD) risk factors in an attempt to refine risk stratification and the need for more aggressive preventive strategies. Two such approaches, carotid artery imaging and brachial artery reactivity testing (BART), are ultrasound based. Numerous carotid artery imaging protocols have been used, and methodologic aspects are described in detail in this review. The panel recommends that protocols: (1) use end-diastolic (minimum dimension) images for intimal-medial thickness (IMT) measurements; (2) provide separate categorization of plaque presence and IMT; (3) avoid use of a single upper limit of normal for IMT because the measure varies with age, sex, and race; and (4) incorporate lumen measurement, particularly when serial measurements are performed to account for changes in distending pressure. Protocols may vary in the number of segments wherein IMT is measured, whether near wall is measured in addition to far wall, and whether IMT measurements are derived from B-mode or M-mode images, depending on the application. BART is a technique that requires meticulous attention to patient preparation and methodologic detail. Its application is substantially more challenging than is carotid imaging and remains largely a research technique that is not readily translated into routine clinical practice.
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Affiliation(s)
- Mary J Roman
- Weill Medical College of Cornell University, New York, NY, USA.
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Gerhard-Herman M, Gardin JM, Jaff M, Mohler E, Roman M, Naqvi TZ. Guidelines for noninvasive vascular laboratory testing: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. Vasc Med 2016; 11:183-200. [PMID: 17288127 DOI: 10.1177/1358863x06070516] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accompanying the rapid growth of interest in percutaneous vascular interventions, there has been increasing interest among cardiologists in performing noninvasive vascular testing using ultrasound. In an attempt to provide recommendations on the best practices in vascular laboratory testing, this report has been prepared by a writing group from the American Society of Echocardiography (ASE) and the Society for Vascular Medicine and Biology. The document summarizes principles integral to vascular duplex ultrasound--including color Doppler, spectral Doppler waveform analysis, power Doppler, and the use of contrast. Appropriate indications and interpretation of carotid artery, renal artery, abdominal aorta, and peripheral artery ultrasound imaging are described. A dedicated section summarizes noninvasive techniques for physiologic vascular testing of the lower extremity arteries--including measurement of segmental pressures and pulse volume plethysmography. The use of exercise testing in the evaluation of peripheral artery disease, ultrasound evaluation of the lower extremities after percutaneous revascularization, and the diagnosis and management of iatrogenic pseudoaneurysm (PSA) is also discussed. A section on the important topic of vascular laboratory accreditation is included. Finally, additional details regarding proper technique for performance of the various vascular tests and procedures are included in the Appendix.
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MESH Headings
- Accreditation
- Aneurysm, False/diagnostic imaging
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Arteries/diagnostic imaging
- Blood Pressure
- Cardiology/education
- Cardiology/methods
- Carotid Arteries/diagnostic imaging
- Curriculum
- Education, Medical, Graduate
- Exercise Test
- Humans
- Image Interpretation, Computer-Assisted
- Insurance, Health, Reimbursement
- Lower Extremity/blood supply
- Medicare/economics
- Peripheral Vascular Diseases/diagnosis
- Peripheral Vascular Diseases/diagnostic imaging
- Peripheral Vascular Diseases/physiopathology
- Peripheral Vascular Diseases/surgery
- Plethysmography
- Pulse
- Renal Artery/diagnostic imaging
- Treatment Outcome
- Ultrasonography, Doppler/economics
- Ultrasonography, Doppler/instrumentation
- Ultrasonography, Doppler/methods
- Ultrasonography, Doppler, Color
- Ultrasonography, Interventional/economics
- Ultrasonography, Interventional/methods
- United States
- Vascular Surgical Procedures
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Gardin JM. The Value of Left Ventricular Relative Wall Thickness in Predicting Ventricular Arrhythmia and Related Death. J Am Coll Cardiol 2016; 67:313-5. [PMID: 26796397 DOI: 10.1016/j.jacc.2015.10.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Julius M Gardin
- Hackensack University Medical Center, Hackensack, New Jersey; and Rutgers New Jersey Medical School, Newark, New Jersey.
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Zhao Y, Delaney JA, Quek RGW, Gardin JM, Hirsch CH, Gandra SR, Wong ND. Cardiovascular Disease, Mortality Risk, and Healthcare Costs by Lipoprotein(a) Levels According to Low-density Lipoprotein Cholesterol Levels in Older High-risk Adults. Clin Cardiol 2016; 39:413-20. [PMID: 27177347 DOI: 10.1002/clc.22546] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 01/17/2016] [Revised: 03/17/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The value of lipoprotein(a) (Lp[a]) for predicting cardiovascular disease (CVD) across low-density lipoprotein cholesterol (LDL-C) is uncertain. HYPOTHESIS In older high-risk adults, higher LDL and Lp(a) combined would be associated with higher CVD risk and more healthcare costs. METHODS We included 3251 high-risk subjects (prior CVD, diabetes, or 10-year Framingham CVD risk >20%) age ≥65 years from the Cardiovascular Health Study and examined the relation of Lp(a) tertiles with incident CVD, coronary heart disease (CHD), and all-cause mortality within LDL-C strata (spanning <70 mg/dL to ≥160 mg/dL). We also examined 1-year all-cause and CVD healthcare costs from Medicare claims. RESULTS Over a 22.5-year follow-up, higher Lp(a) levels predicted CVD and total mortality (both standardized hazard ratio [HR]: 1.06, P < 0.01), whereas higher LDL-C levels predicted higher CHD (standardized HR: 1.09, P < 0.01) but lower total mortality (standardized HR: 0.94, P < 0.001). Adjusted HRs in the highest (vs lowest) tertile of Lp(a) level were 1.95 (P = 0.06) for CVD events and 2.68 (P = 0.03) for CHD events when LDL-C was <70 mg/dL. One-year all-cause healthcare costs were increased for Lp(a) ($771 per SD of 56 µg/mL [P = 0.03], $1976 for Lp(a) 25-64 µg/mL vs <25 µg/mL [P = 0.02], and $1648 for Lp(a) ≥65 µg/mL vs <25 µg/mL [P = 0.054]) but not LDL-C. CONCLUSIONS In older high-risk adults, increased Lp(a) levels were associated with higher CVD risk, especially in those with LDL-C <70 mg/dL, and with higher healthcare costs.
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Affiliation(s)
- Yanglu Zhao
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, Irvine, California.,Department of Epidemiology, School of Public Health, University of California, Los Angeles, California
| | - Joseph A Delaney
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Ruben G W Quek
- Global Health Economics, Amgen Inc., Thousand Oaks, California
| | - Julius M Gardin
- Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Calvin H Hirsch
- Department of Medicine, University of California Davis, Davis, California
| | | | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, Irvine, California
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Boulos NM, Gardin JM, Malik S, Postley J, Wong ND. Carotid Plaque Characterization, Stenosis, and Intima-Media Thickness According to Age and Gender in a Large Registry Cohort. Am J Cardiol 2016; 117:1185-91. [PMID: 26869392 DOI: 10.1016/j.amjcard.2015.12.062] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 12/20/2022]
Abstract
Carotid intima-media thickness (CIMT) is a well-established predictor of cardiovascular disease events. Not well described, however, is the prevalence of plaque and stenosis severity and how this varies according to extent of CIMT, age, and gender. We evaluated the extent of carotid plaque and stenosis severity according to CIMT, age, and gender in a large CIMT screening registry. We studied 9,347 women and 12,676 men (n = 22,023) who received carotid ultrasound scans. The presence and severity of both carotid plaque and stenosis was compared according to extent of CIMT (≥1 mm vs <1 mm), age, and gender using the chi-square test of proportions. Among those aged <45 to ≥80 years, the prevalence of CIMT ≥1 mm ranged from 0.13% to 29.3% in women and 0.6% to 40.1% in men, stenosis ≥50% from 0.1% to 14.9% in women and 0.1% to 13.2% in men, and mixed and/or soft plaque from 7.1% to 66.5% in women, and 9.2% to 65.8% in men (all p <0.001 across age groups). Even when CIMT levels were <1 mm, >30% of patients demonstrated mixed or soft plaque potentially prone to rupture. Of those with CIMT ≥1 mm, more than 70% had such mixed or soft plaque and more than 40% demonstrated stenoses of 30% or greater. In conclusion, we describe in a large CIMT registry study a substantial age-related increase in both men and women of increased CIMT, plaque presence, and severity, and stenosis. Even in those with normal CIMT, mixed or soft plaque was common, further demonstrating the value in assessing for plaque when doing carotid ultrasound.
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Waheed S, Chaves PHM, Gardin JM, Cao JJ. Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS). J Am Heart Assoc 2015; 4:JAHA.115.002308. [PMID: 26645833 PMCID: PMC4845280 DOI: 10.1161/jaha.115.002308] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Impaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all‐cause mortality, and their impact on risk classification using a continuous net reclassification index. Methods and Results We followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all‐cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5–3.0), 1.7 (1.4–2.1), and 3.2 (2.0–5.1) for HF; 1.8 (1.2–2.6), 1.4 (1.1–1.8), and 2.8 (1.7–4.7) for cardiovascular mortality; 1.3 (1.0–1.8), 1.7 (1.4–1.9), and 2.1 (1.5–3.0) for all‐cause mortality, and 1.6 (1.3–2.1), 1.7 (1.5–1.9), and 2.4 (1.7–3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF. Conclusions While risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.
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Affiliation(s)
- Salman Waheed
- Saint Francis Hospital, Roslyn, NY (S.W., J.J.C.) University of Kansas Medical Center, Kansas City, KS (S.W.)
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Florida International University, Miami, FL (P.M.C.)
| | - Julius M Gardin
- Hackensack University Medical Center, Hackensack, NJ (J.M.G.)
| | - Jie Jane Cao
- Saint Francis Hospital, Roslyn, NY (S.W., J.J.C.) State University of New York at Stony Brook, NY (J.J.C.)
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Postley JE, Luo Y, Wong ND, Gardin JM. Identification by ultrasound evaluation of the carotid and femoral arteries of high-risk subjects missed by three validated cardiovascular disease risk algorithms. Am J Cardiol 2015; 116:1617-23. [PMID: 26434511 DOI: 10.1016/j.amjcard.2015.08.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) events are the leading cause of death in the United States and globally. Traditional global risk algorithms may miss 50% of patients who experience ASCVD events. Noninvasive ultrasound evaluation of the carotid and femoral arteries can identify subjects at high risk for ASCVD events. We examined the ability of different global risk algorithms to identify subjects with femoral and/or carotid plaques found by ultrasound. The study population consisted of 1,464 asymptomatic adults (39.8% women) aged 23 to 87 years without previous evidence of ASCVD who had ultrasound evaluation of the carotid and femoral arteries. Three ASCVD risk algorithms (10-year Framingham Risk Score [FRS], 30-year FRS, and lifetime risk) were compared for the 939 subjects who met the algorithm age criteria. The frequency of femoral plaque as the only plaque was 18.3% in the total group and 14.8% in the risk algorithm groups (n = 939) without a significant difference between genders in frequency of femoral plaque as the only plaque. Those identified as high risk by the lifetime risk algorithm included the most men and women who had plaques either femoral or carotid (59% and 55%) but had lower specificity because the proportion of subjects who actually had plaques in the high-risk group was lower (50% and 35%) than in those at high risk defined by the FRS algorithms. In conclusion, ultrasound evaluation of the carotid and femoral arteries can identify subjects at risk of ASCVD events missed by traditional risk-predicting algorithms. The large proportion of subjects with femoral plaque only supports the use of including both femoral and carotid arteries in ultrasound evaluation.
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Hoang K, Zhao Y, Gardin JM, Carnethon M, Mukamal K, Yanez D, Wong ND. LV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes. JACC Cardiovasc Imaging 2015; 8:1007-1015. [PMID: 26319502 DOI: 10.1016/j.jcmg.2015.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 02/26/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes mellitus (DM). BACKGROUND MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD as shown by increased LV mass improves risk prediction compared to standard risk factors in older individuals. METHODS We studied 3,724 adults (mean 72.4 ± 5.4 years of age, 61.0% female, 4.4% African-American) from the Cardiovascular Health Study who had MetS but not DM or had DM alone or had neither condition. Cox regression was used to examine the association of LV mass, (alone and indexed by height and body surface area [BSA]) as determined by echocardiography, with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value, and net reclassification improvement (NRI) for clinical utility of LV mass compared to standard risk factors. RESULTS Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, sex and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]: 1.4, p < 0.001) and without MetS (HR: 1.4, p < 0.001), but not DM (HR: 1.0, p = 0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p < 0.05). Categorical-free net reclassification improvement increased significantly by 17% to 19% in those with MetS. Findings were comparable for CHD, CVD mortality, and total mortality. CONCLUSIONS LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility compared to standard risk factors in older persons with and without MetS but not with DM.
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Affiliation(s)
- Khiet Hoang
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California
| | - Yanglu Zhao
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California
| | - Julius M Gardin
- Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Mercedes Carnethon
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Ken Mukamal
- Department of Medicine, Harvard University, Boston, Massachusetts
| | - David Yanez
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California.
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Gardin JM, Bartz TM, Polak JF, O'Leary DH, Wong ND. What do carotid intima-media thickness and plaque add to the prediction of stroke and cardiovascular disease risk in older adults? The cardiovascular health study. J Am Soc Echocardiogr 2015; 27:998-1005.e2. [PMID: 25172401 DOI: 10.1016/j.echo.2014.06.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate whether the addition of ultrasound carotid intima-media thickness (CIMT) measurements and risk categories of plaque help predict incident stroke and cardiovascular disease (CVD) in older adults. METHODS Carotid ultrasound studies were recorded in the multicenter Cardiovascular Health Study. CVD was defined as coronary heart disease plus heart failure plus stroke. Ten-year risk prediction Cox proportional-hazards models for stroke and CVD were calculated using Cardiovascular Health Study-specific coefficients for Framingham risk score factors. Categories of CIMT and CIMT plus plaque were added to Framingham risk score prediction models, and categorical net reclassification improvement (NRI) and Harrell's c-statistic were calculated. RESULTS In 4,384 Cardiovascular Health Study participants (61% women, 14% black; mean baseline age, 72 ± 5 years) without CVD at baseline, higher CIMT category and the presence of plaque were both associated with higher incidence rates for stroke and CVD. The addition of CIMT improved the ability of Framingham risk score-type risk models to discriminate cases from noncases of incident stroke and CVD (NRI = 0.062, P = .015, and NRI = 0.027, P < .001, respectively), with no further improvement by adding plaque. For both outcomes, NRI was driven by down-classifying those without incident disease. Although the addition of plaque to CIMT did not result in a significant NRI for either outcome, it was significant among those without incident disease. CONCLUSIONS In older adults, the addition of CIMT modestly improves 10-year risk prediction for stroke and CVD beyond a traditional risk factor model, mainly by down-classifying risk in those without stroke or CVD; the addition of plaque to CIMT adds no statistical benefit in the overall cohort, although there is evidence of down-classification in those without events.
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Affiliation(s)
- Julius M Gardin
- Hackensack University Medical Center, Hackensack, New Jersey.
| | | | - Joseph F Polak
- Tufts Medical Center, Boston, Massachusetts; Tufts Medical School, Boston, Massachusetts
| | | | - Nathan D Wong
- University of California, Irvine, Irvine, California
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Alshawabkeh LI, Yee LM, Gardin JM, Gottdiener JS, Odden MC, Bartz TM, Arnold AM, Mukamal KJ, Wallace RB. Years of able life in older persons--the role of cardiovascular imaging and biomarkers: the Cardiovascular Health Study. J Am Heart Assoc 2015; 4:jah3943. [PMID: 25907126 PMCID: PMC4579951 DOI: 10.1161/jaha.114.001745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/03/2022]
Abstract
Background As the U.S. population grows older, there is greater need to examine physical independence. Previous studies have assessed risk factors in relation to either disability or mortality, but an outcome that combines both is still needed. Methods and Results The Cardiovascular Health Study is a population‐based, prospective study where participants underwent baseline echocardiogram, measurement of carotid intima‐media thickness (IMT), and various biomarkers, then followed for up to 18 years. Years of able life (YAL) constituted the number of years the participant was able to perform all activities of daily living. Linear regression was used to model the relationship between selected measures and outcomes, adjusted for confounding variables. Among 4902 participants, mean age was 72.6±5.4 years, median YAL for males was 8.8 (interquartile range [IQR], 4.3 to 13.8) and 10.3 (IQR, 5.8 to 15.8) for females. Reductions in YAL in the fully adjusted model for females and males, respectively, were: −1.34 (95% confidence interval [CI], −2.18, −0.49) and −1.41 (95% CI, −2.03, −0.8) for abnormal left ventricular (LV) ejection fraction, −0.5 (95% CI, −0.78, −0.22) and −0.62 (95% CI, −0.87, −0.36) per SD increase in LV mass, −0.5 (95% CI, −0.7, −0.29) and −0.79 (95% CI, −0.99, −0.58) for IMT, −0.5 (95% CI, −0.64, −0.37) and −0.79 (95% CI, −0.94, −0.65) for N‐terminal pro‐brain natriuretic peptide, −1.08 (95% CI, −1.34, −0.83) and −0.73 (95% CI, −0.97, −0.5) for high‐sensitivity troponin‐T, and −0.26 (95% CI, −0.42, −0.09) and −0.23 (95% CI, −0.41, −0.05) for procollagen‐III N‐terminal propeptide. Most tested variables remained significant even after adjusting for incident cardiovascular (CV) disease. Conclusions In this population‐based cohort, variables obtained by CV imaging and biomarkers of inflammation, coagulation, atherosclerosis, myocardial injury and stress, and cardiac collagen turnover were associated with YAL, an important outcome that integrates physical ability and longevity in older persons.
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Affiliation(s)
- Laith I Alshawabkeh
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, IA (L.I.A.) Carver College of Medicine and the College of Public Health, University of Iowa, Iowa City, IA (L.I.A., R.B.W.)
| | - Laura M Yee
- Department of Biostatistics, University of Washington, Seattle, WA (L.M.Y., T.M.B., A.M.A.)
| | - Julius M Gardin
- Department of Medicine, Hackensack University Medical Center, Hackensack, NJ (J.M.G.)
| | - John S Gottdiener
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Michelle C Odden
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR (M.C.O.)
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA (L.M.Y., T.M.B., A.M.A.)
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, WA (L.M.Y., T.M.B., A.M.A.)
| | - Kenneth J Mukamal
- Divisions of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (K.J.M.)
| | - Robert B Wallace
- Department of Internal Medicine, University of Iowa, Iowa City, IA (R.B.W.) Carver College of Medicine and the College of Public Health, University of Iowa, Iowa City, IA (L.I.A., R.B.W.)
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Gardin JM. Can Calcium Supplementation Improve Stress Echocardiography? JACC Cardiovasc Imaging 2015; 8:397-399. [DOI: 10.1016/j.jcmg.2014.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/26/2022]
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Pellikka PA, Douglas PS, Miller JG, Abraham TP, Baumann R, Buxton DB, Byrd BF, Chen P, Cook NL, Gardin JM, Hansen G, Houle HC, Husson S, Kaul S, Klein AL, Lang RM, Leong-Poi H, Lopez H, Mahmoud TM, Maslak S, McCulloch ML, Metz S, Nagueh SF, Pearlman AS, Pibarot P, Picard MH, Porter TR, Prater D, Rodriguez R, Sarano ME, Scherrer-Crosbie M, Shirali GS, Sinusas A, Slosky JJ, Sugeng L, Tatpati A, Villanueva FS, von Ramm OT, Weissman NJ, Zamani S. American Society of Echocardiography Cardiovascular Technology and Research Summit: a roadmap for 2020. J Am Soc Echocardiogr 2014; 26:325-38. [PMID: 23537771 DOI: 10.1016/j.echo.2013.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Julius M. Gardin
- From the Department of Medicine, Hackensack University Medical Center, Hackensack, NJ; and Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
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Tehrani DM, Gardin JM, Yanez D, Hirsch CH, Lloyd-Jones DM, Stein PK, Wong ND. Impact of inflammatory biomarkers on relation of high density lipoprotein-cholesterol with incident coronary heart disease: cardiovascular Health Study. Atherosclerosis 2013; 231:246-51. [PMID: 24267235 DOI: 10.1016/j.atherosclerosis.2013.08.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 05/28/2013] [Revised: 08/04/2013] [Accepted: 08/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Inflammatory factors and low HDL-C relate to CHD risk, but whether inflammation attenuates any protective association of high HDL-C is unknown. OBJECTIVE Investigate inflammatory markers' individual and collective impact on the association of HDL-C with incident coronary heart disease (CHD). METHODS In 3888 older adults without known cardiovascular disease (CVD), we examined if the inflammatory markers C-reactive protein (CRP), interleukin-6 (IL-6), and lipoprotein-associated phospholipase A2 (Lp-PLA₂) modify the relation of HDL-C with CHD. HDL-C, CRP, IL-6, and Lp-PLA₂ values were grouped as using gender-specific tertiles. Also, an inflammation index of z-score sums for CRP, IL-6, and Lp-PLA₂ was categorized into tertiles. We calculated CHD incidence for each HDL-C/inflammation group and performed Cox regression, adjusted for standard CVD risk factors and triglycerides to examine the relationship of combined HDL-C-inflammation groups with incident events. RESULTS CHD incidence (per 1000 person years) was higher for higher levels of CRP, IL-6, and the index, and lower for higher levels of HDL-C. Compared to high HDL-C/low-inflammation categories (referent), adjusted HRs for incident CHD were increased for those with high HDL-C and high CRP (HR = 1.50, p < 0.01) or highest IL-6 tertile (HR = 1.40, p < 0.05), but not with highest Lp-PLA₂ tertile. Higher CHD incidence was similarly seen for those with intermediate or low HDL-C accompanied by high CRP, high IL-6, or a high inflammatory index. CONCLUSION The protective relation of high HDL-C for incident CHD appears to be attenuated by greater inflammation.
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Affiliation(s)
- David M Tehrani
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine School of Medicine, Irvine, CA, USA
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Gidding SS, Liu K, Colangelo LA, Cook NL, Goff DC, Glasser SP, Gardin JM, Lima JAC. Longitudinal determinants of left ventricular mass and geometry: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circ Cardiovasc Imaging 2013; 6:769-75. [PMID: 23922005 DOI: 10.1161/circimaging.112.000450] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [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] [Indexed: 01/19/2023]
Abstract
BACKGROUND The purpose of this study was to identify determinants of 20-year change in left ventricular (LV) mass (LVM) and LV geometry in black and white young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. METHODS AND RESULTS We studied 2426 black and white men and women (54.7% white) aged 43 to 55 years with cardiovascular risk factor data and echocardiograms from CARDIA year 5 and 25 examinations. In regression models, year 25 LVM or relative wall thickness was the dependent variable and with year 5 echo values, age, sex, race, body mass index, change in body mass index, mean arterial blood pressure, change in mean blood pressure, heart rate, change in heart rate, tobacco use, presence of diabetes mellitus, alcohol use, and physical activity score as independent variables. LVM and relative wall thickness increased, whereas prevalence of normal geometry declined from 84.2% to 69.7%. Significant determinants of year 25 LVM/m(2.7) were year 5 LVM, year 5 and change in body mass index, year 5 and change in mean arterial pressure, year 5 and change in heart rate, baseline diabetes mellitus, and year 5 tobacco and alcohol use (overall r(2)=0.40). Significant determinants of year 25 relative LV wall thickness were year 5 value, black race, change in body mass index, year 5 and change in mean arterial pressure, starting smoking, and year 5 diabetes mellitus (overall r(2)=0.11). CONCLUSIONS Prevalence of abnormal LV hypertrophy and geometry increased from young adulthood to middle age. Both young adult cardiovascular risk traits and change in these traits predicted change in LV mass/geometry.
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Affiliation(s)
- Samuel S Gidding
- Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE
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Tozzi RJ, Abdel-Razek AM, Kipel G, Gardin JM. A Unique Case of a 7-Year-Old With Noonan's Syndrome, Hypertrophic Cardiomyopathy, Biventricular Outflow Tract Obstruction, and a Right Ventricular Aneurysm. J Am Coll Cardiol 2013; 62:643. [DOI: 10.1016/j.jacc.2013.01.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
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Ali A, Hashem M, Rosman HS, Moser L, Rehan A, Davis T, Romanelli M, LaLonde T, Yamasaki H, Barbish B, Michael J, Ali SA, Schreiber TL, Gardin JM. Glycoprotein IIb/IIIa Receptor Antagonists and Risk of Bleeding: A Single-Center Experience in 1020 Patients. J Clin Pharmacol 2013; 44:1328-32. [PMID: 15496651 DOI: 10.1177/0091270004269559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The safety of glycoprotein (GP) IIb/IIIa inhibitors has been well documented in clinical trials. Although these trials have included a broad patient population, the strict enrollment criteria may have resulted in exclusion of patients at a higher risk of bleeding complications. The authors conducted a retrospective chart review of 1020 consecutive patients who received GP IIb/IIIa inhibitors and underwent percutaneous coronary intervention in a large community hospital. They used Thrombolysis in Myocardial Infarction (TIMI) criteria to define major or minor bleeding complications. Bleeding complications developed in 214 (21%) patients, with major bleeding in 89 (9%). Univariate predictors of bleeding were older age, lower body weight, elevated serum creatinine, higher activated partial thromboplastin time (aPTT) level, history of diabetes mellitus (DM), peripheral vascular disease (PVD), congestive heart failure (CHF), and emergency procedure for acute myocardial infarction (AMI). Multivariate predictors of major bleeding were PVD (20% in bleeding group vs 11% in nonbleeders, odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.2-2.6, P < .004), age (68 +/- 2 years, 95% CI = 66-70 in bleeding group vs 63 +/- 13 years, 95% CI = 61.2-63 in nonbleeders, P < .001), and higher aPTT level (66 +/- 27 seconds, 95% CI = 63-70 in bleeding group vs 53 +/- 28 seconds, 95% CI = 51-56 in nonbleeders, P < .001). The risk of bleeding in the large community hospital setting may be higher than in randomized clinical trials. This increased risk is associated with higher hospitalization costs. Recognition of predictors of bleeding should further enhance the safety of these antiplatelet agents.
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Affiliation(s)
- Arshad Ali
- St. John Hospital & Medical Center, Detroit, Michigan, USA
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: Executive Summary. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.07.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1225] [Impact Index Per Article: 102.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:3097-137. [PMID: 23166210 DOI: 10.1161/cir.0b013e3182776f83] [Citation(s) in RCA: 274] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gardin JM, Leifer ES, Kitzman DW, Cohen G, Landzberg JS, Cotts W, Wolfel EE, Safford RE, Bess RL, Fleg JL. Usefulness of Doppler echocardiographic left ventricular diastolic function and peak exercise oxygen consumption to predict cardiovascular outcomes in patients with systolic heart failure (from HF-ACTION). Am J Cardiol 2012; 110:862-9. [PMID: 22683041 DOI: 10.1016/j.amjcard.2012.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 04/06/2012] [Revised: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 11/29/2022]
Abstract
Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was a multicenter, randomized controlled trial designed to examine the safety and efficacy of aerobic exercise training versus usual care in 2,331 patients with systolic heart failure (HF). In HF-ACTION patients with rest transthoracic echocardiographic measurements, the predictive value of 8 Doppler echocardiographic measurements-left ventricular (LV) diastolic dimension, mass, systolic (ejection fraction) and diastolic (mitral valve peak early diastolic/peak late diastolic [E/A] ratio, peak mitral valve early diastolic velocity/tissue Doppler peak early diastolic myocardial velocity [E/E'] ratio, and deceleration time) function, left atrial dimension, and mitral regurgitation severity-was examined for a primary end point of all-cause death or hospitalization and a secondary end point of cardiovascular disease death or HF hospitalization. Also compared was the prognostic value of echocardiographic variables versus peak oxygen consumption (Vo(2)). Mitral valve E/A and E/E' ratios were more powerful independent predictors of clinical end points than the LV ejection fraction but less powerful than peak Vo(2). In multivariate analyses for predicting the primary end point, adding E/A ratio to a basic demographic and clinical model increased the C-index from 0.61 to 0.62, compared with 0.64 after adding peak Vo(2). For the secondary end point, 6 echocardiographic variables, but not the LV ejection fraction or left atrial dimension, provided independent predictive power over the basic model. The addition of E/E' or E/A to the basic model increased the C-index from 0.70 to 0.72 and 0.73, respectively (all p values <0.0001). Simultaneously adding E/A ratio and peak Vo(2) to the basic model increased the C-index to 0.75 (p <0.0005). No echocardiographic variable was significantly related to the change from baseline to 3 months in exercise peak Vo(2). In conclusion, the addition of echocardiographic LV diastolic function variables improves the prognostic value of a basic demographic and clinical model for cardiovascular disease outcomes.
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Waller AH, Gardin JM. Does Cardiovascular Ultrasound Have a Role in Assessment of Cardiovascular Risk in Asymptomatic Persons? Curr Cardiovasc Risk Rep 2012. [DOI: 10.1007/s12170-012-0225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Atchley AE, Iskandrian AE, Bensimhon D, Ellis SJ, Kitzman DW, Shaw LK, Pagnanelli RA, Whellan DJ, Gardin JM, Kao A, Abdul-Nour K, Ewald G, Walsh MN, Kraus WE, O'Connor CM, Borges-Neto S. Relationship of technetium-99m tetrofosmin-gated rest single-photon emission computed tomography myocardial perfusion imaging to death and hospitalization in heart failure patients: results from the nuclear ancillary study of the HF-ACTION trial. Am Heart J 2011; 161:1038-45. [PMID: 21641348 DOI: 10.1016/j.ahj.2011.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 12/21/2010] [Accepted: 02/08/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND We hypothesized that the severity of resting perfusion abnormalities assessed by the summed rest score (SRS) would be associated with a higher rate of adverse outcomes in patients with heart failure (HF) and reduced left ventricular (LV) ejection fraction (EF). METHODS A subset of 240 subjects from HF-ACTION underwent resting technetium-99m tetrofosmin-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Images were evaluated using a 17-segment model to derive the SRS and additional nuclear variables. RESULTS After adjusting for prespecified covariates, SRS was significantly associated with the primary end point (hazard ratio 0.98, 95% confidence interval [CI] 0.97-1.00, P = .04), with a higher SRS corresponding to lower risk of an event. This association was not present in the unadjusted analysis. The relationship between SRS and the primary outcome was likely due to a higher event ratein patients with ischemic HF and a low SRS. The LV phase SD was not predictive of the primary outcome (hazard ratio 1.00, 95% confidence interval 0.99-1.01, P = .49). In a post hoc analysis, nuclear variables provided incremental prognostic information when added to clinical information (P = .006). CONCLUSIONS Gated SPECT MPI provides important information in patients with HF and reduced LVEF. In the adjusted analysis, SRS has an unexpected relationship with the primary end point. Phase SD was not associated with the primary end point. Rest-gated SPECT MPI provides incrementally greater prognostic information than clinical information alone.
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