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Pisaniello AD, Alfaddagh A, Tibuakuu M, Whelton SP, Czarny MJ, Blaha MJ, Tsai MY, Budoff MJ, Shea S, Allison MA, Post WS. Association Between Omega-3 Fatty Acid Levels and Aortic Valve Calcium (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2022; 184:104-110. [PMID: 36127180 DOI: 10.1016/j.amjcard.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022]
Abstract
Calcific aortic valve disease, a condition of chronic inflammation, is associated with increased cardiovascular events and all-cause mortality. Omega-3 fatty acids (O3FAs) reduce both acute and chronic inflammation, but their associations with aortic valve calcium (AVC) have not been studied. The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study of 6,814 adults without clinical cardiovascular disease. Plasma fatty acid levels and cardiac computed tomography (CT) scans were performed at baseline, and CT scans were performed at subsequent clinical visits over a median 9-year period. We assessed whether plasma levels of O3FAs and their species correlate with the presence, severity, and progression of AVC measured by CT in Multi-Ethnic Study of Atherosclerosis. The mean age of the 6,510 included participants with baseline fatty acid levels, AVC, and covariate data was 62.1 ± 10.2 years, and 47.1% of the participants were male. Race distribution was 38.6% White, 27.2% Black, 22.1% Hispanic/Latino, and 12.1% Chinese. Among the 6,510 participants, 5,884 had a subsequent CT scan, and 3,304 had a third CT scan with AVC measurements. At baseline, 862 participants (13.2%) had prevalent AVC (Agatston score >0), and were more likely to be of older age, male, of the White race, have a lower education level, and have co-morbidities that are associated with a higher risk for AVC. Plasma tertiles of eicosapentaenoic acid, docosahexaenoic acid, and total O3FA were not associated with prevalent AVC at baseline, incident AVC, or change in AVC. In conclusion, plasma levels of O3FAs in subjects not routinely supplemented with O3FAs are not useful for predicting the presence or development of AVC. Whether high plasma O3FA levels, achievable by high-dose O3FA over-the-counter supplementation or pharmacotherapy, is associated with AVC requires further investigation.
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Affiliation(s)
- Anthony D Pisaniello
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Discipline of Medicine, The University of Adelaide, Adelaide, Australia
| | - Abdulhamied Alfaddagh
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin Tibuakuu
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seamus P Whelton
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew J Czarny
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew J Budoff
- Division of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California
| | - Steven Shea
- Department of Medicine and, The University of California, San Diego, California; Department ofEpidemiology, Columbia University, New York, New York
| | - Matthew A Allison
- Department of Family Medicine and Public Health, The University of California, San Diego, California
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Salazar IMC, Tibuakuu M, Blumenthal RS, Sarkar S. Cardiovascular Disease in Patients with Diabetes: A Comparison of Professional Society Guidelines. Curr Diabetes Rev 2022; 18:e200821195733. [PMID: 34420507 DOI: 10.2174/1573399817666210820105514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
In this review, we compare major points given in the 2021 American Diabetes Association and the 2020 American Association of Clinical Endocrinologists/American College of Endocrinology guidelines, in particular, the assessment and management of cardiovascular risk in patients with diabetes with a focus on dyslipidemia, blood pressure, and pharmacotherapy in diabetes.
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Affiliation(s)
- Ilton M Cubero Salazar
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Martin Tibuakuu
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sudipa Sarkar
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Oshunbade AA, Lirette ST, Windham BG, Shafi T, Hamid A, Gbadamosi SO, Tin A, Yimer WK, Tibuakuu M, Clark D, Kamimura D, Lutz EA, Mentz RJ, Fox ER, Butler J, Butler KR, Garovic VD, Turner ST, Mosley TH, Hall ME. Hypertensive Diseases in Pregnancy and Kidney Function Later in Life: The Genetic Epidemiology Network of Arteriopathy (GENOA) Study. Mayo Clin Proc 2022; 97:78-87. [PMID: 34565606 PMCID: PMC9031057 DOI: 10.1016/j.mayocp.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/27/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the relationship between hypertensive diseases in pregnancy and kidney function later in life. METHODS We evaluated measured glomerular filtration rate (mGFR) using iothalamate urinary clearance in 725 women of the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Women were classified by self-report as nulliparous (n=62), a history of normotensive pregnancies (n=544), a history of hypertensive pregnancies (n=102), or a history of pre-eclampsia (n=17). We compared adjusted associations among these four groups with mGFR using generalized estimating equations to account for familial clustering. Chronic kidney disease (CKD) was defined as mGFR of less than 60 mL/min per 1.73 m2 or urinary albumin-creatinine ratio (UACR) greater than or equal to 30 mg/g. RESULTS Among women with kidney function measurements (mean age, 59±9 years, 52.9% African American), those with a history of hypertensive pregnancy had lower mGFR (-4.66 ml/min per 1.73 m2; 95% CI, -9.12 to -0.20) compared with women with a history of normotensive pregnancies. Compared with women with a history of normotensive pregnancies, women with a history of hypertensive pregnancy also had higher odds of mGFR less than 60 ml/min per 1.73 m2 (odds ratio, 2.09; 95% CI, 1.21 to 3.60). Additionally, women with a history of hypertensive pregnancy had greater odds for chronic kidney disease (odds ratio, 4.89; 95% CI, 1.55 to 15.44), after adjusting for age, race, education, smoking history, hypertension, body mass index, and diabetes. CONCLUSION A history of hypertension in pregnancy is an important prognostic risk factor for kidney disease. To our knowledge, this is the first and largest investigation showing the association between hypertensive diseases in pregnancy and subsequent kidney disease using mGFR in a large biracial cohort.
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Affiliation(s)
- Adebamike A Oshunbade
- University of Mississippi Medical Center, Department of Medicine, Division of Cardiology, Jackson, MS
| | | | - B Gwen Windham
- Division of Geriatrics, Jackson, MS; MIND Center, University of Mississippi Medical Center, Jackson, MS
| | - Tariq Shafi
- Division of Nephrology and Hypertension, Jackson, MS
| | - Arsalan Hamid
- University of Mississippi Medical Center, Department of Medicine, Division of Cardiology, Jackson, MS
| | - Semiu O Gbadamosi
- Florida International University, Department of Epidemiology, Miami, FL
| | - Adrienne Tin
- Division of Geriatrics, Jackson, MS; MIND Center, University of Mississippi Medical Center, Jackson, MS
| | | | - Martin Tibuakuu
- Johns Hopkins University School of Medicine, Department of Cardiology, Baltimore, MD
| | - Donald Clark
- University of Mississippi Medical Center, Department of Medicine, Division of Cardiology, Jackson, MS
| | - Daisuke Kamimura
- University of Mississippi Medical Center, Department of Medicine, Division of Cardiology, Jackson, MS; Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | | | - Robert J Mentz
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC
| | - Ervin R Fox
- University of Mississippi Medical Center, Department of Medicine, Division of Cardiology, Jackson, MS
| | - Javed Butler
- University of Mississippi Medical Center, Department of Medicine, Division of Cardiology, Jackson, MS
| | - Kenneth R Butler
- Division of Geriatrics, Jackson, MS; MIND Center, University of Mississippi Medical Center, Jackson, MS
| | - Vesna D Garovic
- Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN; Department of Obstetrics and Gynecology, Rochester, MN
| | - Stephen T Turner
- Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN
| | - Thomas H Mosley
- Division of Geriatrics, Jackson, MS; MIND Center, University of Mississippi Medical Center, Jackson, MS
| | - Michael E Hall
- University of Mississippi Medical Center, Department of Medicine, Division of Cardiology, Jackson, MS.
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Shahu A, Okunrintemi V, Tibuakuu M, Khan SU, Gulati M, Marvel F, Blumenthal RS, Michos ED. Income disparity and utilization of cardiovascular preventive care services among U.S. adults. Am J Prev Cardiol 2021; 8:100286. [PMID: 34816144 PMCID: PMC8593567 DOI: 10.1016/j.ajpc.2021.100286] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Abstract
Low income individuals are less likely to receive smoking cessation counseling. Low income individuals are less likely to have their blood pressure checked. Low income individuals are less likely to be receive exercise counseling. Low income individuals are less likely to receive dietary counseling. Low income individuals are less likely to have their cholesterol levels checked.
Objective : Associations between income disparity and utilization of cardiovascular disease (CVD) preventive care services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without CVD, are not well understood. The purpose of this study was to evaluate associations between income and utilization of CVD-preventive services among U.S. adults. Methods : We included adults ≥18 years with and without CVD from the 2006 to 2015 Medical Expenditure Panel Survey. We categorized participants as high-income (>400% of federal poverty level [FPL]), middle income (200–400% of FPL), low-income (125–200% of FPL) and very low (VL)-income (<125% of FPL). We used logistic regression to compare the likelihood of receiving CVD-preventive services by income strata, adjusting for sociodemographic factors and comorbidities. Results : The study included 185,081 participants (representing 194.6 million U.S. adults) without CVD, and 32,862 participants (representing 37 million U.S. adults) with CVD. VL-income adults without CVD were less likely than high-income adults to have blood pressure measured within past 2 years [odds ratio [OR] 0.41 (95% confidence interval [CI] 0.37–0.45)] or cholesterol levels checked within past 5 years [0.36 (0.33–0.38)] or receive counseling about diet modifications [0.77 (0.74–0.81)], exercise [0.81 (0.77–0.85)], or smoking cessation [0.71 (0.63–0.79)] within past year. VL-income adults with CVD were also less likely to have blood pressure [0.32 (0.22–0.46)] or cholesterol [0.33 (0.26–0.42)] checked and receive counseling about exercise [0.84 (0.76–0.93)] or smoking cessation [0.78 (0.61–0.99)]. Additional subgroup analyses restricted to participants who had seen a healthcare provider within the preceding 12 months, as well as secondary analyses stratified by sex, race and ethnicity, showed similar disparities between high-income and VL-income participants. Conclusions : VL-income adults were less likely to be screened for CVD risk factors or receive CVD-prevention counseling than high-income adults, regardless of CVD status. More work must be done to reduce disparities in access to and utilization of CVD-preventive services among adults in different income groups.
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Affiliation(s)
- Andi Shahu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Victor Okunrintemi
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ
| | - Francoise Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
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Osibogun O, Ogunmoroti O, Mathews L, Okunrintemi V, Tibuakuu M, Michos ED. Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2021; 10:e019828. [PMID: 33834848 PMCID: PMC8174160 DOI: 10.1161/jaha.120.019828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi-ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross-sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign-born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non-Hispanic White-, 26% non-Hispanic Black-, 12% Chinese- and 22% Hispanic-Americans. US-born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50-0.79], P<0.001) compared with foreign-born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08-3.36], P=0.03; and 1.65 [1.04-2.63], P=0.03, respectively). Foreign-born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43-0.91], P=0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology Robert Stempel College of Public Health and Social Work Florida International University Miami FL
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | | | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
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Siddiqui E, Okoh A, Tibuakuu M, Hirji S, Hameed I, Osho A, Singh S, Grewal J, Montgomery M, Camacho M, Bravo C. Racial Differences in In-Hospital Outcomes after the Use of Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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7
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Okunrintemi V, Tibuakuu M, Virani SS, Sperling LS, Volgman AS, Gulati M, Cho L, Leucker TM, Blumenthal RS, Michos ED. Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among US Adults: Trends From 2008 to 2017, the Medical Expenditure Panel Survey. J Am Heart Assoc 2020; 9:e018764. [PMID: 33161825 PMCID: PMC7955360 DOI: 10.1161/jaha.120.018764] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022]
Abstract
Background Sex differences in the trends for control of cardiovascular disease (CVD) risk factors have been described, but temporal trends in the age at which CVD and its risk factors are diagnosed and sex-specific differences in these trends are unknown. Methods and Results We used the Medical Expenditure Panel Survey 2008 to 2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease, or stroke, and who reported the age when these conditions were diagnosed, were included. We included 100 709 participants (50.2% women), representing 91.9 million US adults with above conditions. For coronary heart disease and hypercholesterolemia, mean age at diagnosis was 1.06 and 0.92 years older for women, compared with men, respectively (both P<0.001). For stroke, mean age at diagnosis for women was 1.20 years younger than men (P<0.001). The mean age at diagnosis of CVD risk factors became younger over time, with steeper declines among women (annual decrease, hypercholesterolemia [women, 0.31 years; men 0.24 years] and hypertension [women, 0.23 years; men, 0.20 years]; P<0.001). Coronary heart disease was not statistically significant. For stroke, while age at diagnosis decreased by 0.19 years annually for women (P=0.03), it increased by 0.22 years for men (P=0.02). Conclusions The trend in decreasing age at diagnosis for CVD and its risk factors in the United States appears to be more pronounced among women. While earlier identification of CVD risk factors may provide opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD earlier in life, and sex-specific interventions may be needed.
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Affiliation(s)
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | | | | | | | - Martha Gulati
- Division of CardiologyUniversity of Arizona School of MedicinePhoenixAZ
| | - Leslie Cho
- Department of Cardiovascular MedicineCleveland ClinicClevelandOH
| | - Thorsten M. Leucker
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
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Tibuakuu M, Jjingo C, Kirk GD, Thomas DL, Gray R, Ssempijja V, Nalugoda F, Serwadda D, Ocama P, Opio CK, Kleiner DE, Quinn TC, Reynolds SJ. Elevated liver stiffness without histological evidence of liver fibrosis in rural Ugandans. J Viral Hepat 2020; 27:1022-1031. [PMID: 32388879 PMCID: PMC8919060 DOI: 10.1111/jvh.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/20/2020] [Accepted: 04/12/2020] [Indexed: 12/09/2022]
Abstract
Liver fibrosis may be assessed noninvasively with transient electrography (TE). Data on the performance of TE for detecting liver fibrosis in sub-Saharan Africa are limited. We evaluated the diagnostic accuracy of TE by performing liver biopsies on persons with liver fibrosis indicated by TE. We enrolled HIV-infected and HIV-uninfected participants with TE scores consistent with at least minimal disease (liver stiffness measurement [LSM]≥7.1 kPa). Biopsies were performed and staged using the Ishak scoring system. A concordant result was defined using accepted thresholds for significant fibrosis by TE (LSM ≥ 9.3 kPa) and liver biopsy (Ishak score ≥ 2). We used modified Poisson regression methods to quantify the univariate and adjusted prevalence risk ratios (PRR) of the association between covariates and the concordance status of TE and liver biopsy in defining the presence of liver fibrosis. Of 131 participants with valid liver biopsy and TE data, only 5 participants (3.8%) had Ishak score ≥ 2 of whom 4 had LSM ≥ 9.3 kPa (sensitivity = 80%); of the 126 (96.2%) with Ishak score < 2, 76 had LSM < 9.3 kPa (specificity = 61%). In multivariable analysis, discordance was associated with female gender (adjPRR = 1.80, 95%CI 1.1-2.9; P = .019), herbal medicine use (adjPRR 1.64, 95% CI = 1.0-2.5; P = .022), exposure to lake or river water (adjPRR 2.05, 95% CI = 1.1-3.7; P = .016), and current smoking (adjPRR 1.72, 95%CI 1.0-2.9; P = .045). These data suggest that TE among rural Ugandans has low specificity for detection of histologically confirmed liver fibrosis. Caution should be exercised when using this tool to confirm significant liver fibrosis.
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Affiliation(s)
- Martin Tibuakuu
- Department of Medicine, St. Luke’s Hospital, Chesterfield, Missouri
| | - Caroline Jjingo
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Gregory Dale Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David Lee Thomas
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ronald Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Rakai Health Sciences Program, Entebbe, Uganda
| | - Victor Ssempijja
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland
| | | | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ponsiano Ocama
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Thomas Charles Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland,Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Steven James Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland,Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland,Rakai Health Sciences Program, Entebbe, Uganda
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Tibuakuu M, Okunrintemi V, Savji N, Stone NJ, Virani SS, Blankstein R, Thamman R, Blumenthal RS, Michos ED. Nondietary Cardiovascular Health Metrics With Patient Experience and Loss of Productivity Among US Adults Without Cardiovascular Disease: The Medical Expenditure Panel Survey 2006 to 2015. J Am Heart Assoc 2020; 9:e016744. [PMID: 32998625 PMCID: PMC7792398 DOI: 10.1161/jaha.120.016744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/21/2022]
Abstract
Background The American Heart Association 2020 Impact Goals aimed to promote population health through emphasis on cardiovascular health (CVH). We examined the association between nondietary CVH metrics and patient‐reported outcomes among a nationally representative sample of US adults without cardiovascular disease. Methods and Results We included adults aged ≥18 years who participated in the Medical Expenditure Panel Survey between 2006 and 2015. CVH metrics were scored 1 point for each of the following: not smoking, being physically active, normal body mass index, no hypertension, no diabetes mellitus, and no dyslipidemia, or 0 points if otherwise. Diet was not assessed in Medical Expenditure Panel Survey. Patient‐reported outcomes were obtained by telephone survey and included questions pertaining to patient experience and health‐related quality of life. Regression models were used to compare patient‐reported outcomes based on CVH, adjusting for sociodemographic factors and comorbidities. There were 177 421 Medical Expenditure Panel Survey participants (mean age, 45 [17] years) representing ~187 million US adults without cardiovascular disease. About 12% (~21 million US adults) had poor CVH. Compared with individuals with optimal CVH, those with poor CVH had higher odds of reporting poor patient‐provider communication (odds ratio, 1.14; 95% CI, 1.05–1.24), poor healthcare satisfaction (odds ratio, 1.15; 95% CI, 1.08–1.22), poor perception of health (odds ratio, 5.89; 95% CI, 5.35–6.49), at least 2 disability days off work (odds ratio, 1.39; 95% CI, 1.30–1.48), and lower health‐related quality of life scores. Conclusions Among US adults without cardiovascular disease, meeting a lower number of ideal CVH metrics is associated with poor patient‐reported healthcare experience, poor perception of health, and lower health‐related quality of life. Preventive measures aimed at optimizing ideal CVH metrics may improve patient‐reported outcomes among this population.
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Affiliation(s)
- Martin Tibuakuu
- Department of Medicine St. Luke's Hospital Chesterfield MO.,The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | | | - Nazir Savji
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Neil J Stone
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Salim S Virani
- Section of Cardiology Michael E. DeBakey Veterans Affairs Medical Center Section of Cardiovascular Research Baylor College of Medicine Houston TX
| | - Ron Blankstein
- Division of Cardiology Brigham and Women's Hospital Boston MA
| | - Ritu Thamman
- Division of Cardiology University of Pittsburgh School of Medicine Pittsburgh PA
| | - Roger S Blumenthal
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
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10
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Jang S, Ogunmoroti O, Ndumele CE, Zhao D, Rao VN, Fashanu OE, Tibuakuu M, Otvos JD, Benson EM, Ouyang P, Michos ED. Association of the Novel Inflammatory Marker GlycA and Incident Heart Failure and Its Subtypes of Preserved and Reduced Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis. Circ Heart Fail 2020; 13:e007067. [PMID: 32762458 DOI: 10.1161/circheartfailure.120.007067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/15/2022]
Abstract
BACKGROUND GlycA, a nuclear magnetic resonance composite marker of systemic inflammation, reflects serum concentration and glycosylation state of main acute phase reactants. Prior studies have shown plasma GlycA levels were associated with cardiovascular disease even after adjusting for other inflammatory markers. However, little is known about the association of GlycA with the heart failure (HF) subtypes: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction. We examined the association of GlycA with incident HF and its subtypes in a multiethnic cohort. METHODS We studied 6507 Multi-Ethnic Study of Atherosclerosis participants aged 45 to 84 without baseline cardiovascular disease or HF who had data on GlycA and incident hospitalized HF. We used multivariable-adjusted Cox hazards models to evaluate the association of GlycA with incident total HF, HFpEF, and heart failure with reduced ejection fraction. Models were adjusted for sociodemographics, cardiovascular disease risk factors, and inflammatory biomarkers. RESULTS The mean (SD) for age was 62 (10) years and for GlycA was 375 (82) μmol/L; 53% women. Over a median follow-up of 14.0 years, participants in the highest quartile of GlycA, compared with the lowest, experienced increased risk of developing any HF (hazard ratio, 1.48 [95% CI, 1.01-2.18]) in fully adjusted models. However, this increased risk was only seen for HFpEF (2.18 [1.15-4.13]) and not heart failure with reduced ejection fraction [1.06 (0.63-1.79)]. There was no significant interaction by sex, age, or race/ethnicity. CONCLUSIONS GlycA was associated with an increased risk of any HF, and in particular, HFpEF. Future studies should examine mechanisms that might explain differential association of GlycA with HF subtypes, and whether therapeutic lowering of GlycA can prevent HFpEF development. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005487.
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Affiliation(s)
- Sunyoung Jang
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (C.E.N., D.Z., E.D.M.)
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (C.E.N., D.Z., E.D.M.)
| | - Vishal N Rao
- Division of Cardiology Duke University School of Medicine, Durham, NC (V.N.R.)
| | | | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Medicine, St Luke's Hospital, Chesterfield, MO (M.T.)
| | - James D Otvos
- Laboratory Corporation of America Holdings, Morrisville, NC (J.D.O.)
| | - Eve-Marie Benson
- Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela Ouyang
- Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease (S.J., O.O., C.E.N., D.Z., M.T., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Cardiology (C.E.N., E.-M.B., P.O., E.D.M.), Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (C.E.N., D.Z., E.D.M.)
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11
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Tibuakuu M, Okunrintemi V, Shahu A, Ratchford RV, Savji N, Blumenthal RS, Thamman R, Mahtta D, Virani SS, Michos ED. Abstract 25: Patient-reported Outcomes, Resource Utilization, and Healthcare Expenditures Across the 3 Major Atherosclerotic Diseases: The Medical Expenditure Panel Survey (meps). Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Public health campaigns aimed at reducing the morbidity, mortality and economic burden of atherosclerotic cardiovascular disease (ASCVD) have mainly targeted coronary artery disease (CAD). Stroke and peripheral artery disease (PAD) are associated with substantial medical and financial burden for patients and the US healthcare system.
Objective:
We sought to compare the associations of patient-reported outcomes, resource utilization, and healthcare expenditures across the 3 major ASCVD types (CAD, stroke, or PAD).
Methods:
We used data from the Medical Expenditure Panel Survey (MEPS) conducted between 2006-2015 and included adults aged ≥18 yrs. MEPS is a nationally representative US sample and provides information on patient-reported outcomes (PROs), medical conditions, healthcare utilization and expenditures. The ASCVD types were ascertained by ICD-9 codes and/or self-reported data. Participants with more than 1 ASCVD type were not included. The associations of PROs and health utilization were quantified and contrasted across the 3 ASCVD types using multivariable adjusted regression models. A 2-part econometric model was used to assess healthcare expenditures.
Results:
The study sample included 14,262 MEPS participants with 1 type of ASCVD, translating into 15.9 million US adults. The mean age (SD) was 65 (±14) yrs; 48% were women, 59.6% had the diagnosis of CAD only, 37.5% stroke only, and 2.9% PAD only. Participants with stroke were more likely to report poor patient-provider communication [OR 1.37 (95% CI 1.18-1.59)], poor healthcare satisfaction, and more ED visits, and were less likely to be on a statin and aspirin, compared to CAD (
Table
). Participants with PAD also had higher odds of not being on aspirin [3.10 (2.31-4.16)] and statin [2.01 (1.37-2.95)], compared to CAD. PAD was associated with the highest annual total and out-of-pocket expenditures among the 3 ASCVDs.
Conclusion:
Both stroke and PAD were associated with low uptake of guideline-directed preventive therapies, compared to CAD, with PAD having the highest healthcare expenditures among the 3 ASCVD types. Our results highlight a missed opportunity for secondary ASCVD prevention among patients with PAD and stroke, and the need for public health campaigns to direct equal attention to all 3 major ASCVDs.
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12
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Okunrintemi V, Tibuakuu M, Shahu A, Mehta PK, Gulati M, Broni E, Mathews L, Blumenthal RS, Michos ED. Abstract 263: Gynecological Cancer Screening Among Women With Cardiovascular Disease: The Medical Expenditure Panel Survey. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Cardiovascular disease (CVD) and cancer are the leading causes of mortality among adult women in the United States (US), contributing to over 40% of deaths annually. Although the US Preventive Services Task Force recommends routine age-appropriate breast and cervical cancer screening among adult women, it is unknown if its utilization is influenced by the presence of comorbid conditions like CVD. With recent research suggesting that mammography has the potential to alter the course of both breast cancer and heart disease among women, we investigate the routine use of some of these gynecological cancer screening tools among women with and without CVD.
Methods:
Using the 2006-2015 Medical Expenditure Panel Survey (MEPS), a nationally representative database, we included women ≥21 years with valid responses to the gynecological cancer screening questions. Diagnosis of CVD, was ascertained by ICD9 codes or by self-report, and included individuals with coronary artery disease, stroke, heart failure, cardiac dysrhythmias and/or peripheral arterial disease. We evaluated participant responses to self-administered questionnaires:
[How long since last pap smear test? (women 21-65 yrs)]
and
[How long since last mammogram? (women 50-75 yrs)].
Routine gynecological cancer screen was defined as pap smear test done within the last 3 years (women 21-29 yrs)/within the last 5 years (women 30-65 yrs) or mammogram done within the last 2 years (women 50-75 yrs). A χ2 test was used to assess the proportional differences in the use of these gynecological screening tools among women with and without CVD. Weighted multivariable logistic regression was used to determine the association between the presence of CVD and routine gynecological cancer screening.
Results:
The study sample included 104,053 MEPS participants, 14% with a diagnosis of CVD and 86% without a diagnosis of CVD, translating into 14.6 million and 89.9 million US adult women with and without CVD respectively. While
14%
of women without CVD did not have routine pap smear test, a higher proportion of women with CVD
(21%)
reported that they did not undergo routine pap smear screen (
p <0.001
). There was no difference in the proportion of women with or without CVD who reported routine mammogram screen (22% on each arm, p = 0.33). After adjustments for socio-demographic characteristics and comorbid conditions, US adult women with CVD, were less likely to have routine pap smear test
(OR 0.59 [95% CI 0.54-0.65])
and mammogram screen
(OR 0.90 [95% CI 0.82-0.99])
compared with those without CVD.
Conclusion:
Women with CVD were less likely to undergo routine gynecological cancer screening than their peers without CVD. Further studies are needed to understand the reasons for the reported association and devise ways to promote increased utilization of these gynecological cancer screening tools among this high risk, vulnerable population.
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13
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Shahu A, Okunrintemi V, Tibuakuu M, Khan SU, Gulati M, Marvel FA, Blumenthal RS, Michos ED. Abstract 23: Income Disparity and Utilization of Cardiovascular Preventive Care Services in the Medical Expenditure Panel Survey (MEPS). Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Socioeconomic markers such as income level are associated with cardiovascular disease (CVD). However, the associations between income and utilization of CVD preventive services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without established CVD are less well understood.
Methods:
We used data from the nationally representative Medical Expenditure Panel Survey (2006-2015). We included adults (≥18 years old) and divided the sample population into 2 groups: those with CVD (defined by self-reported and/or ICD9 diagnosis of CVD [coronary artery disease, stroke, heart failure, cardiac dysrhythmias and/or peripheral arterial disease]) and those without CVD. Participant responses were recorded by telephone survey. Additional information on health care utilization was collected from physicians, hospitals, and pharmacies. We categorized participants as high income (400% of federal poverty level [FPL]), middle income (200-400% of FPL), low income (125-200% of FPL) and poor/very low income (<125% of FPL). We used logistic regression to compare likelihood of utilizing or receiving certain CVD risk preventive services among participants in different income groups, adjusting for demographics, comorbidities and other socioeconomic factors.
Results:
We included 185,081 participants without CVD (representing 194.6 million US adults without CVD, 48% female) and 32,862 participants with CVD (representing 37 million U.S. adults with CVD); 36% of individuals with CVD were in the high income category, 29% were middle income, 16% and 19% were in the low and poor/very low income group, respectively. Compared with high income adults, adults with low and poor/very low income were less likely to have cholesterol levels or blood pressure checked and receive counseling about diet modifications, exercise, or smoking cessation, regardless of CVD status (
Table
).
Conclusion:
Poor/very low income adults were much less likely to be screened for CVD risk factors or receive counseling for prevention of CVD than high income adults. More work must be done to reduce disparities in access to and utilization of CVD preventive services among adults in different income groups.
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14
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Osibogun O, Ogunmoroti O, Tibuakuu M, Benson EM, Michos ED. Sex differences in the association between ideal cardiovascular health and biomarkers of cardiovascular disease among adults in the United States: a cross-sectional analysis from the multiethnic study of atherosclerosis. BMJ Open 2019; 9:e031414. [PMID: 31772093 PMCID: PMC6886920 DOI: 10.1136/bmjopen-2019-031414] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study investigated the sex differences in the associations between ideal cardiovascular health (CVH), measured by the American Heart Association's Life's Simple 7 metrics, and cardiovascular disease (CVD)-related biomarkers among an ethnically diverse cohort of women and men free of clinical CVD at baseline. SETTING We analysed data from the Multi-Ethnic Study of Atherosclerosis conducted in six centres across the USA (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles, California; New York, New York; and St Paul, Minnesota). PARTICIPANTS This is a cross-sectional study of 5379 women and men, aged 45-84 years old. Mean age (SD) was 62 (10), 52% were women, 38% White, 11% Chinese American, 28% Black and 23% Hispanic. PRIMARY MEASURES The seven metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose) were each scored as 0 points (poor), 1 point (intermediate) or 2 points (ideal). The total CVH score ranged from 0 to 14. The CVD-related biomarkers studied were high-sensitivity C-reactive protein, D-dimer, fibrinogen, homocysteine, high-sensitivity cardiac troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP) and interleukin 6. We examined the association between the CVH score and each biomarker using multivariable linear regression, adjusting for age, race/ethnicity, education, income and health insurance status. RESULTS Higher CVH scores were associated with lower concentrations of all biomarkers, except for NT-proBNP where we found a direct association. There were statistically significant interactions by sex for all biomarkers (p<0.001), but results were qualitatively similar between women and men. CONCLUSION A more favourable CVH score was associated with lower levels of multiple CVD-related biomarkers for women and men, except for NT-proBNP. These data suggest that promotion of ideal CVH would have similarly favourable impact on the reduction of biomarkers of CVD risk for both women and men.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin Tibuakuu
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA
| | - Eve-Marie Benson
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Okunrintemi V, Valero-Elizondo J, Patrick B, Salami J, Tibuakuu M, Ahmad S, Ogunmoroti O, Mahajan S, Khan SU, Gulati M, Nasir K, Michos ED. Gender Differences in Patient-Reported Outcomes Among Adults With Atherosclerotic Cardiovascular Disease. J Am Heart Assoc 2019; 7:e010498. [PMID: 30561253 PMCID: PMC6405598 DOI: 10.1161/jaha.118.010498] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) accounts for approximately one third of deaths in women. Although there is an established relationship between positive patient experiences, health‐related quality of life, and improved health outcomes, little is known about gender differences in patient‐reported outcomes among ASCVD patients. We therefore compared gender differences in patient‐centered outcomes among individuals with ASCVD. Methods and Results Data from the 2006 to 2015 Medical Expenditure Panel Survey, a nationally representative US sample, were used for this study. Adults ≥18 years with a diagnosis of ASCVD, ascertained by International Classification of Diseases, Ninth Revision (ICD‐9) codes and/or self‐reported data, were included. Linear and logistic regression were used to compare self‐reported patient experience, perception of health, and health‐related quality of life by gender. Models adjusted for demographics, socioeconomic status, and comorbidities. There were 21 353 participants included, with >10 000 (47%‐weighted) of the participants being women, representing ≈11 million female adults with ASCVD nationwide. Compared with men, women with ASCVD were more likely to experience poor patient–provider communication (odds ratio 1.25 [95% confidence interval 1.11–1.41]), lower healthcare satisfaction (1.12 [1.02–1.24]), poor perception of health status (1.15 [1.04–1.28]), and lower health‐related quality of life scores. Women with ASCVD also had lower use of aspirin and statins, and greater odds of ≥2 Emergency Department visits/y. Conclusions Women with ASCVD were more likely to report poorer patient experience, lower health‐related quality of life, and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender‐specific differences in healthcare quality, delivery, and ultimately health outcomes among individuals with ASCVD.
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Affiliation(s)
- Victor Okunrintemi
- 1 Department of Internal Medicine East Carolina University Greenville NC
| | | | | | | | - Martin Tibuakuu
- 5 Department of Medicine St. Luke's Hospital Chesterfield MO.,6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Saba Ahmad
- 7 Department of Cardiology Lankenau Medical Center Wynnewood PA
| | - Oluseye Ogunmoroti
- 6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Shiwani Mahajan
- 2 Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT
| | | | - Martha Gulati
- 9 Division of Cardiology University of Arizona College of Medicine Phoenix AZ
| | - Khurram Nasir
- 2 Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,10 Division of Cardiology Yale School of Medicine New Haven CT
| | - Erin D Michos
- 6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD.,11 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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16
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Tibuakuu M, Okunrintemi V, Jirru E, Echouffo Tcheugui JB, Orimoloye OA, Mehta PK, DeFilippis AP, Blaha MJ, Michos ED. National Trends in Cessation Counseling, Prescription Medication Use, and Associated Costs Among US Adult Cigarette Smokers. JAMA Netw Open 2019; 2:e194585. [PMID: 31125108 PMCID: PMC6632149 DOI: 10.1001/jamanetworkopen.2019.4585] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Cigarette smoking is the leading cause of preventable disease and death in the United States. When used separately or in combination, smoking cessation counseling and cessation medications have been associated with increased cessation rates. OBJECTIVES To present trends in self-reported receipt of physician advice to quit smoking and in use of prescription smoking cessation medication along with their associated expenditures among a nationally representative sample of active adult smokers in the United States. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study of US adults aged 18 years or older was conducted from July 5, 2018, through August 15, 2018. Data were collected between January 1, 2006, and December 31, 2015, from the Medical Expenditure Panel Survey, an annual US survey of individuals and families, health care personnel, and employers. Participants (n = 29 106) were noninstitutionalized civilians who were randomly drawn from the respondents of the previous year's National Health Interview Survey. Multivariable logistic regression models were used to examine the associations between sociodemographic factors and receipt of physician cessation advice and use of cessation prescription medication. A 2-part econometric model was used to assess health care expenditures. MAIN OUTCOMES AND MEASURES Trends in self-reported receipt of physician advice to quit and uptake of prescription smoking cessation medications with associated total and out-of-pocket expenditures. RESULTS The study sample consisted of 29 106 participants, with a mean (SD) age of 57 (10) years and a composition of 13 670 women (47.0%). The results were weighted to provide estimates for 31.2 million active adult cigarette smokers. The proportion of smokers who reported receiving physician advice to quit increased from 60.2% (95% CI, 58.5%-62.0%) in 2006 to 2007 to 64.9% (95% CI, 62.8%-66.9%) in 2014 to 2015, with a P for trend = .001. The odds of receiving physician cessation advice was statistically significantly higher in women (odds ratio [OR], 1.50; 95% CI, 1.39-1.59) and lower among uninsured participants (OR, 0.58; 95% CI, 0.52-0.65). Overall, prescription smoking cessation medication use decreased with a corresponding reduction in total expenditures from $146 million (out-of-pocket cost, $46 million) in 2006 to 2007 to $73 million (out-of-pocket cost, $9 million) in 2014 to 2015. Male (odds ratio [OR], 0.78; 95% CI, 0.66-0.91), uninsured (OR, 0.58; 95% CI, 0.41-0.83), and racial/ethnic minority (African American: OR, 0.51 [95% CI, 0.38-0.69]; Asian: OR, 0.31 [95% CI, 0.10-0.93]; Hispanic: OR, 0.53 [95% CI, 0.36-0.78]) participants were less likely to use prescription smoking cessation medications. CONCLUSIONS AND RELEVANCE The lower rates of delivery of physician advice to quit smoking and the lower uptake of known prescription smoking cessation medications among men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-associated comorbidities may be associated with the higher smoking rates among these subgroups despite an all-time low prevalence of smoking in the United States; this finding calls for a more targeted implementation of smoking cessation guidelines.
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Affiliation(s)
- Martin Tibuakuu
- St Luke’s Hospital, Department of Medicine, Chesterfield, Missouri
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Victor Okunrintemi
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Ermias Jirru
- Department of Medicine, New York Presbyterian-Weill Cornell Medical College, New York
| | | | - Olusola A. Orimoloye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Puja K. Mehta
- Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Andrew P. DeFilippis
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Cardiology, University of Louisville, Louisville, Kentucky
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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17
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Fashanu OE, Oyenuga AO, Zhao D, Tibuakuu M, Mora S, Otvos JD, Stein JH, Michos ED. GlycA, a Novel Inflammatory Marker and Its Association With Peripheral Arterial Disease and Carotid Plaque: The Multi-Ethnic Study of Atherosclerosis. Angiology 2019; 70:737-746. [PMID: 31030528 DOI: 10.1177/0003319719845185] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
GlycA, a composite biomarker of systemic inflammation, is associated with cardiovascular disease (CVD) and mortality, but its relationship with peripheral artery disease (PAD) is unknown. We assessed whether plasma GlycA is associated with ankle-brachial index (ABI), carotid plaque (CP), and incident clinical PAD among 6466 Multi-Ethnic Study of Atherosclerosis participants without CVD at baseline. GlycA, ABI, and CP were measured at baseline. Both ABI and CP were remeasured at 10 years. Incident clinical PAD was ascertained from hospital records. We used logistic, Cox, and linear mixed regression models adjusted for demographic and lifestyle factors. Mean (standard deviation, SD) was 62 (10) years for age and 381 (61) µmol/L for GlycA; 53% were women. GlycA was associated with both prevalent low ABI ≤0.8 (prevalence odds ratio [95% confidence interval, CI] per SD increment in GlycA, 1.65 [1.39-1.97]) and CP (1.19 [1.11-1.27]) at baseline. There were no significant associations of GlycA with incident low ABI, incident CP, or 10-year change in ABI or CP score. We identified 110 incident cases of PAD after 79 590 person-years. The hazard ratio (95% CI) of incident PAD per SD increment in GlycA was 1.38 (1.14-1.66). In conclusion, GlycA was associated with prevalent low ABI, prevalent CP, and incident PAD after a median of 14 years.
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Affiliation(s)
- Oluwaseun E Fashanu
- 1 Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.,2 Department of Medicine, St Agnes Hospital, Baltimore, MD, USA
| | - Abayomi O Oyenuga
- 3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Di Zhao
- 1 Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.,4 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin Tibuakuu
- 1 Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.,5 Department of Medicine, St Luke's Hospital, Chesterfield, MO, USA
| | - Samia Mora
- 6 Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James D Otvos
- 7 Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, USA
| | - James H Stein
- 8 Division of Cardiovascular Medicine, University of Wisconsin, Madison, WI, USA
| | - Erin D Michos
- 1 Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.,4 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Okunrintemi V, Benson EMA, Tibuakuu M, Zhao D, Ogunmoroti O, Valero-Elizondo J, Gulati M, Nasir K, Michos ED. Trends and Costs Associated With Suboptimal Physical Activity Among US Women With Cardiovascular Disease. JAMA Netw Open 2019; 2:e191977. [PMID: 30977851 PMCID: PMC6481430 DOI: 10.1001/jamanetworkopen.2019.1977] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Cardiovascular disease (CVD) is the leading cause of death and disability among women. Achievement of recommended physical activity (PA) levels is an essential component of CVD management. OBJECTIVE To describe trends, sociodemographic factors, and health care expenditures associated with suboptimal PA among a nationally representative sample of US women with CVD. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used serial data from the Medical Expenditure Panel Survey from 2006 through 2015. The analyses were conducted in August 2018. Women who had self-reported and/or International Classification of Diseases, Ninth Revision, diagnosis of CVD were included. MAIN OUTCOMES AND MEASURES Recommended PA was defined as 30 minutes or more of moderate- to vigorous-intensity exercise, 5 or more days per week. Weighted logistic regression was used to examine the associations of various sociodemographic factors with suboptimal PA, adjusted for comorbidities. A 2-part econometric model was used to assess health care expenditures. RESULTS A total of 18 027 women were included in this study. The results were weighted to provide estimates for approximately 19.5 million adult women in the United States with CVD (mean [SD] age, 60.4 [16.9] years). More than half of the women with CVD reported suboptimal PA, a trend that increased during the 10-year period, with 58.2% (95% CI, 55.9%-60.5%) of participants reporting suboptimal PA in 2006-2007 vs 61.9% (95% CI, 59.7%-64.2%) in 2014-2015 (P = .004). The proportion of women with suboptimal PA differed by sociodemographic factors. In adjusted models, compared with non-Hispanic white women, African American women (odds ratio, 1.22; 95% CI, 1.08-1.38) and Hispanic women (odds ratio, 1.33; 95% CI, 1.13-1.58) were more likely to have suboptimal PA. Women from low- or very low-income strata (compared with high-income strata), enrolled in public insurance (compared with private insurance), and with less than high school education (compared with at least some college education) were more likely to have suboptimal PA. Health care costs among women with CVD with suboptimal PA were higher compared with those among women who met the recommended PA, and this increased through time, from a mean total health care expenditure of $12 724 (95% CI, $11 627-$13 821) in 2006-2007 to $14 820 (95% CI, $13 521-$16 119) in 2014-2015. CONCLUSIONS AND RELEVANCE The proportion of women with CVD not meeting recommended PA is high and increasing, particularly among certain racial/ethnic and socioeconomic groups, and is associated with significant health care costs. More must be done to improve PA for secondary prevention and reduction of expenditures among women with CVD.
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Affiliation(s)
- Victor Okunrintemi
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Eve-Marie A. Benson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Martin Tibuakuu
- Department of Medicine, St. Luke’s Hospital, Chesterfield, Missouri
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Javier Valero-Elizondo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | - Erin D. Michos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
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19
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Ezeigwe A, Fashanu OE, Zhao D, Budoff MJ, Otvos JD, Thomas IC, Mora S, Tibuakuu M, Michos ED. The novel inflammatory marker GlycA and the prevalence and progression of valvular and thoracic aortic calcification: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2019; 282:91-99. [PMID: 30716566 PMCID: PMC6401213 DOI: 10.1016/j.atherosclerosis.2019.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/09/2018] [Accepted: 01/10/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS GlycA is a novel composite biomarker of systemic inflammation reflecting posttranslational glycosylation of acute phase reactants. GlycA has been associated with coronary artery calcium, cardiovascular disease (CVD) events and mortality. Vascular calcifications outside of the coronary arteries are risk markers of CVD and mortality. Whether GlycA is linked to extra-coronary calcifications (ECC) is not well established. METHODS We studied 6462 MESA participants free of clinical CVD who had plasma GlycA measured at baseline. ECCs [calcification in aortic valve (AVC), mitral annulus (MAC), ascending and descending thoracic aorta (ATAC, DTAC)] were ascertained at baseline and follow-up visit (median 2.3-yrs later) by cardiac CT. Poisson regression models with robust variance estimation assessed associations of GlycA with prevalent and incident ECC. Linear mixed models assessed the cross-sectional and 2-year change in ECC. Models were adjusted for demographic and lifestyle factors. RESULTS In cross-sectional analysis, GlycA (per SD increment) was positively associated with prevalent AVC, ATAC and DTAC with adjusted prevalence ratios (95% CI) of 1.08 (1.01-1.14), 1.18 (1.03-1.34) and 1.10 (1.06-1.14), respectively. There was also a significant association between GlycA and baseline extent of both ATAC and DTAC. Longitudinally, GlycA was positively associated with incident MAC and DTAC, with adjusted incidence ratios of 1.18 (1.03-1.37) and 1.17 (1.07-1.28), respectively. GlycA was also associated with 2-year change in MAC and DTAC extent. CONCLUSIONS In this diverse cohort free from clinical CVD, we found GlycA was positively associated with prevalent and incident ECC measures, in particular for progression of MAC and DTAC.
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Affiliation(s)
- Angelica Ezeigwe
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Oluwaseun E Fashanu
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Agnes Hospital, Baltimore, MD, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, USA
| | - Isac C Thomas
- Department of Medicine, Division of Cardiovascular Medicine, University of California San Diego, San Diego, CA, USA
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martin Tibuakuu
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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20
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Benson EMA, Tibuakuu M, Zhao D, Akinkuolie AO, Otvos JD, Duprez DA, Jacobs DR, Mora S, Michos ED. Associations of ideal cardiovascular health with GlycA, a novel inflammatory marker: The Multi-Ethnic Study of Atherosclerosis. Clin Cardiol 2018; 41:1439-1445. [PMID: 30452775 DOI: 10.1002/clc.23069] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Unhealthy lifestyles and inflammation contribute to cardiovascular disease (CVD). GlycA is a novel biomarker of systemic inflammation representing post-translational glycosylation of acute phase reactants and associated with increased clinical CVD risk. HYPOTHESIS We hypothesized that ideal cardiovascular health (CVH), as assessed by (higher) Life's Simple 7 (LS7) scores, would be associated with lower GlycA levels among individuals free of CVD in a multiethnic community-based population. METHODS This was a cross-sectional study of 6479 Multi-Ethnic Study of Atherosclerosis participants [53% women; mean age 62 ± 10 years] with GlycA levels measured at baseline by nuclear magnetic resonance spectroscopy. The LS7 metrics (smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose) were each scored as ideal (2), moderate (1), or poor (0). Total scores were summed and categorized as optimal (12-14), average (8-11), and inadequate (0-7). Linear regression assessed percent difference in GlycA by LS7 scores, after adjusting for age, sex, ethnicity, education, income, family history of CVD, and other inflammatory biomarkers. RESULTS GlycA levels were 403.4 ± 63.1, 374.4 ± 59.2, and 350.3 ± 56.2 micromoles per liter (μmol/L) for inadequate, average, and optimal CVH, respectively (P-trend <0.001). After multivariable adjustment, GlycA remained independently and inversely associated with CVH categories, with a lower mean GlycA level of 5 μmol/L (95% confidence interval 4.5-5.8) for each one unit increment in LS7 score. CONCLUSIONS Among this group of ethnically diverse individuals without CVD, suboptimal CVH is associated with higher GlycA levels, independent of traditional inflammatory biomarkers. Strategies aimed at improving CVH might reduce GlycA, which could be a marker of reduced risk of future CVD events.
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Affiliation(s)
- Eve-Marie A Benson
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Martin Tibuakuu
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Di Zhao
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Akintunde O Akinkuolie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Center for Lipid Metabolomics, Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, North Carolina
| | - Daniel A Duprez
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erin D Michos
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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21
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Townsend J, Keller S, Tibuakuu M, Thakker S, Webster B, Siegel M, Psoter KJ, Mansour O, Perl TM. Outpatient Parenteral Therapy for Complicated Staphylococcus aureus Infections: A Snapshot of Processes and Outcomes in the Real World. Open Forum Infect Dis 2018; 5:ofy274. [PMID: 30488039 PMCID: PMC6251475 DOI: 10.1093/ofid/ofy274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/23/2018] [Indexed: 12/23/2022] Open
Abstract
Background In the United States, patients discharged on outpatient parenteral antimicrobial therapy (OPAT) are often treated by home health companies (HHCs) or skilled nursing facilities (SNFs). Little is known about differences in processes and outcomes between these sites of care. Methods We performed a retrospective study of 107 patients with complicated Staphylococcus aureus infections discharged on OPAT from 2 academic medical centers. Clinical characteristics, site of posthospital care, process measures (lab test monitoring, clinic follow-up), adverse events (adverse drug events, Clostridium difficile infection, line events), and clinical outcomes at 90 days (cure, relapse, hospital readmission) were collected. Comparisons between HHCs and SNFs were conducted. Results Overall, 33% of patients experienced an adverse event during OPAT, and 64% were readmitted at 90 days. Labs were received for 44% of patients in SNFs and 56% of patients in HHCs. At 90 days after discharge, a higher proportion of patients discharged to an SNF were lost to follow-up (17% vs 3%; P = .03) and had line-related adverse events (18% vs 2%; P < .01). Patients discharged to both sites of care experienced similar clinical outcomes, with favorable outcomes occurring in 61% of SNF patients and 70% of HHC patients at 90 days. There were no differences in rates of relapse, readmission, or mortality. Conclusions Patients discharged to SNFs may be at higher risk for line events than patients discharged to HHCs. Efforts should be made to strengthen basic OPAT processes, such as lab monitoring and clinic follow-up, at both sites of care.
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Affiliation(s)
- Jennifer Townsend
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara Keller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin Tibuakuu
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Sameer Thakker
- Johns Hopkins University Medical School, Baltimore, Maryland
| | - Bailey Webster
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Maya Siegel
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin J Psoter
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Omar Mansour
- Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Trish M Perl
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas
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22
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Abstract
Purpose of review Certain subgroups defined by sociodemographics (race/ethnicity, age, sex and socioeconomic status [SES]), geographic location (rural vs. urban), comorbid conditions and country economic conditions (developed vs. developing) may disproportionately suffer the adverse cardiovascular effects of exposure to ambient air pollution. Yet, previous reviews have had a broad focus on the general population without consideration of these potentially vulnerable populations. Recent findings Over the past decade, a wealth of epidemiologic studies have linked air pollutants including particulate matter, oxides of nitrogen, and carbon monoxide to cardiovascular disease (CVD) risk factors, subclinical CVD, clinical cardiovascular outcomes and cardiovascular mortality in certain susceptible populations. Highest risk for poor CVD outcomes from air pollution exist in racial/ethnic minorities, especially in blacks compared to whites in the U.S, those at low SES, elderly populations, women, those with certain comorbid conditions and developing countries compared to developed countries. However, findings are less consistent for urban compared to rural populations. Summary Vulnerable subgroups including racial/ethnic minorities, women, the elderly, smokers, diabetics and those with prior heart disease had higher risk for adverse cardiovascular outcomes from exposure to air pollution. There is limited data from developing countries where concentrations of air pollutants are more extreme and cardiovascular event rates are higher than that of developed countries. Further epidemiologic studies are needed to understand and address the marked disparities in CVD risk conferred by air pollution globally, particularly among these vulnerable subgroups.
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Affiliation(s)
- Martin Tibuakuu
- St. Luke's Hospital, Department of Medicine, Chesterfield, MO, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University School of Public Health, New York, NY, USA
| | - Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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23
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Amoakwa K, Fashanu OE, Tibuakuu M, Zhao D, Guallar E, Whelton SP, O'Neal WT, Post WS, Budoff MJ, Michos ED. Resting heart rate and the incidence and progression of valvular calcium: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2018; 273:45-52. [PMID: 29677630 PMCID: PMC5949274 DOI: 10.1016/j.atherosclerosis.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/05/2018] [Accepted: 04/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Left-sided valvular calcification is associated with cardiovascular disease (CVD) morbidity and mortality. Resting heart rate (RHR) may influence valvular calcium progression through shear stress. Whether RHR, an established CVD risk factor, is associated with valvular calcium progression is unknown. We assessed whether RHR predicts incidence and progression of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a community-based cohort free of CVD at baseline. METHODS RHR was obtained from baseline electrocardiograms of 5498 MESA participants. MAC and AVC were quantified using Agatston scoring from cardiac computed tomography scans obtained at baseline and at a second examination during follow-up. We examined associations of RHR with incident MAC/AVC and annual change in MAC/AVC scores, after adjusting for demographics, CVD risk factors, physical activity, and atrioventricular nodal blocker use. RESULTS At baseline, participants had mean age of 62 ± 10 years and mean RHR of 63 ± 10 bpm; 12.3% and 8.9% had prevalent AVC and MAC, respectively. Over a median of 2.3 years, 4.1% and 4.5% developed incident AVC and MAC, respectively. Each 10 bpm higher RHR was significantly associated with incident MAC [Risk Ratio 1.17 (95% CI 1.03-1.34)], but not incident AVC. However, RHR was associated with AVC progression [β = 1.62 (0.45-2.80) Agatston units/year for every 10 bpm increment], but not MAC progression. CONCLUSIONS Higher RHR was associated with MAC incidence and AVC progression, independent of traditional CVD risk factors. Future studies are needed to determine whether modification of RHR through lifestyle or pharmacologic interventions can reduce valvular calcium incidence or progression.
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Affiliation(s)
| | - Oluwaseun E Fashanu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eliseo Guallar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Wendy S Post
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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24
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Tibuakuu M, Kianoush S, DeFilippis AP, McEvoy JW, Zhao D, Guallar E, Ballantyne CM, Hoogeveen RC, Blaha MJ, Michos ED. Usefulness of Lipoprotein-Associated Phospholipase A 2 Activity and C-Reactive Protein in Identifying High-Risk Smokers for Atherosclerotic Cardiovascular Disease (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2018; 121:1056-1064. [PMID: 29525060 PMCID: PMC5927844 DOI: 10.1016/j.amjcard.2018.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 11/16/2022]
Abstract
Despite the causal role of cigarette smoking in atherosclerotic cardiovascular disease (ASCVD), the underlying mechanisms are not fully understood. We evaluated the joint relation between smoking and inflammatory markers with ASCVD risk. We tested cross-sectional associations of self-reported smoking status (never, former, current) and intensity (packs/day) with lipoprotein-associated phospholipase A2 (Lp-PLA2) activity and high-sensitivity C-reactive protein (hsCRP) in 10,506 Atherosclerosis Risk in Communities participants at Visit 4 (1996 to 1998). Using Cox hazard models adjusted for demographic and traditional ASCVD risk factors, we examined the associations of smoking status and intensity with incident adjudicated ASCVD events (n = 1,745 cases) over an average of 17 years, stratified by Lp-PLA2 and hsCRP categories. Greater packs/day smoked was linearly associated with higher levels of both Lp-PLA2 and hsCRP among current smokers. Compared with never smokers, the hazard ratio for incident ASCVD in current smokers was 2.04 (95% CI 1.76 to 2.35). Among current smokers, the risk for ASCVD per 1 pack/day greater was 1.39 (1.10 to 1.76). Both Lp-PLA2 activity ≥253 nmol/min/ml and hsCRP >3 mg/L identified current smokers at the highest risk for incident ASCVD, with similar hazard ratios. hsCRP risk-stratified current smokers better based on intensity. Among current smokers, hsCRP improved ASCVD prediction beyond traditional risk factors better than Lp-PLA2 (C-statistic 0.675 for hsCRP vs 0.668 for Lp-PLA2, p = 0.001). In this large cohort with long follow-up, we found a dose-response relation between smoking intensity with Lp-PLA2 activity, hsCRP, and ASCVD events. Although both Lp-PLA2 activity and hsCRP categories identified high risk among current smokers, hsCRP may better stratify risk of future ASCVD.
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Affiliation(s)
- Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew P DeFilippis
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland
| | - Christie M Ballantyne
- Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Texas
| | - Ron C Hoogeveen
- Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Texas
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Medicine, Baltimore, Maryland.
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25
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Okunrintemi V, Tibuakuu M, Valero-Elizondo J, Salami J, Nasir K, Michos ED. Abstract 241: Health Resource Utilization and Healthcare Expenditure Among Myocardial Infarction Patients With Depression. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Depression and myocardial infarction (MI) often coexist and has been associated with worse health outcomes. Evidence suggest that hospital visits and prescription medications account for majority of the healthcare expenditure, even among MI patients and this is expected to increase over the next decade. However, little is known of the excessive burden of depression on health resource utilization and healthcare expenditure among patients with MI. Using a nationally representative sample of the US adult population, we compare healthcare expenditure(total and out-of-pocket) and health resource utilization(emergency room visits and hospitalizations) among MI patients without the diagnosis of depression with depressed MI patients.
Methods:
We used data from the 2006-2015 Medical Expenditure Panel Survey (MEPS) for this study. We included adults ≥18 years with a diagnosis of MI (ICD9 code 410 and/or self-reported) and stratified these individuals based on the presence of the diagnosis of Depression, identified by ICD9 code 311. We used the two-part econometric model to study cost data and regression models adjusted for sociodemographic characteristics and cardiovascular disease risk factors to compare health resource utilization between depressed and non-depressed MI patients.
Results:
The study sample consisted of 6,702 individuals, representing 7.16m MI patients without the diagnosis of depression and 1,381 individuals representing 1.42m depressed MI patients (aged 65 ± 13 years, 63% male). Compared with non-depressed MI patients, MI patients with a diagnosis of depression had higher odds for hospitalizations [OR 1.54 (1.29, 1.83)] and emergency room visits [OR 1.43 (1.21, 1.69)], significantly greater mean annual expenditure as well as an estimated $4,381 ($2,553, $6,209) & $402 ($225, $579) higher annual overall and out-of-pocket healthcare expenditures respectively (Table).
Conclusion:
Depression among MI patients is associated with a significant increase in annual healthcare expenditure and health resource utilization. As a quality improvement measure to increase healthcare efficiency, routine depression screening at follow up visits may be appropriate especially among these high risk population.
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Affiliation(s)
| | | | - Javier Valero-Elizondo
- Tecnologico de Monterrey, Catedra de Cardiologia y Medicina Vascular, Nuevo Leon, Mexico
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Okunrintemi V, Valero-Elizondo J, Michos E, Salami J, Ogunmoroti O, Osondu C, Tibuakuu M, Benson EM, Pawlik T, Nasir K. Abstract 240: Association of Depression Risk With Patient Experience, Healthcare Expenditure and Health Resource Utilization Among Adults With Atherosclerotic Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. Currently, these two conditions are the most common causes of disability in high-income countries and projected to become so for all countries by 2030. Depression is a risk marker for ASCVD and associated with worse health outcomes. In a nationally representative US adult population, we evaluate patient experience, healthcare expenditure and resource utilization among non-depressed ASCVD patients based on their risk for depression.
Methods:
The 2004-2015 Medical Expenditure Panel Survey (MEPS), a nationally representative sample was the basis for our study. We included adults ≥18 years with a diagnosis of ASCVD, ascertained by ICD9 codes and/or self-reported data and excluded those with a diagnosis of Depression, identified by ICD9 code 311. Individuals were stratified by depression risk (based on the Patient Health Questionnaire-2): Two-part econometric model was used to study cost data, and regression models for all other associations, adjusted for ASCVD risk factors.
Results:
The study sample consisted of 16,136 ASCVD patients without the diagnosis of depression (aged 67 ± 10 years, 55% male), translating into 179.2 million US adults, of which 8.6% (15.5 million US adults) had a high risk for depression. Individuals with high vs. low risk for depression had higher overall and out-of-pocket healthcare expenditures ($1,200 & $353, respectively; both p < 0.001). Additionally, those with high risk had higher odds for hospitalizations [OR 1.75 (1.75, 2.32)], poor self-perceived health status [OR 4.83 (3.28, 7.12)], poor patient-provider communication scores [OR 2.44 (1.93, 3.09)], poor patient satisfaction [OR 3.33 (1.64, 6.77)], and significantly worse healthcare-related quality of life measures than those with low risk for depression (Table).
Conclusion:
Among ASCVD patients without a diagnosis of depression, individuals with a greater risk for depression were more likely to report worse healthcare experience, increased resource utilization and higher healthcare spending. To enhance health outcomes and increase healthcare efficiency, more aggressive screening for depression risk to promote improved recognition and intervention are needed among this vulnerable population.
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Affiliation(s)
| | - Javier Valero-Elizondo
- Tecnologico de Monterrey, Catedra de cardiologia y Medicina Vascular, Nuevo Leon, Mexico
| | - Erin Michos
- Johns Hopkins Sch of Medicine, Baltimore, MD
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Tibuakuu M, Zhao D, Saxena A, Brown TT, Jacobson LP, Palella FJ, Witt MD, Koletar SL, Margolick JB, Guallar E, Korada SKC, Budoff MJ, Post WS, Michos ED. Low thigh muscle mass is associated with coronary artery stenosis among HIV-infected and HIV-uninfected men: The Multicenter AIDS Cohort Study (MACS). J Cardiovasc Comput Tomogr 2018; 12:131-138. [PMID: 29396194 DOI: 10.1016/j.jcct.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND HIV-infected individuals are at increased risk for both sarcopenia and cardiovascular disease. Whether an association between low muscle mass and subclinical coronary artery disease (CAD) exists, and if it is modified by HIV serostatus, are unknown. METHODS We performed cross-sectional analysis of 513 male MACS participants (72% HIV-infected) who underwent mid-thigh computed tomography (CT) and non-contrast cardiac CT for coronary artery calcium (CAC) during 2010-2013. Of these, 379 also underwent coronary CT angiography for non-calcified coronary plaque (NCP) and obstructive coronary stenosis ≥50%. Multivariable-adjusted Poisson regression was used to estimate prevalence risk ratios of associations between low muscle mass (<20th percentile of the HIV-uninfected individuals in the sample) and CAC, NCP and obstructive stenosis. RESULTS The prevalence of low thigh muscle mass was similar by HIV serostatus (20%). There was no association of low muscle mass with CAC or NCP. However, low thigh muscle mass was significantly associated with a 2.5-fold higher prevalence of obstructive coronary stenosis, after adjustment for demographics and traditional CAD risk factors [PR 2.46 (95% CI 1.51, 4.01)]. This association remained significant after adjustment for adiposity, inflammation, and physical activity. There was no significant interaction by HIV serostatus (p-interaction = 0.90). CONCLUSIONS In this exploratory analysis, low thigh muscle mass was significantly associated with subclinical obstructive coronary stenosis. Additional studies involving larger sample sizes and prospective analyses are needed to confirm the potential utility of measuring mid-thigh muscle mass for identifying individuals at increased risk for obstructive CAD who might benefit from more aggressive risk factor management.
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Affiliation(s)
- Martin Tibuakuu
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankita Saxena
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mallory D Witt
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, USA
| | - Susan L Koletar
- Division of Infectious Diseases, Ohio State University, Columbus, OH, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, USA
| | - Wendy S Post
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Tibuakuu M, Jones MR, Navas-Acien A, Zhao D, Guallar E, Gassett AJ, Sheppard L, Budoff MJ, Kaufman JD, Michos ED. Exposure to ambient air pollution and calcification of the mitral annulus and aortic valve: the multi-ethnic study of atherosclerosis (MESA). Environ Health 2017; 16:133. [PMID: 29268751 PMCID: PMC5740967 DOI: 10.1186/s12940-017-0346-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/07/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Calcifications of left-sided heart valves are also markers of CVD risk. We investigated whether air pollution was associated with valvular calcification and its progression. METHODS We studied 6253 MESA participants aged 45-84 years who underwent two cardiac CT scans 2.5 years apart to quantify aortic valve calcium (AVC) and mitral annular calcium (MAC). CAC was included for the same timeframe for comparison with AVC/MAC. Ambient particulate matter <2.5 μm (PM2.5) and oxides of nitrogen (NOx) concentrations were predicted from residence-specific spatio-temporal models. RESULTS The mean age (SD) of the study sample was 62 (10) years, 39% were white, 27% black, 22% Hispanic, and 12% Chinese. The prevalence of AVC and MAC at baseline were 13% and 9% respectively, compared to 50% prevalence of CAC. The adjusted prevalence ratios of AVC and MAC for each 5 μg/m3 higher PM2.5 was 1.19 (95% CI 0.87, 1.62) and 1.20 (0.81, 1.77) respectively, and for CAC was 1.14 (1.01, 1.27). Over 2.5 years, the mean change in Agatston units/year for each 5 μg/m3 higher PM2.5 concentration was 0.29 (-5.05, 5.63) for AVC and 4.38 (-9.13, 17.88) for MAC, compared to 8.66 (0.61, 16.71) for CAC. We found no significant associations of NOx with AVC and MAC. CONCLUSION Our findings suggest a trend towards increased 2.5-year progression of MAC with exposure to outdoor PM2.5, although this association could not be confirmed. Additional well-powered studies with longer periods of follow-up are needed to further study associations of air pollution with valvular calcium. TRIAL REGISTRATION Although MESA is not a clinical trial, this cohort is registered at ClinicalTrials.gov Identifier: NCT00005487; Date of registration May 25, 2000.
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Affiliation(s)
- Martin Tibuakuu
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD USA
- Department of Medicine, St. Luke’s Hospital, Chesterfield, MO USA
| | - Miranda R. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University School of Public Health, New York, NY USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Amanda J. Gassett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA USA
- Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA USA
- Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Matthew J. Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA USA
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Division of Cardiology, Johns Hopkins School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD 21287 USA
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Korada SKC, Zhao D, Tibuakuu M, Brown TT, Jacobson LP, Guallar E, Bolan RK, Palella FJ, Margolick JB, Martinson JJ, Budoff MJ, Post WS, Michos ED. Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS). Atherosclerosis 2017; 266:240-247. [PMID: 28886899 DOI: 10.1016/j.atherosclerosis.2017.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. METHODS We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. RESULTS Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interactionHIV<0.05 for all). Among HIV-uninfected men, after adjustment for cardiovascular risk factors, frailty was significantly associated only with CAC>0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. CONCLUSIONS Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.
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Affiliation(s)
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA
| | - Todd T Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeremy J Martinson
- Department of Infectious Disease and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Kianoush S, Bittencourt MS, Lotufo PA, Bensenor IM, Jones SR, DeFilippis AP, Toth PP, Otvos JD, Tibuakuu M, Hall ME, Harada PHN, Blaha MJ. Association Between Smoking and Serum GlycA and High-Sensitivity C-Reactive Protein Levels: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Am Heart Assoc 2017; 6:JAHA.117.006545. [PMID: 28838917 PMCID: PMC5586473 DOI: 10.1161/jaha.117.006545] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 12/27/2022]
Abstract
Background Inflammation is suggested to be a central feature of atherosclerosis, particularly among smokers. We studied whether inflammatory biomarkers GlycA and high‐sensitivity C‐reactive protein are associated with cigarette smoking. Methods and Results A total of 11 509 participants, 6774 from the MESA (Multi‐Ethnic Study of Atherosclerosis) and 4735 from ELSA‐Brasil (The Brazilian Longitudinal Study of Adult Health) were included. We evaluated the cross‐sectional association between multiple measures of smoking behavior and the inflammatory biomarkers, GlycA and high‐sensitivity C‐reactive protein, using regression models adjusted for demographic, anthropometric, and clinical characteristics. Participants were 57.7±11.1 years old and 46.4% were men. Never, former, and current smokers comprised 51.7%, 34.0%, and 14.3% of the population, respectively. Multivariable‐adjusted mean absolute difference in GlycA levels (μmol/L) with 95% confidence interval (CI) were higher for former (4.1, 95% CI, 1.7–6.6 μmol/L) and current smokers (19.9, 95% CI, 16.6–23.2 μmol/L), compared with never smokers. Each 5‐unit increase in pack‐years of smoking was associated with higher GlycA levels among former (0.7, 95% CI, 0.3–1.1 μmol/L) and current smokers (1.6, 95% CI, 0.8–2.4 μmol/L). Among former smokers, each 5‐year increase in time since quitting smoking was associated with lower GlycA levels (−1.6, 95% CI, −2.4 to −0.8 μmol/L) and each 10‐unit increase in number of cigarettes/day was associated with higher GlycA among current smokers (2.8, 95% CI, 0.5–5.2 μmol/L). There were similar significant associations between all measures of smoking behavior, and both log‐transformed GlycA and high‐sensitivity C‐reactive protein. Conclusions Acute and chronic exposure to tobacco smoking is associated with inflammation, as quantified by both GlycA and high‐sensitivity C‐reactive protein. These biomarkers may have utility for the study and regulation of novel and traditional tobacco products.
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Affiliation(s)
- Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of Sao Paulo, Brazil .,School of Medicine, University of Sao Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, University of Sao Paulo, Brazil.,School of Medicine, University of Sao Paulo, Brazil
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.,School of Medicine, University of Louisville, Louisville, KY
| | - Peter P Toth
- Sterling Rock Falls Clinic, Ltd., CGH Medical Center, University of Illinois School of Medicine, Sterling, IL
| | | | - Martin Tibuakuu
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Michael E Hall
- University of Mississippi Medical Center, Division of Cardiology, Jackson, MS
| | - Paulo H N Harada
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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Tibuakuu M, Zhao D, de Boer IH, Guallar E, Bortnick AE, Lutsey PL, Budoff MJ, Kizer JR, Kestenbaum BR, Michos ED. Relation of Serum Vitamin D to Risk of Mitral Annular and Aortic Valve Calcium (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2017; 120:473-478. [PMID: 28583687 DOI: 10.1016/j.amjcard.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
Serum 25-hydroxyvitamin D [25(OH)D] concentration has been identified as a possible modifiable risk factor for cardiovascular disease (CVD). We hypothesized that serum 25(OH)D concentration would be associated with calcifications of the left-sided heart valves, which are markers of CVD risk. Aortic valve calcium (AVC) and mitral annular calcium (MAC) were quantified from cardiac computed tomography scans performed on 5,530 Multi-Ethnic Study of Atherosclerosis participants at the baseline examination (2000 to 2002) and at a follow-up visit at either Examination 2 (2002 to 2004) or Examination 3 (2004 to 2005). 25(OH)D was measured from serum samples collected at the baseline examination. Using relative risk regression, we evaluated the multivariable-adjusted risk of prevalent and incident AVC and MAC in this ethnically diverse population free of clinical CVD at baseline. The mean age of participants was 62 ± 10 years; 53% were women, 40% white, 26% black, 21% Hispanic, and 12% Chinese. Prevalent AVC and MAC were observed in 12% and 9% of study sample, respectively. There were no significant associations between 25(OH)D and prevalent AVC or MAC. Over a mean follow-up of 2.5 years, 4% developed incident AVC and 5% developed incident MAC. After adjusting for demographic variables, each 10 ng/ml higher serum 25(OH)D was associated with a 15% (relative risk 0.85, 95% confidence interval 0.74 to 0.98) lower risk of incident MAC but not AVC. However, this association was no longer significant after adjusting for lifestyle and CVD risk factors. Results suggest a possible link between serum 25(OH)D and the risk for incident MAC, but future studies with longer follow-up are needed to further test this association.
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Chin K, Zhao D, Tibuakuu M, Martin SS, Ndumele CE, Florido R, Windham BG, Guallar E, Lutsey PL, Michos ED. Physical Activity, Vitamin D, and Incident Atherosclerotic Cardiovascular Disease in Whites and Blacks: The ARIC Study. J Clin Endocrinol Metab 2017; 102:1227-1236. [PMID: 28323928 PMCID: PMC5460730 DOI: 10.1210/jc.2016-3743] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/13/2017] [Indexed: 01/01/2023]
Abstract
CONTEXT Physical activity (PA) is associated with 25-hydroxyvitamin D [25(OH)D] levels. Both are associated with atherosclerotic cardiovascular disease (ASCVD), but their joint association with ASCVD risk is unknown. OBJECTIVE To examine the relationship between PA and 25(OH)D, and assess effect modification of 25(OH)D and PA with ASCVD. DESIGN Cross-sectional and prospective study. SETTING Community-dwelling cohort. PARTICIPANTS A total of 10,342 participants free of ASCVD, with moderate- to vigorous-intensity PA assessed (1987 to 1989) and categorized per American Heart Association (AHA) guidelines (recommended, intermediate, or poor). MAIN OUTCOME MEASURES Serum 25(OH)D levels (1990 to 1992) and ASCVD events (i.e., incident myocardial infarction, fatal coronary disease, or stroke) through 2013. RESULTS Participants had mean age of 54 years, and were 57% women, 21% black, 30% 25(OH)D deficient [<20 ng/mL (<50 nmol/L)], and <40% meeting AHA-recommended PA. PA was linearly associated with 25(OH)D levels in whites. Whites meeting recommended PA were 37% less likely to have 25(OH)D deficiency [relative risk, 0.63 (95% confidence interval [CI], 0.56, 0.71)]; there was no significant association in blacks. Over 19.3 years of follow-up, 1800 incident ASCVD events occurred. Recommended PA was associated with reduced ASCVD risk [hazard ratio [HR], 0.78 (95% CI, 0.65, 0.93) and 0.76 (95% CI, 0.62, 0.93)] among participants with intermediate [20 to <30 ng/mL (50 to <75 nmol/L)] and optimal [≥30 ng/mL (≥75 nmol/L)] 25(OH)D, respectively, but not among those with deficient 25(OH)D (P for interaction = 0.04). CONCLUSION PA is linearly associated with higher 25(OH)D levels in whites. PA and 25(OH)D may have synergistic beneficial effects on ASCVD risk.
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Affiliation(s)
- Kathleen Chin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Chiadi E. Ndumele
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
| | - Roberta Florido
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
| | - B. Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
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