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Lin JY, Larson J, Schoenberg J, Sepulveda A, Tinker L, Wheeler M, Albert C, Manson JE, Wells G, Martin LW, Froelicher V, LaMonte M, Kooperberg C, Hlatky MA, Greenland P, Stefanick ML, Perez MV. Serial 7-Day Electrocardiogram Patch Screening for AF in High-Risk Older Women by the CHARGE-AF Score. JACC Clin Electrophysiol 2022; 8:1523-1534. [PMID: 36543503 PMCID: PMC9986967 DOI: 10.1016/j.jacep.2022.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asymptomatic atrial fibrillation (AF) is associated with an increased risk of stroke. The yield of serial electrocardiographic (ECG) screening for AF is unknown. OBJECTIVES The aim of this study was to determine the frequency of AF detected by serial, 7-day ECG patch screenings in older women identified as having an elevated risk of AF according to the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology)-AF clinical prediction score. METHODS Postmenopausal women with a 5-year predicted risk of new-onset AF ≥5% according to CHARGE-AF were recruited from the ongoing WHISH (Women's Health Initiative Strong and Healthy) randomized trial of a physical activity intervention. Participants with AF at baseline by self-report or medical records review were excluded. Screening with 7-day ECG patch monitors was performed at baseline, 6 months, and 12 months from study enrollment. RESULTS On baseline monitoring, 2.5% of the cohort had AF detected, increasing to 3.7% by 6 months and 4.9% cumulatively by 12 months. Yield of patch screening was higher among participants with a higher (≥10%) CHARGE-AF score: 4.2% had AF detected at baseline, 5.9% at 6 months, and 7.2% at 12 months. Most participants with patch-identified AF never had a clinical diagnosis of AF (36 of 46 [78%]). CONCLUSIONS Older women with an elevated CHARGE-AF score had a high prevalence of AF on 7-day ECG patch screening. Serial screening over 12 months substantially increased the detection of AF. These data can be useful in helping identify high-risk participants for enrollment in future studies of the management of asymptomatic AF.(Women's Health Initiative Silent Atrial Fibrillation Recording Study [WHISH STAR]; NCT05366803.).
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Affiliation(s)
- Jeffrey Y Lin
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Joseph Larson
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jenny Schoenberg
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Lesley Tinker
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Matthew Wheeler
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Christine Albert
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - JoAnn E Manson
- Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Gretchen Wells
- Department of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Lisa W Martin
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Victor Froelicher
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Mike LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | | | - Mark A Hlatky
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Philip Greenland
- Department of Medicine, Northwestern University, Evanston, Illinois, USA
| | | | - Marco V Perez
- Department of Medicine, Stanford University, Stanford, California, USA.
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Haring B, Hovey K, LaMonte M, Andrews C, Saquib N, Manson JE, Shimbo D, Ritch R, De Moraes CG, Wassertheil-Smoller S. Blood pressure control and glaucoma risk in postmenopausal women: an analysis from the Women's Health Initiative. Menopause 2022; 29:531-536. [PMID: 35486945 PMCID: PMC9060363 DOI: 10.1097/gme.0000000000001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to glaucoma risk in a large cohort of postmenopausal women. METHODS Prospective follow-up of 101,447 postmenopausal women without prior history of glaucoma enrolled in the Women's Health Initiative Study. BP was measured in-clinic at baseline and after 3 years using standardized procedures. Antihypertensive medication use was determined by drug inventory at baseline and year 3. Women self-reported incident newly diagnosed glaucoma annually. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards analyses adjusting for demographic, medical history, and lifestyle covariates. RESULTS During a mean follow-up of 4.7 years, we documented 7,514 glaucoma cases. Among women not on antihypertensive treatment, those with systolic BP ≥ 140 mm Hg or diastolic BP ≥80 mm Hg were not at higher risk of developing glaucoma (HR 0.97, 95% confidence intervals 0.88-1.08 and HR 1.00 [0.93-1.08], respectively), compared with women with a systolic BP < 120 mm Hg or a diastolic BP 60 to <80 mm Hg. Among women on antihypertensive treatment, neither systolic BP ≥ 140 mm Hg nor diastolic BP ≥80 mm Hg was associated with an increased glaucoma risk (HR 0.89 [0.79-1.00] and HR 0.97 [0.90-1.05], respectively). A diastolic BP <60 mm Hg was not associated with a higher risk compared with a diastolic BP 60 to <80 mm Hg. CONCLUSIONS BP control is not associated with an increased or decreased glaucoma risk in postmenopausal women.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
- Department of Medicine I, University of Würzburg, Würzburg, Bavaria, Germany
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathleen Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Mike LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Chris Andrews
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, NYC, NY, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye & Ear Infirmary New York, NYC, NY USA
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Settem RP, Honma K, Shankar M, Li M, LaMonte M, Xu D, Genco RJ, Browne RW, Sharma A. Tannerella forsythia-produced methylglyoxal causes accumulation of advanced glycation endproducts to trigger cytokine secretion in human monocytes. Mol Oral Microbiol 2018; 33:292-299. [PMID: 29573211 DOI: 10.1111/omi.12224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/27/2022]
Abstract
The periodontal pathogen Tannerella forsythia has the unique ability to produce methylglyoxal (MGO), an electrophilic compound which can covalently modify amino acid side chains and generate inflammatory adducts known as advanced glycation endproducts (AGEs). In periodontitis, concentrations of MGO in gingival-crevicular fluid are increased and are correlated with the T. forsythia load. However, the source of MGO and the extent to which MGO may contribute to periodontal inflammation has not been fully explored. In this study we identified a functional homolog of the enzyme methylglyoxal synthase (MgsA) involved in the production of MGO in T. forsythia. While wild-type T.forsythia produced a significant amount of MGO in the medium, a mutant lacking this homolog produced little to no MGO. Furthermore, compared with the spent medium of the T. forsythia parental strain, the spent medium of the T. forsythia mgsA-deletion strain induced significantly lower nuclear factor-kappa B activity as well as proinflammogenic and pro-osteoclastogenic cytokines from THP-1 monocytes. The ability of T. forsythia to induce protein glycation endproducts via MGO was confirmed by an electrophoresis-based collagen chain mobility shift assay. Together these data demonstrated that T. forsythia produces MGO, which may contribute to inflammation via the generation of AGEs and thus act as a potential virulence factor of the bacterium.
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Affiliation(s)
- R P Settem
- Department of Oral Biology, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - K Honma
- Department of Oral Biology, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - M Shankar
- Department of Biotechnical and Clinical Laboratory Sciences, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - M Li
- Department of Oral Biology, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - M LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - D Xu
- Department of Oral Biology, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - R J Genco
- Department of Oral Biology, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - R W Browne
- Department of Biotechnical and Clinical Laboratory Sciences, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
| | - A Sharma
- Department of Oral Biology, School of Public Health and Health Related Professions, University at Buffalo, Buffalo, NY, USA
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Stone DA, Hawke MW, LaMonte M, Kittner SJ, Acosta J, Corretti M, Sample C, Price TR, Plotnick GD. Ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic stroke: a multiplane transesophageal echocardiographic study. Am Heart J 1995; 130:105-8. [PMID: 7611098 DOI: 10.1016/0002-8703(95)90243-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.3] [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] [Indexed: 01/26/2023]
Abstract
Atherosclerotic plaque ulcers > or = 2 mm in depth and width in the thoracic aorta have been implicated by autopsy study as a cause of unexplained or cryptogenic ischemic strokes. Transesophageal echocardiography (TEE) allows visualization of complex atherosclerotic lesions of the thoracic aorta. We compared the prevalence of thoracic aorta ulcerated plaques (ulcers > or = 2 mm in both depth and width) in three age-matched groups undergoing multiplane TEE: group 1, 23 patients with cryptogenic ischemic stroke; group 2, 26 patients with known-cause strokes; and group 3, 57 control patients without strokes. TEEs were interpreted in a blinded fashion. Ulcerated plaques were found in 9 (39%) group 1 patients but in only 2 (8%) group 2 patients and in only 4 (7%) group 3 patients (p < 0.001). There was an association between advancing age and the presence of ulcerated plaques (p < 0.02). We conclude that ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic ischemic stroke and should be considered a potential source of cerebral emboli.
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Affiliation(s)
- D A Stone
- Department of Medicine, University of Maryland Hospital, Baltimore 21201-1595, USA
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