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Lovinsky-Desir S, Hirsh JA, Hoffman EA, Allen NB, Bertoni AG, Guo J, Jacobs DR, Laine AF, Malinsky D, Michos ED, Sack C, Shen W, Watson KE, Wysoczanski A, Barr RG, Smith BM. Indices of Childhood Socioeconomic Status and Dysanapsis among Older Adults: The Multi-Ethnic Study of Atherosclerosis Lung Study. Ann Am Thorac Soc 2024. [PMID: 38747708 DOI: 10.1513/annalsats.202401-006rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Affiliation(s)
| | - Jana A Hirsh
- Drexel University Dornsife School of Public Health, 37412, Epidemiology and Biostatistics, Philadelphia, Pennsylvania, United States
| | - Eric A Hoffman
- University of Iowa Carver College of Medicine, Radiology, Iowa City, Iowa, United States
| | | | - Alain G Bertoni
- Wake Forest University, Department of Epidemiology and Prevention, Winston-Salem, North Carolina, United States
| | - Junfeng Guo
- University of Iowa Carver College of Medicine, Radiology, Iowa City, Iowa, United States
| | - David R Jacobs
- University of Minnesota, Epidemiology, Minneapolis, Minnesota, United States
| | - Andrew F Laine
- Columbia University, 5798, Department of Biomedical Engineering, New York, New York, United States
| | - Daniel Malinsky
- Columbia University Mailman School of Public Health, 33638, Department of Biostatistics, New York, New York, United States
| | - Erin D Michos
- Johns Hopkins University, Medicine, Baltimore, Maryland, United States
| | | | - Wei Shen
- Columbia University Irving Medical Center, 21611, New York, New York, United States
| | - Karol E Watson
- University of California at Los Angeles, Medicine, Los Angeles, California, United States
| | | | - R Graham Barr
- Columbia University, 5798, New York, New York, United States
| | - Benjamin M Smith
- Columbia University Medical Center, Medicine, NY, New York, United States
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2
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Vameghestahbanati M, Kingdom L, Hoffman EA, Kirby M, Allen NB, Angelini E, Bertoni A, Hamid Q, Hogg JC, Jacobs DR, Laine A, Maltais F, Michos ED, Sack C, Sin D, Watson KE, Wysoczanksi A, Couper D, Cooper C, Han M, Woodruff P, Tan WC, Bourbeau J, Barr RG, Smith BM. Airway tree caliber heterogeneity and airflow obstruction among older adults. J Appl Physiol (1985) 2024; 136:1144-1156. [PMID: 38420676 DOI: 10.1152/japplphysiol.00694.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Smaller mean airway tree caliber is associated with airflow obstruction and chronic obstructive pulmonary disease (COPD). We investigated whether airway tree caliber heterogeneity was associated with airflow obstruction and COPD. Two community-based cohorts (MESA Lung, CanCOLD) and a longitudinal case-control study of COPD (SPIROMICS) performed spirometry and computed tomography measurements of airway lumen diameters at standard anatomical locations (trachea-to-subsegments) and total lung volume. Percent-predicted airway lumen diameters were calculated using sex-specific reference equations accounting for age, height, and lung volume. The association of airway tree caliber heterogeneity, quantified as the standard deviation (SD) of percent-predicted airway lumen diameters, with baseline forced expired volume in 1-second (FEV1), FEV1/forced vital capacity (FEV1/FVC) and COPD, as well as longitudinal spirometry, were assessed using regression models adjusted for age, sex, height, race-ethnicity, and mean airway tree caliber. Among 2,505 MESA Lung participants (means ± SD age: 69 ± 9 yr; 53% female, mean airway tree caliber: 99 ± 10% predicted, airway tree caliber heterogeneity: 14 ± 5%; median follow-up: 6.1 yr), participants in the highest quartile of airway tree caliber heterogeneity exhibited lower FEV1 (adjusted mean difference: -125 mL, 95%CI: -171,-79), lower FEV1/FVC (adjusted mean difference: -0.01, 95%CI: -0.02,-0.01), and higher odds of COPD (adjusted odds ratio: 1.42, 95%CI: 1.01-2.02) when compared with the lowest quartile, whereas longitudinal changes in FEV1 and FEV1/FVC did not differ significantly. Observations in CanCOLD and SPIROMICS were consistent. Among older adults, airway tree caliber heterogeneity was associated with airflow obstruction and COPD at baseline but was not associated with longitudinal changes in spirometry.NEW & NOTEWORTHY In this study, by leveraging two community-based samples and a case-control study of heavy smokers, we show that among older adults, airway tree caliber heterogeneity quantified by CT is associated with airflow obstruction and COPD independent of age, sex, height, race-ethnicity, and dysanapsis. These observations suggest that airway tree caliber heterogeneity is a structural trait associated with low baseline lung function and normal decline trajectory that is relevant to COPD.
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Affiliation(s)
| | - Leina Kingdom
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Norrina B Allen
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, United States
| | - Elsa Angelini
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Medicine, Columbia University, New York, New York, United States
| | - Alain Bertoni
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Qutayba Hamid
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
| | - Andrew Laine
- Department of Medicine, Columbia University, New York, New York, United States
| | - Francois Maltais
- Faculty of Medicine , University of Laval, Laval, Quebec, Canada
| | - Erin D Michos
- Faculty of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Don Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Artur Wysoczanksi
- Department of Medicine, Columbia University, New York, New York, United States
| | - David Couper
- Department of Biostatistics, University of North Carolina, North Carolina, United States
| | - Christopher Cooper
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Meilan Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, United States
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, New York, United States
| | - Benjamin M Smith
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Columbia University, New York, New York, United States
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Ning H, Perak AM, Siddique J, Wilkins JT, Lloyd-Jones DM, Allen NB. Association Between Life's Essential 8 Cardiovascular Health Metrics With Cardiovascular Events in the Cardiovascular Disease Lifetime Risk Pooling Project. Circ Cardiovasc Qual Outcomes 2024; 17:e010568. [PMID: 38639077 DOI: 10.1161/circoutcomes.123.010568] [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: 10/03/2023] [Accepted: 01/31/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The American Heart Association recently launched updated cardiovascular health metrics, termed Life's Essential 8 (LE8). Compared with Life's Simple 7 (LS7), the new approach added sleep health as an eighth metric and updated the remaining 7 health factors and behaviors. The association of the updated LE8 score with long-term cardiovascular disease (CVD) outcomes and death is unknown. METHODS We pooled individual-level data from 6 contemporary US-based cohorts from the Cardiovascular Lifetime Risk Pooling Project. Total LE8 score (0-100 points), LE8 score without sleep (0-100 points), and prior LS7 scores (0-14 points) were calculated separately. We used multivariable-adjusted Cox models to evaluate the association of LE8 with CVD, CVD subtypes, and all-cause mortality among younger, middle, and older adult participants. Net reclassification improvement analysis was used to measure the improvement in CVD risk classification with the addition of LS7 and LE8 recategorization based on score quartile rankings. RESULTS Our sample consisted of 32 896 US adults (7836 [23.8%] Black; 14 941 [45.4%] men) followed for 642 000 person-years, of whom 9391 developed CVD events. Each 10-point higher overall LE8 score was associated with lower risk by 22% to 40% for CVD, 24% to 43% for congenital heart disease, 17% to 34% for stroke, 23% to 38% for heart failure, and 17% to 21% for all causes of mortality events across age strata. LE8 score provided more granular differentiation of the related CVD risk than LS7. Overall, 19.5% and 15.5% of the study participants were recategorized upward and downward based on LE8 versus LS7 categories, respectively, and the recategorization was significantly associated with CVD risk in addition to LS7 score. The addition of recategorization between LE8 and LS7 categories improved CVD risk reclassification across age groups (clinical net reclassification improvement, 0.06-0.12; P<0.01). CONCLUSIONS These findings support the improved utility of the LE8 algorithm for assessing overall cardiovascular health and future CVD risk.
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Affiliation(s)
- Hongyan Ning
- Department of Preventive Medicine (H.N., A.M.P., J.S., J.T.W., D.M.L.-J., N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda M Perak
- Department of Preventive Medicine (H.N., A.M.P., J.S., J.T.W., D.M.L.-J., N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL (A.M.P.)
| | - Juned Siddique
- Department of Preventive Medicine (H.N., A.M.P., J.S., J.T.W., D.M.L.-J., N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John T Wilkins
- Department of Preventive Medicine (H.N., A.M.P., J.S., J.T.W., D.M.L.-J., N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Cardiology, Department of Medicine (J.T.W., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine (H.N., A.M.P., J.S., J.T.W., D.M.L.-J., N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Cardiology, Department of Medicine (J.T.W., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine (H.N., A.M.P., J.S., J.T.W., D.M.L.-J., N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL
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4
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An J, Fischer H, Ni L, Xia M, Choi SK, Morrissette KL, Wei R, Reynolds K, Muntner P, Safford MM, Moran AE, Bellows BK, Isasi CR, Allen NB, Xanthakis V, Colantonio LD, Zhang Y. Association Between Young Adult Characteristics and Blood Pressure Trajectories. J Am Heart Assoc 2024; 13:e033053. [PMID: 38563367 DOI: 10.1161/jaha.123.033053] [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: 10/10/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Blood pressure (BP) trajectories from young adulthood through middle age are associated with cardiovascular risk. We examined the associations of hypertension risk factors with BP trajectories among a large diverse sample. METHODS AND RESULTS We analyzed data from young adults, aged 18 to 39 years, with untreated BP <140/90 mm Hg at baseline from Kaiser Permanente Southern California (N=355 324). We used latent growth curve models to identify 10-year BP trajectories and to assess the associations between characteristics in young adulthood and BP trajectories. We identified the following 5 distinct systolic BP trajectories, which appeared to be determined mainly by the baseline BP with progressively higher BP at each year: group 1 (lowest BP trajectory, 7.9%), group 2 (26.5%), group 3 (33.0%), group 4 (25.4%), and group 5 (highest BP trajectory, 7.3%). Older age (adjusted odds ratio for 30-39 versus 18-29 years, 1.23 [95% CI, 1.18-1.28]), male sex (13.38 [95% CI, 12.80-13.99]), obesity (body mass index ≥30 versus 18.5-24.9 kg/m2, 14.81 [95% CI, 14.03-15.64]), overweight (body mass index 25-29.9 versus 18.5-24.9 kg/m2, 3.16 [95% CI, 3.00-3.33]), current smoking (1.58 [95% CI, 1.48-1.67]), prediabetes (1.21 [95% CI, 1.13-1.29]), diabetes (1.60 [95% CI, 1.41-1.81]) and high low-density lipoprotein cholesterol (≥160 versus <100 mg/dL, 1.52 [95% CI, 1.37-1.68]) were associated with the highest BP trajectory (group 5) compared with the reference group (group 2). CONCLUSIONS Traditional hypertension risk factors including smoking, diabetes, and elevated lipids were associated with BP trajectories in young adults, with obesity having the strongest association with the highest BP trajectory group.
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Affiliation(s)
- Jaejin An
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
- Department of Health Systems Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA USA
| | - Heidi Fischer
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Liang Ni
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Mengying Xia
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
| | - Soon Kyu Choi
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Kerresa L Morrissette
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Rong Wei
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Kristi Reynolds
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA
- Department of Health Systems Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA USA
| | - Paul Muntner
- Department of Epidemiology University of Alabama at Birmingham Birmingham AL USA
| | - Monika M Safford
- Division of General Internal Medicine Weill Cornell Medicine New York NY USA
| | - Andrew E Moran
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
| | - Brandon K Bellows
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY USA
| | - Norrina B Allen
- Division of Epidemiology Northwestern University Chicago IL USA
| | - Vanessa Xanthakis
- Department of Medicine Boston University Chobanian and Avedisian School of Medicine Boston MA USA
- Department of Biostatistics Boston University School of Public Health Boston MA USA
| | | | - Yiyi Zhang
- Division of General Medicine Columbia University Irving Medical Center New York NY USA
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5
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Zink J, Booker R, Wolff-Hughes DL, Allen NB, Carnethon MR, Alexandria SJ, Berrigan D. Longitudinal associations of screen time, physical activity, and sleep duration with body mass index in U.S. youth. Int J Behav Nutr Phys Act 2024; 21:35. [PMID: 38566134 PMCID: PMC10988901 DOI: 10.1186/s12966-024-01587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Youth use different forms of screen time (e.g., streaming, gaming) that may be related to body mass index (BMI). Screen time is non-independent from other behaviors, including physical activity and sleep duration. Statistical approaches such as isotemporal substitution or compositional data analysis (CoDA) can model associations between these non-independent behaviors and health outcomes. Few studies have examined different types of screen time, physical activity, and sleep duration simultaneously in relation to BMI. METHODS Data were baseline (2017-2018) and one-year follow-up (2018-2019) from the Adolescent Brain Cognitive Development Study, a multi-site study of a nationally representative sample of U.S. youth (N = 10,544, mean [SE] baseline age = 9.9 [0.03] years, 48.9% female, 45.4% non-White). Participants reported daily minutes of screen time (streaming, gaming, socializing), physical activity, and sleep. Sex-stratified models estimated the association between baseline behaviors and follow-up BMI z-score, controlling for demographic characteristics, internalizing symptoms, and BMI z-score at baseline. RESULTS In females, isotemporal substitution models estimated that replacing 30 min of socializing (β [95% CI] = -0.03 [-0.05, -0.002]), streaming (-0.03 [-0.05, -0.01]), or gaming (-0.03 [-0.06, -0.01]) with 30 min of physical activity was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing (-0.03 [-0.05, -0.01]), streaming (-0.02 [-0.03, -0.01]), or gaming (-0.02 [-0.03, -0.01]) with 30 min of sleep was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing with 30 min of gaming was associated with a lower follow-up BMI z-score (-0.01 [-0.03, -0.0001]). CoDA estimated that in males, a greater proportion of time spent in baseline socializing, relative to the remaining behaviors, was associated with a higher follow-up BMI z-score (0.05 [0.02, 0.08]). In females, no associations between screen time and BMI were observed using CoDA. CONCLUSIONS One-year longitudinal associations between screen time and BMI may depend on form of screen time, what behavior it replaces (physical activity or sleep), and participant sex. The alternative statistical approaches yielded somewhat different results. Experimental manipulation of screen time and investigation of biopsychosocial mechanisms underlying the observed sex differences will allow for causal inference and can inform interventions.
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Affiliation(s)
- Jennifer Zink
- Division of Cancer Control and Population Sciences, Behavioral Research Program, Health Behaviors Research Branch, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Robert Booker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Chicago, IL, 60611, USA
| | - Dana L Wolff-Hughes
- Division of Cancer Control and Population Sciences, Epidemiology and Genomics Research Program, Risk Factors Assessment Branch, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Chicago, IL, 60611, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Chicago, IL, 60611, USA
| | - Shaina J Alexandria
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Chicago, IL, 60611, USA
| | - David Berrigan
- Division of Cancer Control and Population Sciences, Behavioral Research Program, Health Behaviors Research Branch, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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Gupta DK, Lewis CE, Allen NB. Dietary Sodium and Blood Pressure-Reply. JAMA 2024; 331:1155-1156. [PMID: 38563837 DOI: 10.1001/jama.2024.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Deepak K Gupta
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
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Phillips AZ, Wang Y, Allen NB. Patterns of health care interactions of individuals with alcohol use disorder: A latent class analysis. J Subst Use Addict Treat 2024; 159:209251. [PMID: 38072388 PMCID: PMC11005937 DOI: 10.1016/j.josat.2023.209251] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/29/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Given the high rates at which individuals with alcohol use disorder (AUD) utilize health care for co-existing conditions, health systems are promising venues for interventions that will facilitate access to AUD treatment. However, how individuals with AUD interact with such systems and, thus, how systems should intervene is unclear. In this study, we seek to identify patterns in how individuals diagnosed with AUD within an academic health system interacted with the system prior to diagnosis. METHODS We use electronic health records from a single academic health system in a major US metropolitan area to create a deidentified retrospective cohort including all individuals age 18+ diagnosed with AUD 2010-2019 (n = 26,899). Latent class analysis (LCA) identified subgroups defined by aspects of previous system interaction and health status, including having an in-system primary care provider, previous utilization of primary and specialty care, diagnosis setting, payer, and presence of other chronic conditions. We then assessed subgroup differences in demographics and associations with in-system AUD treatment receipt in the year following diagnosis, adjusting for demographics. RESULTS The population was on average 38.6 years old (standard deviation = 15.4) and predominantly male (66.1 %), White (64.5 %), and not of Hispanic/Latino ethnicity (87.8 %). Only 4.7 % received in-system treatment following diagnosis. We deemed the four-class model the optimal LCA model. This model identified subgroups that can be described as 1) average utilization (20.7 % of population), 2) low utilization (54.5 %), 3) high health burden and low utilization (14.2 %), and 4) high health burden and high utilization (10.6 %). Predicted membership in the high health burden and high utilization subgroup and low utilization subgroup were associated with higher and lower odds of treatment receipt, respectively, compared with predicted membership in the average utilization subgroup (odds ratio (OR) for high/high subgroup = 1.21, 95 % confidence interval (CI) = 1.01, 1.27; OR for low subgroup = 0.29 95 % CI = 0.24, 0.34). CONCLUSION Individuals diagnosed with AUD within a health system interact with that system in markedly different ways and are unlikely to benefit uniformly from system-based interventions to facilitate treatment. Group-tailored interventions are more likely to have impact and provide returns on investments for systems.
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Affiliation(s)
- Aryn Z Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA; Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD 20742, USA.
| | - Yaojie Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA.
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8
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Shah NS, Huang X, Petito LC, Bancks MP, Kanaya AM, Talegawkar S, Farhan S, Carnethon MR, Lloyd-Jones DM, Allen NB, Kandula NR, Khan SS. Social and psychosocial determinants of racial and ethnic differences in cardiovascular health: The MASALA and MESA studies. Am J Prev Cardiol 2024; 17:100636. [PMID: 38322182 PMCID: PMC10844663 DOI: 10.1016/j.ajpc.2024.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/08/2024] Open
Abstract
Background Social and psychosocial determinants are associated with cardiovascular health (CVH). Objectives To quantify the contributions of social and psychosocial factors to racial/ethnic differences in CVH. Methods In the Multi-Ethnic Study of Atherosclerosis and Mediators of Atherosclerosis in South Asians Living in America cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14) in Black, Chinese, Hispanic, or South Asian compared with White participants. Results Among 7,978 adults (mean age 61 [SD 10] years, 52 % female), there were 1,892 Black (mean CVH score for decomposition analysis 7.96 [SD 2.1]), 804 Chinese (CVH 9.69 [1.8]), 1,496 Hispanic (CVH 8.00 [2.1]), 1,164 South Asian (CVH 9.16 [2.0]), and 2,622 White (CVH 8.91 [2.1]) participants. The factors that were associated with the largest magnitude of explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equal to White participants, Black participants' mean CVH score would be 0.14 [SE 0.05] points higher); place of birth for Chinese participants (if proportion of US-born and foreign-born individuals among Chinese adults were equivalent to White participants, Chinese participants' mean CVH score would be 0.22 [0.10] points lower); and education for Hispanic and South Asian participants (if educational attainment were equivalent to White participants, Hispanic and South Asian participants' mean CVH score would be 0.55 [0.11] points higher and 0.37 [0.11] points lower, respectively). Conclusions In these multiethnic US cohorts, social and psychosocial factors were associated with racial/ethnic differences in CVH.
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Affiliation(s)
- Nilay S. Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Xiaoning Huang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Alka M. Kanaya
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sameera Talegawkar
- George Washington University School of Public Health, Washington, DC, United States
| | - Saaniya Farhan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Donald M. Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Namratha R. Kandula
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Wakschlag LS, MacNeill LA, Pool LR, Smith JD, Adam H, Barch DM, Norton ES, Rogers CE, Ahuvia I, Smyser CD, Luby JL, Allen NB. Predictive Utility of Irritability "In Context": Proof-of-Principle for an Early Childhood Mental Health Risk Calculator. J Clin Child Adolesc Psychol 2024; 53:231-245. [PMID: 36975800 PMCID: PMC10533737 DOI: 10.1080/15374416.2023.2188553] [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] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE We provide proof-of-principle for a mental health risk calculator advancing clinical utility of the irritability construct for identification of young children at high risk for common, early onsetting syndromes. METHOD Data were harmonized from two longitudinal early childhood subsamples (total N = 403; 50.1% Male; 66.7% Nonwhite; Mage = 4.3 years). The independent subsamples were clinically enriched via disruptive behavior and violence (Subsample 1) and depression (Subsample 2). In longitudinal models, epidemiologic risk prediction methods for risk calculators were applied to test the utility of the transdiagnostic indicator, early childhood irritability, in the context of other developmental and social-ecological indicators to predict risk of internalizing/externalizing disorders at preadolescence (Mage = 9.9 years). Predictors were retained when they improved model discrimination (area under the receiver operating characteristic curve [AUC] and integrated discrimination index [IDI]) beyond the base demographic model. RESULTS Compared to the base model, the addition of early childhood irritability and adverse childhood experiences significantly improved the AUC (0.765) and IDI slope (0.192). Overall, 23% of preschoolers went on to develop a preadolescent internalizing/externalizing disorder. For preschoolers with both elevated irritability and adverse childhood experiences, the likelihood of an internalizing/externalizing disorder was 39-66%. CONCLUSIONS Predictive analytic tools enable personalized prediction of psychopathological risk for irritable young children, holding transformative potential for clinical translation.
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Affiliation(s)
- Lauren S. Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Leigha A. MacNeill
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Lindsay R. Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin D. Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT
| | - Hubert Adam
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Deanna M. Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Elizabeth S. Norton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cynthia E. Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Isaac Ahuvia
- Department of Clinical Psychology, Stony Brook University, Stony Brook, NY
| | - Christopher D. Smyser
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Joan L. Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Norrina B. Allen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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10
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Osibogun O, Ogunmoroti O, Turkson-Ocran RA, Okunrintemi V, Kershaw KN, Allen NB, Michos ED. Financial strain is associated with poorer cardiovascular health: The multi-ethnic study of atherosclerosis. Am J Prev Cardiol 2024; 17:100640. [PMID: 38419947 PMCID: PMC10899015 DOI: 10.1016/j.ajpc.2024.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Psychosocial stress is associated with increased cardiovascular disease (CVD) risk. The relationship between financial strain, a toxic form of psychosocial stress, and ideal cardiovascular health (CVH) is not well established. We examined whether financial strain was associated with poorer CVH in a multi-ethnic cohort free of CVD at baseline. Methods This was a cross-sectional analysis of 6,453 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis. Financial strain was assessed by questionnaire and responses were categorized as yes or no. CVH was measured from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood glucose and blood pressure). A CVH score of 14 was calculated by assigning points to the categories of each metric (poor = 0 points, intermediate = 1 point, ideal = 2 points). Multinomial logistic regression was used to examine the association of financial strain with the CVH score (inadequate 0-8, average 9-10, and optimal 11-14 points) adjusting for sociodemographic factors, depression and anxiety. Results The mean age (SD) was 62 (10) and 53 % were women. Financial strain was reported by 25 % of participants. Participants who reported financial strain had lower odds of average (OR, 0.82 [95 % CI, 0.71, 0.94]) and optimal (0.73 [0.62, 0.87]) CVH scores. However, in the fully adjusted model, the association was only significant for optimal CVH scores (0.81, [0.68, 0.97]). Conclusion Financial strain was associated with poorer CVH. More research is needed to understand this relationship so the burden of CVD can be decreased, particularly among people experiencing financial hardship.
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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, USA
| | - Oluseye Ogunmoroti
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Victor Okunrintemi
- Division of Cardiovascular Disease, Houston Methodist Hospital, Houston, TX, USA
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B. Allen
- Division of Cardiovascular Disease, Houston Methodist Hospital, Houston, TX, USA
| | - Erin D. Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Ware L, Vermeulen B, Maposa I, Flood D, Brant LC, Khandelwal S, Singh K, Soares S, Jessen N, Perman G, Riaz BK, Sachdev HS, Allen NB, Labarthe DR. Comparison of Cardiovascular Health Profiles Across Population Surveys From 5 High- to Low-Income Countries. CJC Open 2024; 6:582-596. [PMID: 38559335 PMCID: PMC10980894 DOI: 10.1016/j.cjco.2023.11.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Abstract
Background To facilitate the shift from risk-factor management to primordial prevention of cardiovascular disease, the American Heart Association developed guidelines to score and track cardiovascular health (CVH). How the prevalence and trajectories of a high level of CVH across the life course compare among high- and lower-income countries is unknown. Methods Nationally representative survey data with CVH variables (physical activity, cigarette smoking, body mass index, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the US for adults (aged 18-69 years and not pregnant). Data were harmonized, and CVH metrics were scored using the American Heart Association guidelines, as high (2), moderate (1), or low (0), with the prevalence of high scores (better CVH) across the life course compared across countries. Results Among 28,092 adults (Ethiopia n = 7686, 55.2% male; Bangladesh n = 6731, 48.4% male; Brazil n = 7241, 47.9% male; England n = 2691, 49.5% male, and the US n = 3743, 50.3% male), the prevalence of high CVH scores decreased as country income level increased. Declining CVH with age was universal across countries, but differences were already observable in those aged 18 years. Excess body weight appeared to be the main driver of poor CVH in higher-income countries, and the prevalence of current smoking was highest in Bangladesh. Conclusions Our findings suggest that CVH decline with age may be universal. Interventions to promote and preserve CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where the level of CVH remains relatively high, protection of whole societies from risk-factor epidemics may still be feasible.
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Affiliation(s)
- Lisa Ware
- South African Medical Research Council Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bridget Vermeulen
- South African Medical Research Council Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luisa C.C. Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Sara Soares
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Public Health (ITR), University of Porto, Porto, Portugal
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit of the Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Gastón Perman
- Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Baizid Khoorshid Riaz
- National Institute of Preventive & Social Medicine (NIPSOM), Ministry of Health & Family Welfare, Mohakhali, Dhaka, Bangladesh
| | | | - Norrina B. Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Darwin R. Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
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12
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Kim JS, Sun Y, Balte P, Cushman M, Boyle R, Tracy RP, Styer LM, Bell TD, Anderson MR, Allen NB, Schreiner PJ, Bowler RP, Schwartz DA, Lee JS, Xanthakis V, Doyle MF, Regan EA, Make BJ, Kanaya AM, Wenzel SE, Coresh J, Isasi CR, Raffield LM, Elkind MSV, Howard VJ, Ortega VE, Woodruff P, Cole SA, Henderson JM, Mantis NJ, Parker MM, Demmer RT, Oelsner EC. Demographic and Clinical Factors Associated With SARS-CoV-2 Spike 1 Antibody Response Among Vaccinated US Adults: the C4R Study. Nat Commun 2024; 15:1492. [PMID: 38374032 PMCID: PMC10876680 DOI: 10.1038/s41467-024-45468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
This study investigates correlates of anti-S1 antibody response following COVID-19 vaccination in a U.S. population-based meta-cohort of adults participating in longstanding NIH-funded cohort studies. Anti-S1 antibodies were measured from dried blood spots collected between February 2021-August 2022 using Luminex-based microsphere immunoassays. Of 6245 participants, mean age was 73 years (range, 21-100), 58% were female, and 76% were non-Hispanic White. Nearly 52% of participants received the BNT162b2 vaccine and 48% received the mRNA-1273 vaccine. Lower anti-S1 antibody levels are associated with age of 65 years or older, male sex, higher body mass index, smoking, diabetes, COPD and receipt of BNT16b2 vaccine (vs mRNA-1273). Participants with a prior infection, particularly those with a history of hospitalized illness, have higher anti-S1 antibody levels. These results suggest that adults with certain socio-demographic and clinical characteristics may have less robust antibody responses to COVID-19 vaccination and could be prioritized for more frequent re-vaccination.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Yifei Sun
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Pallavi Balte
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Rebekah Boyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Linda M Styer
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Taison D Bell
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - David A Schwartz
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joyce S Lee
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vanessa Xanthakis
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Margaret F Doyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sally E Wenzel
- Department of Medicine, Department of Immunology, and Department of Environmental Medicine and Occupational Health, University of Pittsburgh School of Medicine, School of Public Health, Pittsburgh, PA, USA
| | - Josef Coresh
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor E Ortega
- Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Joel M Henderson
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Nicholas J Mantis
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA
| | - Monica M Parker
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Division of Epidemiology, Department of Quantitative Health Sciences, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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13
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Buschur KL, Pottinger TD, Vogel-Claussen J, Powell CA, Aguet F, Allen NB, Ardlie K, Bluemke DA, Durda P, Hermann EA, Hoffman EA, Lima JAC, Liu Y, Malinsky D, Manichaikul A, Motahari A, Post WS, Prince MR, Rich SS, Rotter JI, Smith BM, Tracy RP, Watson K, Winther HB, Lappalainen T, Barr RG. Peripheral Blood Mononuclear Cell Gene Expression Associated with Pulmonary Microvascular Perfusion: The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease Study. Ann Am Thorac Soc 2024. [PMID: 38335160 DOI: 10.1513/annalsats.202305-417oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
Rationale Chronic obstructive pulmonary disease (COPD) and emphysema are associated with endothelial damage and altered pulmonary microvascular perfusion. Molecular mechanisms underlying these changes are poorly understood in patients due, in part, to the inaccessibility of the pulmonary vasculature. Peripheral blood mononuclear cells (PBMC) interact with the pulmonary endothelium. Objective To test the association between gene expression in PBMCs and pulmonary microvascular perfusion in COPD. Methods The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited two independent samples of COPD cases and controls with 10 or more pack-years. In both samples, pulmonary microvascular blood flow, pulmonary microvascular blood volume (PMBV), and mean transit time were assessed on contrast-enhanced MRI, and PBMC gene expression was assessed by microarray. Additional replication was performed in a third sample with PMBV measures on contrast-enhanced, dual-energy CT. Differential expression analyses were adjusted for age, gender, race-ethnicity, educational attainment, height, weight, smoking status, and pack-years. Results The 79 participants in the discovery sample had mean age of 69±6 years, 44% were female, 25% were non-white, 34% were current smokers and 66% had COPD. There were large PBMC gene expression signatures associated with pulmonary microvascular perfusion traits, with several replicated in the replication sets with MRI (n=47) or dual-energy CT scan (n=157) measures. Many of the identified genes are involved in inflammatory processes, including NF-κB and chemokine signaling pathways. Conclusions PBMC gene expression in NF-κB, inflammatory and chemokine signaling pathways was associated pulmonary microvascular perfusion in COPD, potentially offering new targetable candidates for novel therapies.
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Affiliation(s)
- Kristina L Buschur
- Columbia University Medical Center, 21611, Department of Medicine, New York, New York, United States
- New York Genome Center, 377591, New York, New York, United States;
| | - Tess D Pottinger
- Columbia University Medical Center, 21611, Department of Medicine, New York, New York, United States
| | - Jens Vogel-Claussen
- Hannover Medical School, 9177, Department of Diagnostic and Interventional Radiology, Hannover, Niedersachsen, Germany
- Johns Hopkins University School of Medicine, 1500, Department of Radiology, Baltimore, Maryland, United States
| | - Charles A Powell
- Mount Sinai Medical Center, 5944, Department of Medicine, New York, New York, United States
| | - Francois Aguet
- Broad Institute, 33577, Cambridge, Massachusetts, United States
| | - Norrina B Allen
- Northwestern University, 3270, Department of Preventive Medicine, Evanston, Illinois, United States
| | - Kristin Ardlie
- Broad Institute, 33577, Cambridge, Massachusetts, United States
| | - David A Bluemke
- University of Wisconsin-Madison School of Medicine and Public Health, 5232, Department of Radiology, Madison, Wisconsin, United States
| | - Peter Durda
- University of Vermont, Department of Pathology and Laboratory Medicine, Burlington, Vermont, United States
| | - Emilia A Hermann
- Columbia University Medical Center, 21611, Department of Medicine, New York, New York, United States
| | - Eric A Hoffman
- University of Iowa Carver College of Medicine, Radiology, Iowa City, Iowa, United States
| | - João A C Lima
- Johns Hopkins University, Medicine/Division of Cardiology, Baltimore, United States
| | - Yongmei Liu
- Duke University School of Medicine, 12277, Medicine, Durham, North Carolina, United States
| | - Daniel Malinsky
- Columbia University Mailman School of Public Health, 33638, Department of Biostatistics, New York, New York, United States
| | - Ani Manichaikul
- University of Virginia, 2358, Center for Public Health Genomics, Charlottesville, Virginia, United States
| | - Amin Motahari
- University of Iowa, 4083, Radiology, Iowa City, Iowa, United States
| | - Wendy S Post
- Johns Hopkins University, Medicine, Baltimore, Maryland, United States
| | - Martin R Prince
- Columbia University Medical Center, 21611, Department of Radiology, New York, New York, United States
| | - Stephen S Rich
- University of Virginia, 2358, Center for Public Health Genomics, Charlottesville, Virginia, United States
| | - Jerome I Rotter
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 11The Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Torrance, California, United States
| | - Benjamin M Smith
- Columbia University Medical Center, Department of Medicine, NY, New York, United States
- McGill University Health Centre, 54473, Research Institute, Montreal, Quebec, Canada
| | - Russell P Tracy
- University of Vermont, Pathology, Burlington , Vermont, United States
| | - Karol Watson
- University of California at Los Angeles, Medicine, Los Angeles, California, United States
| | - Hinrich B Winther
- Hannover Medical School, 9177, Department of Diagnostic and Interventional Radiology, Hannover, Niedersachsen, Germany
| | - Tuuli Lappalainen
- New York Genome Center, 377591, New York, New York, United States
- Columbia University, 5798, Systems Biology, New York, New York, United States
- KTH Royal Institute of Technology, 7655, Department of Gene Technology, Stockholm, Stockholm, Sweden
| | - R Graham Barr
- Columbia University Medical Center, 21611, Department of Medicine, New York, New York, United States
- Columbia University Medical Center, 21611, Department of Epidemiology, New York, New York, United States
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14
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Petito LC, McCabe ME, Pool LR, Krefman AE, Perak AM, Marino BS, Juonala M, Kähönen M, Lehtimäki T, Bazzano LA, Liu L, Pahkala K, Laitinen TT, Raitakari OT, Gooding HC, Daniels SR, Skinner AC, Greenland P, Davis MM, Wakschlag LS, Van Horn L, Hou L, Lloyd-Jones DM, Labarthe DR, Allen NB. A Proposed Pediatric Clinical Cardiovascular Health Reference Standard. Am J Prev Med 2024; 66:216-225. [PMID: 37751803 DOI: 10.1016/j.amepre.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Clinical cardiovascular health is a construct that includes 4 health factors-systolic and diastolic blood pressure, fasting glucose, total cholesterol, and body mass index-which together provide an evidence-based, more holistic view of cardiovascular health risk in adults than each component separately. Currently, no pediatric version of this construct exists. This study sought to develop sex-specific charts of clinical cardiovascular health for age to describe current patterns of clinical cardiovascular health throughout childhood. METHODS Data were used from children and adolescents aged 8-19 years in six pooled childhood cohorts (19,261 participants, collected between 1972 and 2010) to create reference standards for fasting glucose and total cholesterol. Using the models for glucose and cholesterol as well as previously published reference standards for body mass index and blood pressure, clinical cardiovascular health charts were developed. All models were estimated using sex-specific random-effects linear regression, and modeling was performed during 2020-2022. RESULTS Models were created to generate charts with smoothed means, percentiles, and standard deviations of clinical cardiovascular health for each year of childhood. For example, a 10-year-old girl with a body mass index of 16 kg/m2 (30th percentile), blood pressure of 100/60 mm Hg (46th/50th), glucose of 80 mg/dL (31st), and total cholesterol of 160 mg/dL (46th) (lower implies better) would have a clinical cardiovascular health percentile of 62 (higher implies better). CONCLUSIONS Clinical cardiovascular health charts based on pediatric data offer a standardized approach to express clinical cardiovascular health as an age- and sex-standardized percentile for clinicians to assess cardiovascular health in childhood to consider preventive approaches at early ages and proactively optimize lifetime trajectories of cardiovascular health.
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Affiliation(s)
- Lucia C Petito
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
| | - Megan E McCabe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Lindsay R Pool
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Amy E Krefman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Amanda M Perak
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
| | - Bradley S Marino
- Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center-Tampere - FCRCT, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Finnish Cardiovascular Research Center-Tampere - FCRCT, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lydia A Bazzano
- Department of Epidemiology, School of Public Health & Tropical Medicine, Tulane University, New Orleans, Los Angeles
| | - Lei Liu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Tomi T Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Holly C Gooding
- Division of General Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Philip Greenland
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Matthew M Davis
- Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
| | - Darwin R Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
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Krefman AE, Stephen J, Carolan P, Sedaghat S, Mansolf M, Soumare A, Gross AL, Aiello AE, Singh-Manoux A, Ikram MA, Helmer C, Tzourio C, Satizabal C, Levine DA, Lloyd-Jones D, Briceño EM, Sorond FA, Wolters FJ, Himali J, Launer LJ, Zhao L, Haan M, Lopez OL, Debette S, Seshadri S, Judd SE, Hughes TM, Gudnason V, Scholtens D, Allen NB. Cohort Profile: Dementia Risk Prediction Project (DRPP). Int J Epidemiol 2024; 53:dyae012. [PMID: 38339864 PMCID: PMC10858348 DOI: 10.1093/ije/dyae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Stephen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Padraig Carolan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aïcha Soumare
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison E Aiello
- Robert N Butler Columbia Aging Center and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Claudia Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily M Briceño
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Farzaneh A Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Departments of Radiology & Nuclear Medicine, and Alzheimer Centre Erasmus MC, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jayandra Himali
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Oscar L Lopez
- Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stéphanie Debette
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy M Hughes
- Departments of Internal Medicine and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sakhuja S, Jaeger BC, Yano Y, Shimbo D, Lewis CE, Clark Iii D, Tajeu GS, Hardy ST, Allen NB, Shikany JM, Schwartz JE, Viera AJ, Muntner P. Race differences in ambulatory blood pressure monitoring parameters. Blood Press Monit 2024; 29:23-30. [PMID: 37889596 DOI: 10.1097/mbp.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Mean systolic and diastolic blood pressure (SBP and DBP) on ambulatory blood pressure (BP) monitoring (ABPM) are higher among Black compared with White adults. With 48 to 72 BP measurements obtained over 24 h, ABPM can generate parameters other than mean BP that are associated with increased risk for cardiovascular events. There are few data on race differences in ABPM parameters other than mean BP. METHODS To estimate differences between White and Black participants in ABPM parameters, we used pooled data from five US-based studies in which participants completed ABPM (n = 2580). We calculated measures of SBP and DBP level, including mean, load, peak, and measures of SBP and DBP variability, including average real variability (ARV) and peak increase. RESULTS There were 1513 (58.6%) Black and 1067 (41.4%) White participants with mean ages of 56.1 and 49.0 years, respectively. After multivariable adjustment, asleep SBP and DBP load were 5.7% (95% CI: 3.5-7.9%) and 2.7% (95% CI: 1.1-4.3%) higher, respectively, among Black compared with White participants. Black compared with White participants also had higher awake DBP ARV (0.3 [95%CI: 0.0-0.6] mmHg) and peak increase in DBP (0.4 [95% CI: 0.0-0.8] mmHg). There was no evidence of Black:White differences in awake measures of SBP level, asleep peak SBP or DBP, awake and asleep measures of SBP variability or asleep measures of DBP variability after multivariable adjustment. CONCLUSION Asleep SBP load, awake DBP ARV and peak increase in awake DBP were higher in Black compared to White participants, independent of mean BP on ABPM.
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Affiliation(s)
- Swati Sakhuja
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Byron C Jaeger
- Wake Forest University School of Medicine, Winston-Salem
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | | | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Shakia T Hardy
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Joseph E Schwartz
- Columbia University, New York, New York
- Stony Brook University, Stony Brook, New York, USA
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, Alabama
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Yu J, Yang X, Deng Y, Krefman AE, Pool LR, Zhao L, Mi X, Ning H, Wilkins J, Lloyd-Jones DM, Petito LC, Allen NB. Incorporating longitudinal history of risk factors into atherosclerotic cardiovascular disease risk prediction using deep learning. Sci Rep 2024; 14:2554. [PMID: 38296982 PMCID: PMC10830564 DOI: 10.1038/s41598-024-51685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
It is increasingly clear that longitudinal risk factor levels and trajectories are related to risk for atherosclerotic cardiovascular disease (ASCVD) above and beyond single measures. Currently used in clinical care, the Pooled Cohort Equations (PCE) are based on regression methods that predict ASCVD risk based on cross-sectional risk factor levels. Deep learning (DL) models have been developed to incorporate longitudinal data for risk prediction but its benefit for ASCVD risk prediction relative to the traditional Pooled Cohort Equations (PCE) remain unknown. Our study included 15,565 participants from four cardiovascular disease cohorts free of baseline ASCVD who were followed for adjudicated ASCVD. Ten-year ASCVD risk was calculated in the training set using our benchmark, the PCE, and a longitudinal DL model, Dynamic-DeepHit. Predictors included those incorporated in the PCE: sex, race, age, total cholesterol, high density lipid cholesterol, systolic and diastolic blood pressure, diabetes, hypertension treatment and smoking. The discrimination and calibration performance of the two models were evaluated in an overall hold-out testing dataset. Of the 15,565 participants in our dataset, 2170 (13.9%) developed ASCVD. The performance of the longitudinal DL model that incorporated 8 years of longitudinal risk factor data improved upon that of the PCE [AUROC: 0.815 (CI 0.782-0.844) vs 0.792 (CI 0.760-0.825)] and the net reclassification index was 0.385. The brier score for the DL model was 0.0514 compared with 0.0542 in the PCE. Incorporating longitudinal risk factors in ASCVD risk prediction using DL can improve model discrimination and calibration.
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Affiliation(s)
- Jingzhi Yu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Xiaoyun Yang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yu Deng
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy E Krefman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lindsay R Pool
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Xinlei Mi
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hongyan Ning
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John Wilkins
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lucia C Petito
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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18
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Magnani JW, Ning H, Wilkins JT, Lloyd-Jones DM, Allen NB. Educational Attainment and Lifetime Risk of Cardiovascular Disease. JAMA Cardiol 2024; 9:45-54. [PMID: 37910110 PMCID: PMC10620672 DOI: 10.1001/jamacardio.2023.3990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
Importance Education is a social determinant of health. Quantifying its association with lifetime cardiovascular disease (CVD) risk has public health importance. Objective To calculate lifetime risk estimates of incident CVD and CVD subtypes and estimate years lived with and without CVD by education. Design, Setting, and Participants Included community-based cohort studies with adjudicated cardiovascular events used pooled individual-level data from 1985 to 2015 of 6 prospective cohort studies. The study team assessed the association between education and lifetime CVD risk with modified Kaplan-Meier and Cox models accounting for competing risk of noncardiovascular death. The study team estimated years lived with and without CVD by education with the Irwin restricted mean and the utility of adding educational attainment to CVD risk assessment. Participants (baseline 40 to 59 years old and 60 to 79 years old) were without CVD at baseline and had complete education, cardiovascular risk factors, and prospective CVD outcomes data. Data were analyzed from January 2022 to September 2022. Exposures Educational attainment (less than high school, high school completion, some college, or college graduate). Main outcome and measures Cardiovascular events (fatal and nonfatal coronary heart disease, heart failure, and stroke; CVD-related deaths; and total CVD encompassing any of these events). Results There were 40 998 participants (23 305 female [56.2%]) with a mean (SD) age of 58.1 (9.7) years for males and 58.3 (9.9) years for females. Compared with college graduates, those with less than high school or high school completion had higher lifetime CVD risks. Among middle-aged men, the competing hazard ratios (HRs) for a CVD event were 1.58 (95% CI, 1.38-1.80), 1.30 (95% CI, 1.10-1.46), and 1.16 (95% CI, 1.00-1.34) in those with less than high school, high school, and some college, respectively, compared with those with college completion. Among women, these competing HRs were 1.70 (95% CI, 1.49-1.95), 1.19 (95% CI, 1.05-1.35), and 0.98 (95% CI, 0.83-1.15). Individuals with higher education had longer duration of life prior to incident CVD. Education provided limited contribution toward enhancing CVD risk prediction. Conclusions and relevance Lower education was associated with lifetime CVD risk across adulthood; higher education translated to healthy longevity. Educational policy initiatives may associate with long-term health benefits.
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Affiliation(s)
- Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T. Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Bowling CB, Faldowski RA, Sloane R, Pieper C, Brown TH, Dooley EE, Burrows BT, Allen NB, Gabriel KP, Lewis CE. Multimorbidity trajectories in early adulthood and middle age: Findings from the CARDIA prospective cohort study. J Multimorb Comorb 2024; 14:26335565241242277. [PMID: 38586603 PMCID: PMC10998492 DOI: 10.1177/26335565241242277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
Background Multimorbidity research has focused on the prevalence and consequences of multimorbidity in older populations. Less is known about the accumulation of chronic conditions earlier in the life course. Methods We identified patterns of longitudinal multimorbidity accumulation using 30 years of data from in-person exams, annual follow-ups, and adjudicated end-points among 4,945 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Chronic conditions included arthritis, asthma, atrial fibrillation, cancer, end stage renal disease, chronic obstructive pulmonary disease, coronary heart disease, diabetes, heart failure, hyperlipidemia, hypertension, and stroke. Trajectory patterns were identified using latent class growth curve models. Results Mean age (SD) at baseline (1985-6) was 24.9 (3.6), 55% were female, and 51% were Black. The median follow-up was 30 years (interquartile range 25-30). We identified six trajectory classes characterized by when conditions began to accumulate and the rapidity of accumulation: (1) early-fifties, slow, (2) mid-forties, fast, (3) mid-thirties, fast, (4) late-twenties, slow, (5) mid-twenties, slow, and (6) mid-twenties, fast. Compared with participants in the early-fifties, slow trajectory class, participants in mid-twenties, fast were more likely to be female, Black, and currently smoking and had a higher baseline mean waist circumference (83.6 vs. 75.6 cm) and BMI (27.0 vs. 23.4 kg/m2) and lower baseline physical activity (414.1 vs. 442.4 exercise units). Conclusions A life course approach that recognizes the heterogeneity in patterns of accumulation of chronic conditions from early adulthood into middle age could be helpful for identifying high risk subgroups and developing approaches to delay multimorbidity progression.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Richard A Faldowski
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Richard Sloane
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Carl Pieper
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Tyson H Brown
- Department of Sociology, Duke University, Durham NC, USA
| | - Erin E Dooley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brett T Burrows
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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20
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Ajibewa TA, Kershaw KN, Carr JJ, Terry JG, Gabriel KP, Carnethon MR, Wong M, Allen NB. Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study. Am J Prev Med 2023:S0749-3797(23)00516-0. [PMID: 38143043 DOI: 10.1016/j.amepre.2023.12.015] [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: 08/11/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Higher levels of perceived stress are associated with adverse cardiovascular health. It is plausible that these associations are attenuated among individuals with positive psychological factors such as social support and health-enhancing behaviors. Therefore, this study examined longitudinal associations of chronic stress with cardiovascular disease (CVD) events, and whether social support and physical activity (PA) modify these associations. METHODS Data from 3,401 adults (mean age 40.2 years; 46.7% Black; 56.2% women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, with no prior CVD event in 2000-2001 were analyzed. Chronic stress lasting ≥6 months across 5 life domains (work, financial, relationships, health of self, and health of close other) was self-reported. Adjudicated CVD events (fatal/or nonfatal CVD event) were ascertained yearly through 2020. PA and social support were self-reported via questionnaires. Statistical analyses were conducted in 2023 using multivariable stepwise Accelerated Failure Time analysis to assess associations between key study variables. RESULTS The mean chronic stress score was 1.30±1.33 stressors and, by 2020, 220 participants had experienced a CVD event. Chronic stress was associated with lowered survival (time ratio: 0.92; 95% CI: 0.854-0.989), when adjusted for sociodemographic and lifestyle variables but no longer significant when adjusting for clinical factors. Neither PA nor social support were significant modifiers (all ps>0.05). CONCLUSIONS Chronic stress was associated with the risk of having a CVD event among middle-aged adults, due at least in part to clinical mediators. Studies should continue exploring positive psychosocial and behavioral factors that may modify this association.
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Affiliation(s)
| | - Kiarri N Kershaw
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J Jeffrey Carr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - James G Terry
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Mandy Wong
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Norrina B Allen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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21
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Gupta DK, Lewis CE, Varady KA, Su YR, Madhur MS, Lackland DT, Reis JP, Wang TJ, Lloyd-Jones DM, Allen NB. Effect of Dietary Sodium on Blood Pressure: A Crossover Trial. JAMA 2023; 330:2258-2266. [PMID: 37950918 PMCID: PMC10640704 DOI: 10.1001/jama.2023.23651] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/29/2023] [Indexed: 11/13/2023]
Abstract
Importance Dietary sodium recommendations are debated partly due to variable blood pressure (BP) response to sodium intake. Furthermore, the BP effect of dietary sodium among individuals taking antihypertensive medications is understudied. Objectives To examine the distribution of within-individual BP response to dietary sodium, the difference in BP between individuals allocated to consume a high- or low-sodium diet first, and whether these varied according to baseline BP and antihypertensive medication use. Design, Setting, and Participants Prospectively allocated diet order with crossover in community-based participants enrolled between April 2021 and February 2023 in 2 US cities. A total of 213 individuals aged 50 to 75 years, including those with normotension (25%), controlled hypertension (20%), uncontrolled hypertension (31%), and untreated hypertension (25%), attended a baseline visit while consuming their usual diet, then completed 1-week high- and low-sodium diets. Intervention High-sodium (approximately 2200 mg sodium added daily to usual diet) and low-sodium (approximately 500 mg daily total) diets. Main Outcomes and Measures Average 24-hour ambulatory systolic and diastolic BP, mean arterial pressure, and pulse pressure. Results Among the 213 participants who completed both high- and low-sodium diet visits, the median age was 61 years, 65% were female and 64% were Black. While consuming usual, high-sodium, and low-sodium diets, participants' median systolic BP measures were 125, 126, and 119 mm Hg, respectively. The median within-individual change in mean arterial pressure between high- and low-sodium diets was 4 mm Hg (IQR, 0-8 mm Hg; P < .001), which did not significantly differ by hypertension status. Compared with the high-sodium diet, the low-sodium diet induced a decline in mean arterial pressure in 73.4% of individuals. The commonly used threshold of a 5 mm Hg or greater decline in mean arterial pressure between a high-sodium and a low-sodium diet classified 46% of individuals as "salt sensitive." At the end of the first dietary intervention week, the mean systolic BP difference between individuals allocated to a high-sodium vs a low-sodium diet was 8 mm Hg (95% CI, 4-11 mm Hg; P < .001), which was mostly similar across subgroups of age, sex, race, hypertension, baseline BP, diabetes, and body mass index. Adverse events were mild, reported by 9.9% and 8.0% of individuals while consuming the high- and low-sodium diets, respectively. Conclusions and Relevance Dietary sodium reduction significantly lowered BP in the majority of middle-aged to elderly adults. The decline in BP from a high- to low-sodium diet was independent of hypertension status and antihypertensive medication use, was generally consistent across subgroups, and did not result in excess adverse events. Trial Registration ClinicalTrials.gov Identifier: NCT04258332.
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Affiliation(s)
- Deepak K. Gupta
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | - Krista A. Varady
- Department of Kinesiology and Nutrition, University of Illinois–Chicago
| | - Yan Ru Su
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Meena S. Madhur
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Clinical Pharmacology, Indiana University, Indianapolis
| | - Daniel T. Lackland
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston
| | - Jared P. Reis
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Thomas J. Wang
- Department of Medicine, University of Texas–Southwestern Medical Center, Dallas
| | | | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
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22
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Chirinos DA, Kershaw KN, Allen NB, Carroll AJ, Lewis TT, Schreiner PJ, Lewis CE, Kiefe CI, Mezuk B, Carnethon MR. Depressive Symptom Subgroups and Their Association with Prevalent and Incident Cardiovascular Risk Factors in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Int J Behav Med 2023; 30:891-903. [PMID: 36670342 DOI: 10.1007/s12529-022-10144-z] [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] [Accepted: 12/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND We sought to identify depressive symptom subgroups in a community sample of young adults, investigate their stability over time, and determine their association with prevalent and incident cardiovascular disease (CVD) risk factors. METHOD Participants were 3377 adults from the Coronary Artery Risk Development in Young Adults study. Using latent class and latent transition analysis, we derived subgroups based on items of the 20-item version of the Center for Epidemiologic Studies Depression Scale in 1990, and examined patterns of change over a 10-year period (1990-2000). Cox regression models were used to examine associations between subgroup membership and prevalent (2000) and incident (2000 to 2016) obesity, hypertension, and diabetes. RESULTS Three baseline subgroups were identified and labeled: "No Symptoms" (63.5%), "Lack of Positive Affect" (PA, 25.6%), and "Depressed Mood" (10.9%). At 10-year follow-up, individuals in "No Symptoms" subgroup had the highest probability (0.84) of being classified within the same subgroup. Participants classified as "Lack of PA" were likely (0.46) to remain in the same subgroup or be classified as "No Symptoms." Participants in the "Depressed Mood" were most likely to transition to the "Lack of PA" subgroup (0.38). Overall, 30.5% of participants transitioned between subgroups, with 11.4% classified as "Worsening" and 19.1% as "Improving." Relative to the "No Symptoms Stable," other subgroups ("Depressed Stable," "Worsening," and "Improving") were associated with prevalent obesity and hypertension. CONCLUSION We identified distinct depressive symptom subgroups that are variably stable over time, and their change patterns were differentially associated with CVD risk factor prevalence.
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Affiliation(s)
- Diana A Chirinos
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Allison J Carroll
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Cora E Lewis
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
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Khan SS, Vaughan AS, Harrington K, Seegmiller L, Huang X, Pool LR, Davis MM, Allen NB, Capewell S, O’Flaherty M, Miller GE, Mehran R, Vogel B, Kershaw KN, Lloyd-Jones DM, Grobman WA. US County-Level Variation in Preterm Birth Rates, 2007-2019. JAMA Netw Open 2023; 6:e2346864. [PMID: 38064212 PMCID: PMC10709777 DOI: 10.1001/jamanetworkopen.2023.46864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Preterm birth is a leading cause of preventable neonatal morbidity and mortality. Preterm birth rates at the national level may mask important geographic variation in rates and trends at the county level. Objective To estimate age-standardized preterm birth rates by US county from 2007 to 2019. Design, Setting, and Participants This serial cross-sectional study used data from the National Center for Health Statistics composed of all live births in the US between 2007 and 2019. Data analyses were performed between March 22, 2022, and September 29, 2022. Main Outcomes and Measures Age-standardized preterm birth (<37 weeks' gestation) and secondarily early preterm birth (<34 weeks' gestation) rates by county and year calculated with a validated small area estimation model (hierarchical bayesian spatiotemporal model) and percent change in preterm birth rates using log-linear regression models. Results Between 2007 and 2019, there were 51 044 482 live births in 2383 counties. In 2007, the national age-standardized preterm birth rate was 12.6 (95% CI, 12.6-12.7) per 100 live births. Preterm birth rates varied significantly among counties, with an absolute difference between the 90th and 10th percentile counties of 6.4 (95% CI, 6.2-6.7). The gap between the highest and lowest counties for preterm births was 20.7 per 100 live births in 2007. Several counties in the Southeast consistently had the highest preterm birth rates compared with counties in California and New England, which had the lowest preterm birth rates. Although there was no statistically significant change in preterm birth rates between 2007 and 2019 at the national level (percent change, -5.0%; 95% CI, -10.7% to 0.9%), increases occurred in 15.4% (95% CI, 14.1%-16.9%) of counties. The absolute and relative geographic inequalities were similar across all maternal age groups. Higher quartile of the Social Vulnerability Index was associated with higher preterm birth rates (quartile 4 vs quartile 1 risk ratio, 1.34; 95% CI, 1.31-1.36), which persisted across the study period. Similar patterns were observed for early preterm birth rates. Conclusions and Relevance In this serial cross-sectional study of county-level preterm and early preterm birth rates, substantial geographic disparities were observed, which were associated with place-based social disadvantage. Stability in aggregated rates of preterm birth at the national level masked increases in nearly 1 in 6 counties between 2007 and 2019.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adam S. Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine Harrington
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura Seegmiller
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaoning Huang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lindsay R. Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew M. Davis
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Simon Capewell
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Gregory E. Miller
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Roxana Mehran
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Associate Editor, JAMA Cardiology
| | - Birgit Vogel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus
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24
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Zarubin VC, Damme KSF, Vargas T, Osborne KJ, Norton ES, Briggs-Gowan M, Allen NB, Wakschlag L, Mittal VA. Neurodevelopmental vulnerability to psychosis: developmentally-based methods enable detection of early life inhibitory control deficits that predict psychotic-like experiences at the transition to adolescence. Psychol Med 2023; 53:7746-7755. [PMID: 37395596 PMCID: PMC10761594 DOI: 10.1017/s003329172300171x] [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] [Indexed: 07/04/2023]
Abstract
BACKGROUND Inhibitory control develops in early childhood, and atypical development may be a measurable marker of risk for the later development of psychosis. Additionally, inhibitory control may be a target for intervention. METHODS Behavioral performance on a developmentally appropriate Go/No-Go task including a frustration manipulation completed by children ages 3-5 years (early childhood; n = 107) was examined in relation to psychotic-like experiences (PLEs; 'tween'; ages 9-12), internalizing symptoms, and externalizing symptoms self-reported at long-term follow-up (pre-adolescence; ages 8-11). ERP N200 amplitude for a subset of these children (n = 34) with electrophysiological data during the task was examined as an index of inhibitory control. RESULTS Children with lower accuracy on No-Go trials compared to Go trials in early childhood (F(1,101) = 3.976, p = 0.049), evidenced higher PLEs at the transition to adolescence 4-9 years later, reflecting a specific deficit in inhibitory control. No association was observed with internalizing or externalizing symptoms. Decreased accuracy during the frustration manipulation predicted higher internalizing, F(2,202) = 5.618, p = 0.004, and externalizing symptoms, F(2,202) = 4.663, p = 0.010. Smaller N200 amplitudes were observed on No-Go trials for those with higher PLEs, F(1,101) = 6.075, p = 0.020; no relationship was observed for internalizing or externalizing symptoms. CONCLUSIONS Long-term follow-up demonstrates for the first time a specific deficit in inhibitory control behaviorally and electrophysiology, for individuals who later report more PLEs. Decreases in task performance under frustration induction indicated risk for internalizing and externalizing symptoms. These findings suggest that pathophysiological mechanisms for psychosis are relevant and discriminable in early childhood, and further, suggest an identifiable and potentially modifiable target for early intervention.
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Affiliation(s)
- Vanessa C Zarubin
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - K Juston Osborne
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Elizabeth S Norton
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Communication Sciences & Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Margaret Briggs-Gowan
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Norrina B Allen
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
- Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
| | - Laurie Wakschlag
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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25
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Angelini ED, Yang J, Balte PP, Hoffman EA, Manichaikul AW, Sun Y, Shen W, Austin JHM, Allen NB, Bleecker ER, Bowler R, Cho MH, Cooper CS, Couper D, Dransfield MT, Garcia CK, Han MK, Hansel NN, Hughes E, Jacobs DR, Kasela S, Kaufman JD, Kim JS, Lappalainen T, Lima J, Malinsky D, Martinez FJ, Oelsner EC, Ortega VE, Paine R, Post W, Pottinger TD, Prince MR, Rich SS, Silverman EK, Smith BM, Swift AJ, Watson KE, Woodruff PG, Laine AF, Barr RG. Pulmonary emphysema subtypes defined by unsupervised machine learning on CT scans. Thorax 2023; 78:1067-1079. [PMID: 37268414 PMCID: PMC10592007 DOI: 10.1136/thorax-2022-219158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Treatment and preventative advances for chronic obstructive pulmonary disease (COPD) have been slow due, in part, to limited subphenotypes. We tested if unsupervised machine learning on CT images would discover CT emphysema subtypes with distinct characteristics, prognoses and genetic associations. METHODS New CT emphysema subtypes were identified by unsupervised machine learning on only the texture and location of emphysematous regions on CT scans from 2853 participants in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), a COPD case-control study, followed by data reduction. Subtypes were compared with symptoms and physiology among 2949 participants in the population-based Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study and with prognosis among 6658 MESA participants. Associations with genome-wide single-nucleotide-polymorphisms were examined. RESULTS The algorithm discovered six reproducible (interlearner intraclass correlation coefficient, 0.91-1.00) CT emphysema subtypes. The most common subtype in SPIROMICS, the combined bronchitis-apical subtype, was associated with chronic bronchitis, accelerated lung function decline, hospitalisations, deaths, incident airflow limitation and a gene variant near DRD1, which is implicated in mucin hypersecretion (p=1.1 ×10-8). The second, the diffuse subtype was associated with lower weight, respiratory hospitalisations and deaths, and incident airflow limitation. The third was associated with age only. The fourth and fifth visually resembled combined pulmonary fibrosis emphysema and had distinct symptoms, physiology, prognosis and genetic associations. The sixth visually resembled vanishing lung syndrome. CONCLUSION Large-scale unsupervised machine learning on CT scans defined six reproducible, familiar CT emphysema subtypes that suggest paths to specific diagnosis and personalised therapies in COPD and pre-COPD.
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Affiliation(s)
- Elsa D Angelini
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
- LTCI, Institut Polytechnique de Paris, Telecom Paris, Palaiseau, France
- NIHR Imperial Biomedical Research Centre, ITMAT Data Science Group, Imperial College, London, UK
| | - Jie Yang
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Pallavi P Balte
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric A Hoffman
- Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Ani W Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Yifei Sun
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Wei Shen
- Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University Irving Medical Center, New York, New York, USA
| | - John H M Austin
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Norrina B Allen
- Institute for Public Health and Medicine (IPHAM) - Center for Epidemiology and Population Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eugene R Bleecker
- Department of Medicine, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - David Couper
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - MeiLan K Han
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emlyn Hughes
- Department of Physics, Columbia University, New York, New York, USA
| | - David R Jacobs
- Division of Epidemiology and Community Public Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Silva Kasela
- Department of Systems Biology, Columbia University Irving Medical Center, New York, New York, USA
- New York Genome Center, New York, New York, USA
| | - Joel Daniel Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - John Shinn Kim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Tuuli Lappalainen
- Department of Systems Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Malinsky
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Fernando J Martinez
- Department of Medicine, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Victor E Ortega
- Department of Pulmonary Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Wendy Post
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tess D Pottinger
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew J Swift
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California, San Francisco, California, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University Irving Medical Center, New York, New York, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
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Yu J, Yang X, Deng Y, Krefman AE, Pool LR, Zhao L, Mi X, Ning H, Wilkins J, Lloyd-Jones DM, Petito LC, Allen NB. Incorporating longitudinal history of risk factors into atherosclerotic cardiovascular disease risk prediction using deep learning. Res Sq 2023:rs.3.rs-3405388. [PMID: 37886463 PMCID: PMC10602136 DOI: 10.21203/rs.3.rs-3405388/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background It is increasingly clear that longitudinal risk factor levels and trajectories are related to risk for atherosclerotic cardiovascular disease (ASCVD) above and beyond single measures. Currently used in clinical care, the Pooled Cohort Equations (PCE) are based on regression methods that predict ASCVD risk based on cross-sectional risk factor levels. Deep learning (DL) models have been developed to incorporate longitudinal data for risk prediction but its benefit for ASCVD risk prediction relative to the traditional Pooled Cohort Equations (PCE) remain unknown. Objective To develop a ASCVD risk prediction model that incorporates longitudinal risk factors using deep learning. Methods Our study included 15,565 participants from four cardiovascular disease cohorts free of baseline ASCVD who were followed for adjudicated ASCVD. Ten-year ASCVD risk was calculated in the training set using our benchmark, the PCE, and a longitudinal DL model, Dynamic-DeepHit. Predictors included those incorporated in the PCE: sex, race, age, total cholesterol, high density lipid cholesterol, systolic and diastolic blood pressure, diabetes, hypertension treatment and smoking. The discrimination and calibration performance of the two models were evaluated in an overall hold-out testing dataset. Results Of the 15,565 participants in our dataset, 2,170 (13.9%) developed ASCVD. The performance of the longitudinal DL model that incorporated 8 years of longitudinal risk factor data improved upon that of the PCE [AUROC: 0.815 (CI: 0.782-0.844) vs 0.792 (CI: 0.760-0.825)] and the net reclassification index was 0.385. The brier score for the DL model was 0.0514 compared with 0.0542 in the PCE. Conclusion Incorporating longitudinal risk factors in ASCVD risk prediction using DL can improve model discrimination and calibration.
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Reges O, Krefman AE, Hardy ST, Yano Y, Muntner P, Pool LR, Gordon-Larsen P, Wang Y, Lloyd-Jones DM, Allen NB. Race- and Sex-Specific Factors Associated With Age-Related Slopes in Systolic Blood Pressure: Findings From the CARDIA Study. Hypertension 2023; 80:1890-1899. [PMID: 37470199 DOI: 10.1161/hypertensionaha.123.21217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Although blood pressure (BP) increases throughout young adulthood for most individuals, the age-related slope is not uniform. This study aimed to assess associations of demographic, clinical, behavioral, psychosocial, and neighborhood characteristics with age-related BP slope among 4 race-sex groups who participated in the Coronary Artery Risk Development in Young Adults study. METHODS Individuals (n=3554) aged 18 to 30 years were included in this analysis if they had normal BP at baseline and ≥2 BP measurements during the years 1985/1986 to 2015/2016. Associations of exposure variables with systolic BP slope were assessed using multivariate linear models. RESULTS Over a mean follow-up of ~30 years, greater decade increases in systolic BP were estimated among Black than White participants (mean difference between Black females and White females: 3.0 mm Hg/decade; between Black males and White males: 4.7 mm Hg/decade). The exposure risk factors associated with greater increases in systolic BP throughout adulthood varied by race and sex. None of these factors were associated with increases in systolic BP in all race-sex groups. Parent history of high BP was associated with a steeper positive slope among Black females (effect size per decade: 1.1 [95% CI, 0.6-1.6]; P<0.01), Black males (0.6 [95% CI, 0.02-1.2]; P<0.05), and White females (0.6 [95% CI, 0.2-1.0]; P<0.01). Other risk factors were associated with greater age-related yearly increases in systolic BP among 1 or 2 of the 4 race-sex groups or were not statistically significant. CONCLUSIONS Culturally tailored BP reduction approach should be considered in conjunction with primordial prevention, to moderate increases in BP throughout adulthood.
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Affiliation(s)
- Orna Reges
- Department of Health Systems Management, Ariel University, Israel (O.R.)
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Amy E Krefman
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Shakia T Hardy
- Department of Epidemiology, University of Alabama at Birmingham (S.T.H., P.M.)
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham (S.T.H., P.M.)
| | - Lindsay R Pool
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC (P.G.-L.)
| | - Yaojie Wang
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
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28
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Ware L, Vermeulen B, Maposa I, Floo D, Brant LCC, Khandelwal S, Singh K, Soares S, Jessen N, Perman G, Riaz BK, Sachdev HS, Allen NB, Labarthe DR. Comparison of cardiovascular health profiles across population surveys from five high- to low-income countries. medRxiv 2023:2023.07.26.23293185. [PMID: 37546768 PMCID: PMC10402230 DOI: 10.1101/2023.07.26.23293185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Aims With the greatest burden of cardiovascular disease morbidity and mortality increasingly observed in lower-income countries least prepared for this epidemic, focus is widening from risk factor management alone to primordial prevention to maintain high levels of cardiovascular health (CVH) across the life course. To facilitate this, the American Heart Association (AHA) developed CVH scoring guidelines to evaluate and track CVH. We aimed to compare the prevalence and trajectories of high CVH across the life course using nationally representative adult CVH data from five diverse high- to low-income countries. Methods Surveys with CVH variables (physical activity, cigarette smoking, body mass, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the United States (US). Participants were included if they were 18-69y, not pregnant, and had data for these CVH metrics. Comparable data were harmonized and each of the CVH metrics was scored using AHA guidelines as high (2), moderate (1), or low (0) to create total CVH scores with higher scores representing better CVH. High CVH prevalence by age was compared creating country CVH trajectories. Results The analysis included 28,092 adults (Ethiopia n=7686, 55.2% male; Bangladesh n=6731, 48.4% male; Brazil n=7241, 47.9 % male; England n=2691, 49.5% male, and the US n=3743, 50.3% male). As country income level increased, prevalence of high CVH decreased (>90% in Ethiopia, >68% in Bangladesh and under 65% in the remaining countries). This pattern remained using either five or all six CVH metrics and following exclusion of underweight participants. While a decline in CVH with age was observed for all countries, higher income countries showed lower prevalence of high CVH already by age 18y. Excess body weight appeared the main driver of poor CVH in higher income countries, while current smoking was highest in Bangladesh. Conclusion Harmonization of nationally representative survey data on CVH trajectories with age in 5 highly diverse countries supports our hypothesis that CVH decline with age may be universal. Interventions to promote and preserve high CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where CVH remains relatively high, protection of whole societies from risk factor epidemics may still be feasible.
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Affiliation(s)
- Lisa Ware
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bridget Vermeulen
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Floo
- Wuqu’ Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luisa CC Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Brazil
| | | | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Sara Soares
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Portugal
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
- Research Unit of the Department of Medicine, Maputo Central Hospital, Mozambique
| | - Gastón Perman
- Department of Public Health. Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - Baizid Khoorshid Riaz
- National Institute of Preventive & Social Medicine (NIPSOM), Ministry of Health & Family Welfare, Mohakhali, Dhaka, Bangladesh
| | | | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Darwin R Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
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29
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Pool LR, Petito LC, Yang X, Krefman AE, Perak AM, Davis MM, Greenland P, Rosenman M, Zmora R, Wang Y, Hou L, Marino BS, Van Horn L, Wakschlag LS, Labarthe D, Lloyd-Jones DM, Allen NB. Cardiovascular health trajectories from age 2-12: a pediatric electronic health record study. Ann Epidemiol 2023; 83:40-46.e4. [PMID: 37084989 DOI: 10.1016/j.annepidem.2023.04.007] [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] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Many children have non-ideal cardiovascular health (CVH), but little is known about the course of CVH in early childhood. We identified CVH trajectories in children and assess the generalizability of these trajectories in an external sample. METHODS We used data spanning 2010-2018 from children aged 2-12 years within the Chicago Area Patient-Centered Outcomes Research Network-an electronic health record network. Four clinical systems comprised the derivation sample and a fifth the validation sample. Body mass index, blood pressure, cholesterol, and blood glucose were categorized as ideal, intermediate, and poor using clinical measurements, laboratory readings, and International Classification of Diseases diagnosis codes and summed for an overall CVH score. Group-based trajectory modeling was used to create CVH score trajectories which were assessed for classification accuracy in the validation sample. RESULTS Using data from 122,363 children (47% female, 47% non-Hispanic White) three trajectories were identified: 59.5% maintained high levels of clinical CVH, 23.4% had high levels of CVH that declined, and 17.1% had intermediate levels of CVH that further declined with age. A similar classification emerged when the trajectories were fitted in the validation sample. CONCLUSIONS Stratification of CVH was present by age 2, implicating the need for early life and preconception prevention strategies.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lucia C Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xiaoyun Yang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marc Rosenman
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Rachel Zmora
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Yaojie Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren S Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Sarma AA, Paniagua SM, Lau ES, Wang D, Liu EE, Larson MG, Hamburg NM, Mitchell GF, Kizer J, Psaty BM, Allen NB, Lely AT, Gansevoort RT, Rosenberg E, Mukamal K, Benjamin EJ, Vasan RS, Cheng S, Levy D, Boer RADE, Gottdiener JS, Shah SJ, Ho JE. Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women. J Card Fail 2023; 29:1032-1042. [PMID: 36638956 PMCID: PMC10333450 DOI: 10.1016/j.cardfail.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Greater parity has been associated with cardiovascular disease risk. We sought to find whether the effects on cardiac remodeling and heart failure risk are clear. METHODS We examined the association of number of live births with echocardiographic measures of cardiac structure and function in participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction using a Fine-Gray subdistribution hazards model in a pooled analysis of n = 12,635 participants in the FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary analyses included major cardiovascular disease, myocardia infarction and stroke. RESULTS Among n = 3931 FHS participants (mean age 48 ± 13 years), higher numbers of live births were associated with worse left ventricular fractional shortening (multivariable β -1.11 (0.31); P = 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics, including global circumferential strain and longitudinal and radial dyssynchrony (P < 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes, women with ≥ 5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19-3.12; P = 0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37-0.91; P = 0.02). CONCLUSIONS Greater numbers of live births are associated with worse cardiac structure and function. There was no association with overall HF, but a higher number of live births was associated with greater risk for incident HFrEF.
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Affiliation(s)
- Amy A Sarma
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Samantha M Paniagua
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emily S Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Dongyu Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth E Liu
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martin G Larson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Naomi M Hamburg
- Department of Medicine, Sections of Cardiology and Vascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gary F Mitchell
- Department of Research, Cardiovascular Engineering, Norwood, MA, USA
| | - Jorge Kizer
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Norrina B Allen
- Department of Epidemiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A Titia Lely
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ronald T Gansevoort
- Division of Nephrology, Department of Medicine, University Medical Center Groningen, The Netherlands
| | - Emily Rosenberg
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA; Boston University Center for Computing and Data Sciences, Boston, MA, USA
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Levy
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Rudolf A DE Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | | | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Abstract
Since it was first defined by the American Heart Association in 2010, cardiovascular health (CVH) has been extensively studied across the life course. In this review, we present the current literature examining early life predictors of CVH, the later life outcomes of child CVH, and the relatively few interventions which have specifically addressed how to preserve and promote CVH across populations. We find that research on CVH has demonstrated that prenatal and childhood exposures are consistently associated with CVH trajectories from childhood through adulthood. CVH measured at any point in life is strongly predictive of future cardiovascular disease, dementia, cancer, and mortality as well as a variety of other health outcomes. This speaks to the importance of intervening early to prevent the loss of optimal CVH and the accumulation of cardiovascular risk. Interventions to improve CVH are not common but those that have been published most often address multiple modifiable risk factors among individuals within the community. Relatively few interventions have been focused on improving the construct of CVH in children. Future research is needed that will be both effective, scalable, and sustainable. Technology including digital platforms as well as implementation science will play key roles in achieving this vision. In addition, community engagement at all stages of this research is critical. Lastly, prevention strategies that are tailored to the individual and their context may help us achieve the promise of personalized prevention and help promote ideal CVH in childhood and across the life course.
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Affiliation(s)
- Havisha Pedamallu
- Division of Internal Medicine, Department of Medicine (H.P.), Northwestern University Feinberg School of Medicine
| | - Rachel Zmora
- Department of Preventive Medicine (R.Z., A.M.P., N.B.A.), Northwestern University Feinberg School of Medicine
| | - Amanda M Perak
- Department of Preventive Medicine (R.Z., A.M.P., N.B.A.), Northwestern University Feinberg School of Medicine
- Department of Pediatrics, Lurie Children's Hospital, Chicago, IL (A.M.P.)
| | - Norrina B Allen
- Department of Preventive Medicine (R.Z., A.M.P., N.B.A.), Northwestern University Feinberg School of Medicine
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32
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Vameghestahbanati M, Sack C, Wysoczanski A, Hoffman EA, Angelini E, Allen NB, Bertoni AG, Guo J, Jacobs DR, Kaufman JD, Laine A, Lin CL, Malinsky D, Michos ED, Oelsner EC, Shea SJ, Watson KE, Benedetti A, Barr RG, Smith BM. Association of dysanapsis with mortality among older adults. Eur Respir J 2023; 61:2300551. [PMID: 37263750 PMCID: PMC10580540 DOI: 10.1183/13993003.00551-2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
Dysanapsis – an anthropometric mismatch between airway tree calibre and lung size that is common in the general population – is strongly associated with all-cause mortality and increases susceptibility to tobacco smoking-related diseases https://bit.ly/42oDe8J
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Affiliation(s)
| | | | | | | | - Elsa Angelini
- Columbia University, New York, NY, USA
- NIHR Imperial Biomedical Research Centre, ITMAT Data Science Group, Imperial College London, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Benjamin M Smith
- McGill University, Montreal, QC, Canada
- Columbia University, New York, NY, USA
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33
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Khan SS, Post WS, Guo X, Tan J, Zhu F, Bos D, Sedaghati-Khayat B, van Rooij J, Aday A, Allen NB, Bos MM, Uitterlinden AG, Budoff MJ, Lloyd-Jones DM, Mosley JD, Rotter JI, Greenland P, Kavousi M. Coronary Artery Calcium Score and Polygenic Risk Score for the Prediction of Coronary Heart Disease Events. JAMA 2023; 329:1768-1777. [PMID: 37219552 PMCID: PMC10208141 DOI: 10.1001/jama.2023.7575] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Importance Coronary artery calcium score and polygenic risk score have each separately been proposed as novel markers to identify risk of coronary heart disease (CHD), but no prior studies have directly compared these markers in the same cohorts. Objective To evaluate change in CHD risk prediction when a coronary artery calcium score, a polygenic risk score, or both are added to a traditional risk factor-based model. Design, Setting, and Participants Two observational population-based studies involving individuals aged 45 years through 79 years of European ancestry and free of clinical CHD at baseline: the Multi-Ethnic Study of Atherosclerosis (MESA) study involved 1991 participants at 6 US centers and the Rotterdam Study (RS) involved 1217 in Rotterdam, the Netherlands. Exposure Traditional risk factors were used to calculate CHD risk (eg, pooled cohort equations [PCEs]), computed tomography for the coronary artery calcium score, and genotyped samples for a validated polygenic risk score. Main Outcomes and Measures Model discrimination, calibration, and net reclassification improvement (at the recommended risk threshold of 7.5%) for prediction of incident CHD events were assessed. Results The median age was 61 years in MESA and 67 years in RS. Both log (coronary artery calcium+1) and polygenic risk score were significantly associated with 10-year risk of incident CHD (hazards ratio per SD, 2.60; 95% CI, 2.08-3.26 and 1.43; 95% CI, 1.20-1.71, respectively), in MESA. The C statistic for the coronary artery calcium score was 0.76 (95% CI, 0.71-0.79) and for the polygenic risk score, 0.69 (95% CI, 0.63-0.71). The change in the C statistic when each was added to the PCEs was 0.09 (95% CI, 0.06-0.13) for the coronary artery calcium score, 0.02 (95% CI, 0.00-0.04) for the polygenic risk score, and 0.10 (95% CI, 0.07-0.14) for both. Overall categorical net reclassification improvement was significant when the coronary artery calcium score (0.19; 95% CI, 0.06-0.28) but was not significant when the polygenic risk score (0.04; 95% CI, -0.05 to 0.10) was added to the PCEs. Calibration of the PCEs and models with coronary artery calcium and/or polygenic risk scores was adequate (all χ2<20). Subgroup analysis stratified by the median age demonstrated similar findings. Similar findings were observed for 10-year risk in RS and in longer-term follow-up in MESA (median, 16.0 years). Conclusions and Relevance In 2 cohorts of middle-aged to older adults from the US and the Netherlands, the coronary artery calcium score had better discrimination than the polygenic risk score for risk prediction of CHD. In addition, the coronary artery calcium score but not the polygenic risk score significantly improved risk discrimination and risk reclassification for CHD when added to traditional risk factors.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wendy S. Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Jingyi Tan
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Fang Zhu
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Daniel Bos
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bahar Sedaghati-Khayat
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen van Rooij
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Aaron Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maxime M. Bos
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - André G. Uitterlinden
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Donald M. Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan D. Mosley
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Philip Greenland
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Senior Editor, JAMA
| | - Maryam Kavousi
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Sawicki KT, Ning H, Allen NB, Carnethon MR, Wallia A, Otvos JD, Ben-Sahra I, McNally EM, Snell-Bergeon JK, Wilkins JT. Longitudinal trajectories of branched chain amino acids through young adulthood and diabetes in later life. JCI Insight 2023; 8:166956. [PMID: 37092552 DOI: 10.1172/jci.insight.166956] [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] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/24/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUNDElevated circulating branched chain amino acids (BCAAs), measured at a single time point in middle life, are strongly associated with an increased risk of developing type 2 diabetes mellitus (DM). However, the longitudinal patterns of change in BCAAs through young adulthood and their association with DM in later life are unknown.METHODSWe serially measured BCAAs over 28 years in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort of apparently healthy Black and White young adults at baseline. Trajectories of circulating BCAA concentrations from years 2-30 (for prevalent DM) or years 2-20 (for incident DM) were determined by latent class modeling.RESULTSAmong 3,081 apparently healthy young adults, trajectory analysis from years 2-30 revealed 3 distinct BCAA trajectory groups: low-stable (n = 1,427), moderate-stable (n = 1,384), and high-increasing (n = 270) groups. Male sex, higher body mass index, and higher atherogenic lipid fractions were more common in the moderate-stable and high-increasing groups. Higher risk of prevalent DM was associated with the moderate-stable (OR = 2.59, 95% CI: 1.90-3.55) and high-increasing (OR = 6.03, 95% CI: 3.86-9.43) BCAA trajectory groups in adjusted models. A separate trajectory group analysis from years 2-20 for incident DM after year 20 showed that moderate-stable and high-increasing trajectory groups were also significantly associated with higher risk of incident DM, after adjustment for clinical variables and glucose levels.CONCLUSIONBCAA levels track over a 28-year span in most young adults, but serial clinical metabolomic measurements identify subpopulations with rising levels associated with high risk of DM in later life.FUNDINGThis research was supported by the NIH, under grants R01 HL146844 (JTW) and T32 HL069771 (MRC). The CARDIA study is conducted and supported by the NIH National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (HHSN268201800005I and HHSN268201800007I), Northwestern University (HHSN268201800003I), the University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I).
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Affiliation(s)
- Konrad T Sawicki
- Division of Cardiology, Department of Medicine
- Department of Preventive Medicine; and
| | | | | | | | - Amisha Wallia
- Division of Cardiology, Department of Medicine
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, North Carolina, USA
| | | | - Elizabeth M McNally
- Division of Cardiology, Department of Medicine
- Department of Biochemistry and Molecular Genetics and
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John T Wilkins
- Division of Cardiology, Department of Medicine
- Department of Preventive Medicine; and
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Krefman AE, Ghamsari F, Turner DR, Lu A, Borsje M, Wood CW, Petito LC, Polubriaginof FCG, Schneider D, Ahmad F, Allen NB. Using electronic health record data to link families: an illustrative example using intergenerational patterns of obesity. J Am Med Inform Assoc 2023; 30:915-922. [PMID: 36857086 PMCID: PMC10114127 DOI: 10.1093/jamia/ocad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/03/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE Electronic health record (EHR) data are a valuable resource for population health research but lack critical information such as relationships between individuals. Emergency contacts in EHRs can be used to link family members, creating a population that is more representative of a community than traditional family cohorts. MATERIALS AND METHODS We revised a published algorithm: relationship inference from the electronic health record (RIFTEHR). Our version, Pythonic RIFTEHR (P-RIFTEHR), identifies a patient's emergency contacts, matches them to existing patients (when available) using network graphs, checks for conflicts, and infers new relationships. P-RIFTEHR was run on December 15, 2021 in the Northwestern Medicine Electronic Data Warehouse (NMEDW) on approximately 2.95 million individuals and was validated using the existing link between children born at NM hospitals and their mothers. As proof-of-concept, we modeled the association between parent and child obesity using logistic regression. RESULTS The P-RIFTEHR algorithm matched 1 157 454 individuals in 448 278 families. The median family size was 2, the largest was 32 persons, and 247 families spanned 4 generations or more. Validation of the mother-child pairs resulted in 95.1% sensitivity. Children were 2 times more likely to be obese if a parent is obese (OR: 2.30; 95% CI, 2.23-2.37). CONCLUSION P-RIFTEHR can identify familiar relationships in a large, diverse population in an integrated health system. Estimates of parent-child inheritability of obesity using family structures identified by the algorithm were consistent with previously published estimates from traditional cohort studies.
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Affiliation(s)
- Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Farhad Ghamsari
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Daniel R Turner
- IT Research Computing Services, Northwestern University, Evanston, Illinois, USA
| | - Alice Lu
- Northwestern Medicine Enterprise Data Warehouse, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Martin Borsje
- Northwestern Medicine Enterprise Data Warehouse, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Colby Witherup Wood
- IT Research Computing Services, Northwestern University, Evanston, Illinois, USA
| | - Lucia C Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Daniel Schneider
- Northwestern Medicine Enterprise Data Warehouse, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Faraz Ahmad
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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36
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Jiang X, Lewis CE, Allen NB, Sidney S, Yaffe K. Premature Cardiovascular Disease and Brain Health in Midlife: The CARDIA Study. Neurology 2023; 100:e1454-e1463. [PMID: 36697246 PMCID: PMC10104620 DOI: 10.1212/wnl.0000000000206825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/02/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To understand the role of premature (defined as ≤ 60 years) cardiovascular disease (CVD) in brain health earlier in life, we examined the associations of premature CVD with midlife cognition and white matter health. METHODS We studied a prospective cohort in the Coronary Artery Risk Development in Young Adults study, who were 18-30 years at baseline (1985-1986) and followed up to 30 years when 5 cognitive tests measuring different domains were administered. A subset (656 participants) had brain MRI measures of white matter hyperintensity (WMH) and white matter integrity. A premature CVD event was adjudicated based on medical records of coronary heart disease, stroke/TIA, congestive heart failure, carotid artery disease, and peripheral artery disease. We conducted linear regression to determine the associations of nonfatal premature CVD with cognitive performance (z-standardized), cognitive decline, and MRI measures. RESULTS Among 3,146 participants, the mean age (57% women and 48% Black) was 55.1 ± 3.6 years, with 5% (n = 147) having premature CVD. Adjusting for demographics, education, literacy, income, depressive symptoms, physical activity, diet, and APOE, premature CVD was associated with lower cognition in 4 of 5 domains: global cognition (-0.22, 95% CI -0.37 to -0.08), verbal memory (-0.28, 95% CI -0.44 to -0.12), processing speed (-0.46, 95% CI -0.62 to -0.31), and executive function (-0.38, 95% CI -0.55 to -0.22). Premature CVD was associated with greater WMH (total, temporal, and parietal lobes) and higher white matter mean diffusivity (total and temporal lobes) after adjustment for covariates. These associations remained significant after adjusting for cardiovascular risk factors (CVRFs) and excluding those with stroke/TIA. Premature CVD was also associated with accelerated cognitive decline over 5 years (adjusted OR 3.07, 95% CI 1.65-5.71). DISCUSSION Premature CVD is associated with worse midlife cognition and white matter health, which is not entirely driven by stroke/TIA and even independent of CVRFs. Preventing CVD in early adulthood may delay the onset of cognitive decline and promote brain health over the life course.
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Affiliation(s)
- Xiaqing Jiang
- From the Department of Psychiatry and Behavioral Sciences (X.J., K.Y.), University of California San Francisco; Department of Epidemiology (C.E.L.), School of Public Health, University of Alabama at Birmingham; Department of Preventive Medicine (N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL; Kaiser Permanente Division of Research (S.S.), Oakland, CA; Department of Epidemiology and Biostatistics (K.Y.), University of California San Francisco; Department of Neurology (K.Y.), University of California; and San Francisco VA Health Care System (K.Y.)
| | - Cora E Lewis
- From the Department of Psychiatry and Behavioral Sciences (X.J., K.Y.), University of California San Francisco; Department of Epidemiology (C.E.L.), School of Public Health, University of Alabama at Birmingham; Department of Preventive Medicine (N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL; Kaiser Permanente Division of Research (S.S.), Oakland, CA; Department of Epidemiology and Biostatistics (K.Y.), University of California San Francisco; Department of Neurology (K.Y.), University of California; and San Francisco VA Health Care System (K.Y.)
| | - Norrina B Allen
- From the Department of Psychiatry and Behavioral Sciences (X.J., K.Y.), University of California San Francisco; Department of Epidemiology (C.E.L.), School of Public Health, University of Alabama at Birmingham; Department of Preventive Medicine (N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL; Kaiser Permanente Division of Research (S.S.), Oakland, CA; Department of Epidemiology and Biostatistics (K.Y.), University of California San Francisco; Department of Neurology (K.Y.), University of California; and San Francisco VA Health Care System (K.Y.)
| | - Stephen Sidney
- From the Department of Psychiatry and Behavioral Sciences (X.J., K.Y.), University of California San Francisco; Department of Epidemiology (C.E.L.), School of Public Health, University of Alabama at Birmingham; Department of Preventive Medicine (N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL; Kaiser Permanente Division of Research (S.S.), Oakland, CA; Department of Epidemiology and Biostatistics (K.Y.), University of California San Francisco; Department of Neurology (K.Y.), University of California; and San Francisco VA Health Care System (K.Y.)
| | - Kristine Yaffe
- From the Department of Psychiatry and Behavioral Sciences (X.J., K.Y.), University of California San Francisco; Department of Epidemiology (C.E.L.), School of Public Health, University of Alabama at Birmingham; Department of Preventive Medicine (N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL; Kaiser Permanente Division of Research (S.S.), Oakland, CA; Department of Epidemiology and Biostatistics (K.Y.), University of California San Francisco; Department of Neurology (K.Y.), University of California; and San Francisco VA Health Care System (K.Y.).
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Domanski MJ, Wu CO, Tian X, Hasan AA, Ma X, Huang Y, Miao R, Reis JP, Bae S, Husain A, Jacobs DR, Allen NB, Lee MLT, Hong CC, Farkouh ME, Lloyd-Jones DM, Fuster V. Association of Incident Cardiovascular Disease With Time Course and Cumulative Exposure to Multiple Risk Factors. J Am Coll Cardiol 2023; 81:1151-1161. [PMID: 36948731 DOI: 10.1016/j.jacc.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The quantitative relationship of incident cardiovascular disease (CVD) to lifetime cumulative risk factor exposure is not well understood. OBJECTIVES Using CARDIA (Coronary Artery Risk Development in Young Adults) study data, we examined the quantitative associations of cumulative exposure over time to multiple, simultaneously operating risk factors with CVD incidence and the incidence of its components. METHODS Regression models were developed quantifying the influence of the time course and severity of multiple CVD risk factors, operating simultaneously, on risk of incident CVD. The outcomes were incident CVD and the incidence of its components: coronary heart disease, stroke, and congestive heart failure. RESULTS Our study included 4,958 asymptomatic adults enrolled in CARDIA from 1985 to 1986 (ages 18 to 30 years) who were followed for 30 years. Risk of incident CVD depends on the time course and severity of a series of independent risk factors, the impact of which is mediated by their effects on individual CVD components after age 40 years. Cumulative exposure (AUC vs time) to low-density lipoprotein cholesterol and triglycerides was independently associated with risk of incident CVD. Of the blood pressure variables, areas under the mean arterial pressure vs time curve and the pulse pressure vs time curve were strongly and independently associated with incident CVD risk. CONCLUSIONS The quantitative description of the link between risk factors and CVD informs the construction of individualized CVD mitigation strategies, design of primary prevention trials, and assessment of public health impact of risk factor-based interventions.
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Affiliation(s)
- Michael J Domanski
- Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA.
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ahmed A Hasan
- Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Xiaoyang Ma
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yi Huang
- Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA; Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Rui Miao
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Anwar Husain
- Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mei-Ling T Lee
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland, USA
| | - Charles C Hong
- Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA
| | - Michael E Farkouh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Valentin Fuster
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sinha A, Ning H, Cameron N, Bancks M, Carnethon MR, Allen NB, Wilkins JT, Lloyd-Jones DM, Khan SS. Atherosclerotic Cardiovascular Disease or Heart Failure: First Cardiovascular Event in Adults With Prediabetes and Diabetes. J Card Fail 2023; 29:246-254. [PMID: 36343785 DOI: 10.1016/j.cardfail.2022.10.426] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with prediabetes and diabetes are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Whether ASCVD or HF is more likely to occur first in these populations within different race-sex groups is unknown. OBJECTIVE To determine the competing risk for the first cardiovascular event by subtype in Black and white men and women with prediabetes and diabetes. METHODS Individual-level data from adults without ASCVD or HF were pooled from 6 population-based cohorts. We estimated the competing cumulative incidences of ASCVD, HF and noncardiovascular death as the first event in middle-aged (40-59 years) and older (60-79 years) adults, stratified by race and sex, with normal fasting plasma glucose (FPG < 100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) at baseline. Within each race-sex group, we estimated risk the adjusted hazard ratio of ASCVD, HF and noncardiovascular death in adults with prediabetes and diabetes relative to adults with normoglycemia after adjusting for cardiovascular risk factors. RESULTS In 40,117 participants with 638,910 person-years of follow-up, 5781 cases of incident ASCVD and 3179 cases of incident HF occurred. In middle-aged adults with diabetes, competing cumulative incidence of ASCVD as a first event was higher than HF in white men (35.4% vs 11.6%), Black men (31.6% vs 15.1%) and white women (24.3% vs 17.2%) but not in Black women (26.4% vs 28.4%). Within each group, the adjusted hazard ratio of ASCVD and HF was significantly higher in adults with diabetes than in adults with normal FPG levels. Findings were largely similar in middle-aged adults with prediabetes and older adults with prediabetes or diabetes. CONCLUSIONS Black women with diabetes are more likely to develop HF as their first CVD event, whereas individuals with diabetes from other race-sex groups are more likely to present first with ASCVD. These results can inform the tailoring of primary prevention therapies for either HF- or ASCVD-specific pathways based on individual-level risk.
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Affiliation(s)
- Arjun Sinha
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL.
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Natalie Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Michael Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine; Winston-Salem, NC
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - John T Wilkins
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Donald M Lloyd-Jones
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Sadiya S Khan
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
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Wilkins JT, Alruwaili W, Ning H, Sawicki KT, Sniderman AD, Otvos JD, Jacobs DR, Murthy VL, Shah RV, Rohatgi A, Allen NB. Abstract P594: High-Density Lipoprotein Particle Concentrations and Long-Term Atherosclerotic Disease Risk in Young Adults. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Introduction:
HDL particles vary in size and concentration. Indices of overall HDL particle concentration (HDL-P) and the concentrations of different HDL size subspecies (small: H1-H3, medium: H4, H5, and large: H6, H7) have differential associations with near-term CVD events in middle-aged adults. It is unclear if measures of HDL particle concentration predict long-term ASCVD risk in young adults.
Methods:
Among CARDIA participants (ppts), NMR was used to measure HDL-P and HDL particle size subgroup H1-H7 concentrations. HDL cholesterol (HDL-C) was measured using standard assays. We stratified the ppts into 2 age windows: 20-30y (n= 1645) and 30-40y (n=2922). We used adjusted Cox proportional hazards models to assess the associations between a 1SD higher HDL-C, HDL-P, and HDL1-7 subgroups with incident ASCVD events. We added HDL-P, HDL H1-H7, and HDL-C separately to a modified Pooled Cohort Equation (PCE) model; model performance (discrimination and reclassification) was evaluated.
Results:
81 and 163 ASCVD events occurred over (median (IQR)) 31.8y (31.1-32.0y) for the 20-30y age window and over 26.8y (19.1-27.1y) for the 30-40y age window, respectively. In ppts age 20-30y, a higher HDL-P and HDL-C were not associated with ASCVD events, however a higher HDL H6 subgroup level was associated with lower risk for ASCVD in demographic adjusted models. In the age 30-40y group, higher HDL-P, HDL-C, and H6 subgroup were significantly associated with lower ASCVD risks in all models. There were no significant differences in c-statistics across PCE models. However, there were improvements in reclassification for all HDL measures when added to the PCE model in the 20-30y age window, and significant improvements in reclassification when HDL H1-7 were added to the PCE for the 30-40y age window.
Conclusion:
At younger ages (<40y) differences in HDL particle abundance, in particular large particles, may help reclassify long-term risk for ASCVD in some.
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Wilkins JT, Ning H, Sawicki K, Sawicki KT, Sniderman AD, Otvos JD, Rana JS, Murthy V, Murthy VL, Shah RV, Allen NB, Lloyd-Jones D. Abstract P453: Apolipoprotein B, Low-Density Lipoprotein Particle Number, Non-High-Denisity Lipoprotein Cholesterol, Low-Density Lipoprotein Cholesterol, and Total Cholesterol for Atherosclerotic Cardiovascular Disease Risk Prediction in Young Adults. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Introduction:
Measures of atherogenic particle number (apoB and LDL particle number [LDL-P]) are stronger predictors of atherosclerotic cardiovascular disease (ASCVD) risk than measures of cholesterol concentration (LDL-C, non-HDL-C, total cholesterol [TC]) in middle-aged adults. It is unclear if this is true for younger adults.
Methods:
Among CARDIA participants (ppts), NMR was used to measure apoB and LDL-P. Non-HDL-C and TC were measured using standard assays; LDL-C was calculated using the Friedewald equation. We stratified the ppts into two age windows: age 20-30y (n=1645) and age 30-40y (n=2922). We used adjusted Cox proportional hazards models to assess the associations of 1SD higher apoB, LDL-P, non-HDL-C, LDL-C, or TC with incident ASCVD events. We substituted each measure of atherogenic lipid burden for TC in a modified Pooled Cohort Equation (PCE) model (with and without HDL-C); and model performance (discrimination and reclassification) was evaluated.
Results:
There were 81 and 163 ASCVD events over (median [IQR]) 31.8y (31.1-32.0y) for the age 20-30 age window and over 26.8y (19.1-27.1y) for the 30-40y age window, respectively. In ppts age 20-30y, a 1SD higher apoB, LDL-P, non-HDL-C, and LDL-C were significantly associated with incident ASCVD in demographic adjusted models. The strengths of associations with ASCVD were not significantly different across these measures. For the 30-40y age window, all measures of atherogenic lipoproteins were significantly associated with ASCVD; the strengths of association were not significantly different across atherogenic lipid measures in all models. There were no significant differences in the C-statistic and no improvement in reclassification when each measure was used to replace TC in the PCE model.
Conclusions:
ApoB, LDL-P, LDL-C or non-HDL-C may be slightly better markers of long-term ASCVD risk than TC in adults < 30y. However, in adults between 30-40y all measures of atherogenic lipid burden appeared to be equivalent predictors of long-term risk.
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AGHAJI QUEENN, Nwabuo CC, Appiah D, Yuichiro Y, Viera AJ, Allen NB, Rana JS, Lloyd-Jones D, Schreiner PJ, AC Lima J. Abstract MP32: Body Weight Variability in Young Adulthood and Echocardiographic Precursors of Heart Failure in Later Life: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.mp32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Background:
The association between variability in body mass index (BMI) in early adulthood and cardiac structure and function in midlife has not been previously examined.
Methods:
We examined 2371 Coronary Artery Risk Development in Young Adults (CARDIA) participants who had BMI assessments across 25-years (CARDIA exam year 0 [1985-1986], 2 [1987-1989], 5 [1990-1991], 7 [1992-1993], 10 [1995-1996], 15 [2000-2001], 20 [2005-2006], and 25 [2010-2011]) as well as echocardiography data at the year-25 exam (2010-2011). BMI variability was assessed by standard deviation (SD) across 25 years. Adjusted multivariable linear regression models were used to assess the association between echocardiography variables (dependent variable) and SD of BMI (independent variable). Model 1 was adjusted for standard cardiac risk factors (age, sex, race, education, blood pressure, anti-hypertension medication use, smoking, fasting plasma glucose, alcohol consumption, physical activity, HDL and total cholesterol. Model 2 was additionally adjusted for mean BMI.
Results:
Among participants included in the analysis, mean [SD] age at the year 25 exam [2010-2011] was 50.4 [3.6] years; 44.5% were men; and 41.3% were black). In model 1, greater SD of BMI was associated with greater left ventricular mass (β 5.18g, p<0.001), left ventricular global longitudinal strain 0.08, p=0.01, and left atrial volume (β 1.60ml, p<0.001). Additional adjustment for mean BMI, attenuated associations (p>.05 for all). Greater SD of BMI was associated with worse diastolic function (E/é) (β 0.11, p<0.001). Observed association between BMI variability and E/é persisted even after accounting for mean BMI (β 0.08, p=0.01).
Conclusions:
Greater body weight variability in young adulthood was associated with modest unfavorable midlife alterations in diastolic function.
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Affiliation(s)
| | | | - Duke Appiah
- Texas Tech Univ Health Sciences Ce, Lubbock, TX
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Shah NS, Huang X, Petito L, Bancks M, Kanaya AM, Talegawkar S, Farhan S, Carnethon MR, Lloyd-Jones D, Allen NB, Kandula N, Khan SS. Abstract P360: Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health: The MESA and MASALA Studies. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:
Social and psychosocial factors are associated with cardiovascular health (CVH) and may underlie race/ethnic differences in CVH. Quantifying the contribution of individual-level social and psychosocial factors to racial and ethnic differences in CVH may guide strategies to reduce disparities.
Methods:
In the MESA and MASALA cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14, with 14 indicating optimal CVH) in Black, Chinese, Hispanic, or South Asian compared with White participants.
Results:
Among 7,978 adults (mean age 61 [SE 10] years, 52% female), there were 1,892 Black (mean CVH score 7.96), 804 Chinese (CVH 9.69), 1,496 Hispanic (CVH 8.00), 1,164 South Asian (CVH 9.16), and 2,622 White (CVH 8.91) participants. The factors that statistically contributed the most to explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equivalent to White participants, Black participants’ mean CVH score would be 0.14 points higher, p<0.05); place of birth for Chinese participants (if proportion of US-born and foreign-born individuals among Chinese adults were equivalent to White participants, Chinese participants’ mean CVH score would be 0.22 points lower, p<0.05); and education for Hispanic and South Asian participants (if educational attainment were equivalent to White participants, Hispanic and South Asian participants’ mean CVH score would be 0.55 points higher and 0.37 points lower, respectively, p<0.05 for both).
Conclusions:
In this multiethnic US cohort, social and psychosocial factors statistically explained racial and ethnic differences in CVH. Socioeconomic and immigration-related factors contributed the largest magnitude to CVH differences between race and ethnic groups.
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Ning H, Lloyd-Jones D, Perak AM, Labarthe DR, Greenland P, Allen NB. Abstract P634: Life’s Essential 8 and the Role of Sleep in Atherosclerotic Cardiovascular Disease: Coronary Artery Risk Development in Young Adults (CARDIA) Study and Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Sleep affects other cardiovascular health (CVH) behaviors and factors, and it is associated with cardiovascular disease. The AHA recently updated the definition of CVH to include sleep (“Life’s Essential 8”; LE8). Associations of the LE8 CVH score (with or without sleep) with atherosclerotic cardiovascular disease (ASCVD) risk have not been described.
Methods:
We included CARDIA and MESA participants (ppts), stratified into younger (ages 30-45, n=4332), middle-aged (ages 45-60, n=4793), and older groups (ages 60-75, n=3168). CVH score (range: 0-100) with sleep (8 metrics) and without sleep (7 metrics) was scored separately and categorized by age-specific quartiles. Reclassification of CVH score with the addition of sleep and associations with ASCVD events were assessed at each age.
Results:
Mean (SD) CVH scores with and without sleep were 72.8 (13.2) and 73.0 (14.2) for younger, 67.1 (14.6) and 65.6 (15.8) for middle-aged, 64.6 (13.6) and 63.0 (14.9) for older ppts. Self-reported Black race and less favorable socioeconomic and psychosocial status were associated with shorter sleep duration, as were lower CVH scores. When sleep was included in the CVH score, 81.9%-83.0% (by age group) of ppts had consistent CVH score quartiles, 7.7%-8.9% were reclassified into a higher CVH score quartile, and 7.8%-9.3% were reclassified into a lower CVH score quartile. Including sleep tended to result in worse CVH scores for men and Black ppts. Higher CVH scores were associated with significantly greater probability of ASCVD-free survival (Figure 1A). Each 10-point higher CVH score was associated with 21%-39% lower hazards for ASCVD across age groups, and the CVH score including sleep had somewhat stronger associations with ASCVD than the CVH score without sleep (Figure 1B).
Conclusion:
Higher CVH using the LE8 score is associated with lower ASCVD risk. The inclusion of sleep in the CVH score reclassified almost 20% of participants and resulted in somewhat stronger associations between CVH score and ASCVD.
Characters: 1730/1750 max allowed
Figure 1: Age, sex, race, and education adjusted association of LE8 and ASCVD(A-adjusted ASCVD-free Survival Curves by quartile of CVH score; B-adjusted hazard ratio and 95%CI)
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Thangada N, Gidding S, Colangelo LA, Hornikel B, Khan S, Pandey A, Allen NB, Sidney S, Carnethon MR, Lewis CE, Lloyd-Jones D, Gabriel KP. Abstract 31: Associations Between Cardiorespiratory Fitness (CRF) in Early Adulthood, Retention Through Midlife, and Heart Failure (HF) Stages: Findings From Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Introduction:
Prior studies demonstrate that poor CRF in early adulthood is associated with adverse cardiac structure and function in midlife. The purpose of this study is to examine if higher early adulthood CRF and retention of CRF through midlife are associated with lower subsequent risk of subclinical or clinical HF.
Methods:
CARDIA participants with available data on CRF at baseline (Year [Y] 0: 1985-86), follow-up (Y7 or Y20), and HF staging data by Y30 were included. CRF was estimated using treadmill duration from a maximal, symptom-limited graded exercise test via modified Balke protocol. An adjusted linear mixed model was used to estimate treadmill duration when CRF assessment was missing at Y7 or 20. HF stages were defined using AHA HF staging criteria, including Stage 0 (no HF risk factors). Clinical HF was adjudicated by committee. Adjusted multinomial models tested associations between Y0 CRF and percent CRF retained through Y20 with HF stages at Y30, with Stage 0 as the reference. Interactions by the four race-sex groups were examined.
Results:
Of 2,565 individuals (25.1±3.5 y, 43% Black, 55% female), 30% (n=778), 37% (n=952), 32% (n=813), and 1% (n=32) were classified as Stages 0, A, B, or C/D by Y30 exam, respectively. Compared with Stage 0, every 1-minute increment higher CRF in early-adulthood was associated with a lower adjusted odds ratio of HF [Stage A: 0.72 (95% CI 0.68, 0.76), Stage B: 0.80 (95% CI 0.75, 0.84), Stage C/D 0.86 (95% CI 0.71, 1.04)]. Compared with Stage 0, every 1-standard deviation of % CRF retained at Y20 (midlife) was also associated with a lower odds of Stage A, B, and C/D HF at Y30 (Figure). A race-sex interaction was not observed (p-interaction 0.42).
Conclusion:
Higher early adulthood CRF, and greater retention of CRF through midlife, were associated with lower risk of developing subclinical or clinical HF. Strategies to maintain optimal CRF across the young adulthood to midlife transition may be important in prevention of HF.
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Affiliation(s)
| | | | | | | | - Sadiya Khan
- Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | | | | | | | | | - Cora E Lewis
- Univeristy of Alabama at Birmingham, Birmingham, AL
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Kim JS, Sun Y, Balte P, Cushman M, Tracy RP, Styer L, Anderson MR, Allen NB, Schreiner P, Bowler RP, Schwartz D, Lee J, Xanthakis V, Doyle M, Kanaya AM, Elkind MS, Howard VJ, Ortega V, Woodruff P, Cole S, Mantis N, Parker M, Barr RG, Oelsner E, Demmer R. Abstract P540: Cardiovascular Disease Risk Factors and Antibody Response to COVID-19 Vaccination: The C4R Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:
Adults with cardiovascular co-morbidities and risk factors are at greater risk of severe COVID-19. These same risk factors may also be associated with an attenuated antibody response to COVID-19 vaccines, although studies in diverse, U.S. population-based cohorts have been limited.
Methods:
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) conducted a serosurvey for SARS-CoV-2 antibodies via dried blood spot (DBS) in 14 U.S. cohorts. IgG antibodies to SARS-CoV-2 spike subunit 1 (S1) and nucleocapsid (N) were measured from DBS using a semi-quantitative microsphere immunoassay and reported as median fluorescence intensity (MFI). Multivariable adjusted linear models regressed log-transformed anti-S1 MFI on age, sex, race/ethnicity, education attainment, self-reported diabetes, hypertension, cardiovascular disease (CVD), chronic kidney disease, smoking history, body mass index (BMI), asthma, obstructive lung diseases, DBS batch, anti-N MFI, vaccine type, time between vaccine and DBS, and vaccine dose at time of DBS collection. Results are presented as the percent difference in anti-S1 MFI compared with a reference group.
Results:
There were 6614 vaccinated participants prior to booster regimens and DBS collection (April 2021-July 2022) with 50%, 48%, and 2% of the cohort who received BNT162b2, mRNA-1273, or other vaccines, respectively. The mean (SD) time between vaccination and DBS was 3.8 (1.8) months. Over 10% of the cohort had self-reported a history of diabetes, 55% had hypertension, and 74% had a BMI>25 kg/m
2
. Anti-S1 MFI decreased as the time between vaccine dose and DBS collection increased. Diabetes was associated with a 16.1% lower anti-S1 MFI (95%CI:-22.4,-9.5) whereas neither hypertension (-3.8%;95%CI:-9.3,2.1), nor cardiovascular disease history (-5.3%;95%CI:-16.3,7.4) were associated with anti-S1 MFI. Former and current smoking history were each associated with a lower anti-S1 MFI: (-6.6%;95%CI:-12.1,-0.8) and (-16.1%;95%CI:-24.7,-6.6), respectively. Participants with a BMI 25-29.9 kg/m
2
had a 7.6% higher anti-S1 MFI (95%CI:0.3,15.4) whereas those with a BMI of 30-35 kg/m
2
and >35 kg/m
2
had 6.2% (95%CI:-2.4,15.5) higher and 8.9% lower (95%CI:-17.6,0.7) MFI levels, respectively. Older age and male sex were each associated with a lower anti-S1 MFI and mRNA-1273 vaccine, Asian subgroup, higher anti-N titer, and prior COVID-19 infection were each associated with higher anti-S1 MFI. Chronic kidney disease, education attainment, and lung disease were not associated with anti-S1 MFI.
Conclusions:
Several traditional cardiovascular disease risk factors were associated with diminished humoral responses to the initial COVID-19 vaccine regimens in a diverse U.S. population-based cohort and may have implications on strategies to improve vaccine responses.
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Affiliation(s)
| | | | | | | | | | - Linda Styer
- New York State Dept of Health Wadsworth Cntr, Albany, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shelley Cole
- Texas Biomedical Rsch Institute, San Antonio, TX
| | | | - Monica Parker
- New York State Dept of Health Wadsworth Cntr, Albany, NY
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Shah NS, Huang X, Cameron N, Petito L, Allen NB, Carnethon MR, Greenland P, Lloyd-Jones D, Khan SS. Abstract 39: Association of Cardiovascular Health With Time Lived Free of Coronary Artery Calcium. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Zero coronary artery calcium (CAC) is associated with lower risk of cardiovascular disease. More time lived without CAC may delay coronary artery disease morbidity, but prediction of when CAC will first develop is not well understood. To inform cardiovascular prevention, we evaluated how cardiovascular health (CVH) relates to time lived without CAC.
Methods:
In Multi-Ethnic Study of Atherosclerosis (MESA) participants with zero CAC at baseline followed up to 10 years, we used Kaplan-Meier curves to estimate restricted mean survival time since study entry lived with zero CAC, by baseline CVH per Life’s Simple 7 metrics categorized as high (score 12-14), moderate (8-11), and low (0-7), and stratified by sex and age (45-64, 65-84 years).
Results:
Among 3416 participants without CAC at baseline (63% female, mean age 58 [SD 9] years, mean CVH score 8.8 [2.1]), mean years lived with zero CAC was 4.9 (SD 3.5) years. Women with high CVH lived on average 6.6 (95% CI 6.4-6.8) years with zero CAC, with moderate CVH 6.2 (6.1-6.3) years with zero CAC, and with low CVH 5.6 (5.3-5.8) years with zero CAC. Men with high CVH lived on average 6.4 (5.9-6.9) years with zero CAC, with moderate CVH 6.1 (5.9-6.3) years with zero CAC, and with low CVH 5.5 (5.1-5.9) years with zero CAC (Figure A). Among participants aged 45-64 years, those with high CVH lived on average 7.4 (7.1-7.6) years with zero CAC, with moderate CVH 6.8 (6.6-6.9) years with zero CAC, and with low CVH 5.9 (5.7-6.2) years with zero CAC. Among participants aged 65-84 years, those with high CVH lived on average 5.1 (4.5-5.7) years with zero CAC, with moderate CVH 5.2 (5.0-5.4) years with zero CAC, and with low CVH 4.9 (4.6-5.2) years with zero CAC (Figure B).
Conclusions:
High CVH was associated with longer time lived with zero CAC in women and men. Adults aged 45-64 years with high or intermediate CVH at baseline had longer time lived with zero CAC compared with those with low CVH. Older adults had no difference in time lived with zero CAC based on CVH. Maintaining CVH in midlife may delay onset of CAC.
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Shah RV, Steffen LM, Nayor M, Reis JP, Jacobs DR, Allen NB, Lloyd-Jones D, Meyer K, Cole J, Piaggi P, Vasan RS, Clish CB, Murthy VL. Dietary metabolic signatures and cardiometabolic risk. Eur Heart J 2023; 44:557-569. [PMID: 36424694 PMCID: PMC10169425 DOI: 10.1093/eurheartj/ehac446] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS Observational studies of diet in cardiometabolic-cardiovascular disease (CM-CVD) focus on self-reported consumption of food or dietary pattern, with limited information on individual metabolic responses to dietary intake linked to CM-CVD. Here, machine learning approaches were used to identify individual metabolic patterns related to diet and relation to long-term CM-CVD in early adulthood. METHODS AND RESULTS In 2259 White and Black adults (age 32.1 ± 3.6 years, 45% women, 44% Black) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, multivariate models were employed to identify metabolite signatures of food group and composite dietary intake across 17 food groups, 2 nutrient groups, and healthy eating index-2015 (HEI2015) diet quality score. A broad array of metabolites associated with diet were uncovered, reflecting food-related components/catabolites (e.g. fish and long-chain unsaturated triacylglycerols), interactions with host features (microbiome), or pathways broadly implicated in CM-CVD (e.g. ceramide/sphingomyelin lipid metabolism). To integrate diet with metabolism, penalized machine learning models were used to define a metabolite signature linked to a putative CM-CVD-adverse diet (e.g. high in red/processed meat, refined grains), which was subsequently associated with long-term diabetes and CVD risk numerically more strongly than HEI2015 in CARDIA [e.g. diabetes: standardized hazard ratio (HR): 1.62, 95% confidence interval (CI): 1.32-1.97, P < 0.0001; CVD: HR: 1.55, 95% CI: 1.12-2.14, P = 0.008], with associations replicated for diabetes (P < 0.0001) in the Framingham Heart Study. CONCLUSION Metabolic signatures of diet are associated with long-term CM-CVD independent of lifestyle and traditional risk factors. Metabolomics improves precision to identify adverse consequences and pathways of diet-related CM-CVD.
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Affiliation(s)
- Ravi V Shah
- Vanderbilt University Medical Center, Vanderbilt Clinical and Translational Research Center (VTRACC), Nashville, TN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Matthew Nayor
- Cardiology Division, Boston University School of Medicine, Boston, MA, USA
| | - Jared P Reis
- Epidemiology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Katie Meyer
- Nutrition Department, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Joanne Cole
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Paolo Piaggi
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Ramachandran S Vasan
- Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, and Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Clary B Clish
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Venkatesh L Murthy
- Department of Medicine and Radiology, University of Michigan, 1338 Cardiovascular Center, Ann Arbor, MI 48109-5873, USA
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Hammond MM, Pool LR, Krefman AE, Ning H, Lima JAC, Shah SJ, Yeboah J, Lloyd-Jones DM, Allen NB, Khan SS. Cardiac Structure and Function Phenogroups and Risk of Incident Heart Failure (from the Multi-ethnic Study of Atherosclerosis). Am J Cardiol 2023; 187:54-61. [PMID: 36459748 DOI: 10.1016/j.amjcard.2022.10.003] [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: 05/18/2022] [Revised: 08/27/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
Indices of cardiac structure and function, such as left ventricular (LV) mass and ejection fraction, have been associated with risk of incident heart failure (HF), but the clinical relevance of data-driven grouping of a comprehensive set of cardiac parameters is unclear. In Multi-Ethnic Study of Atherosclerosis participants, latent class analysis was applied in the sample stratified by gender to define phenogroups on the basis of cardiovascular magnetic resonance imaging parameters of right ventricular and LV structure and function at baseline. Cox proportional hazard models in gender-stratified analyses were used to assess the association between phenogroup membership and risk of HF subtypes adjusting for potential confounders. In the 4,204 participants (mean age 61 ± 10 years, 53% women), the mean follow-up time was 14 ± 4 years for men and 15 ± 4 years for women. For both genders, 4 distinct phenogroups were identified: (1) ideal cardiac mechanics; (2) higher output/hypertrophied LV; (3) impaired ejection fraction/dilated LV; and (4) higher output/hyperdynamic (LV). Men in phenogroups 4 (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.60 to 5.31, p = 0.0005), 3 (HR 3.52, 95% CI 1.90 to 6.53, p <0.0001), and 2 (HR 3.49, 95% CI 1.94 to 6.28, p <0.0001) had higher rates of incident HF than did men in phenogroup 1, in fully adjusted models. No significant associations were found between phenogroup membership and incident HF in women. In conclusion, phenogroup membership based on cardiac structure and function in men was significantly associated with incident HF. Integration of cardiac magnetic resonance imaging variables may help identify differential risk for HF in men.
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Affiliation(s)
- Michael M Hammond
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lindsay R Pool
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy E Krefman
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hongyan Ning
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joao A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph Yeboah
- and Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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South AM, Allen NB. Antenatal Programming of Hypertension: Paradigms, Paradoxes, and How We Move Forward. Curr Hypertens Rep 2022; 24:655-667. [PMID: 36227517 PMCID: PMC9712278 DOI: 10.1007/s11906-022-01227-z] [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] [Accepted: 09/28/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Synthesize the clinical, epidemiological, and preclinical evidence for antenatal programming of hypertension and critically appraise paradigms and paradoxes to improve translation. RECENT FINDINGS Clinical and epidemiological studies persistently demonstrate that antenatal factors contribute to programmed hypertension under the developmental origins of health and disease framework, including lower birth weight, preterm birth, and fetal growth restriction. Preclinical mechanisms include preeclampsia, maternal diabetes, maternal undernutrition, and antenatal corticosteroid exposure. However, clinical and epidemiological studies to date have largely failed to adequately identify, discuss, and mitigate many sources and types of bias in part due to heterogeneous study designs and incomplete adherence to scientific rigor. These limitations have led to incomplete and biased paradigms as well as persistent paradoxes that have significantly limited translation into clinical and population health interventions. Improved understanding of these paradigms and paradoxes will allow us to substantially move the field forward.
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Affiliation(s)
- Andrew M South
- Department of Pediatrics, Section of Nephrology, Brenner Children's, Wake Forest University School of Medicine, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Department of Surgery-Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Cardiovascular Sciences Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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50
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Massey SH, Pool LR, Estabrook R, Level RA, Shisler S, Stacks AM, Neiderhiser JM, Espy KA, Wakschlag LS, Eiden RD, Allen NB. Within-person decline in pregnancy smoking is observable prior to pregnancy awareness: Evidence across two independent observational cohorts. Addict Biol 2022; 27:e13245. [PMID: 36301213 PMCID: PMC9939010 DOI: 10.1111/adb.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
Decreased consumption of nicotine and other drugs during pregnancy appears to be a cross-species phenomenon from which mechanism(s) capable of interrupting addictive processes could be elucidated. Whether pregnancy influences smoking behaviour independent of women's knowledge of the pregnancy, however, has not been considered. Using repeated measures analysis of variance (ANOVA), we estimated within-person change in mean cigarettes/day smoked across the estimated date of conception but prior to individually reported dates of pregnancy recognition using longitudinal smoking data from two independent observational cohorts, the Growing Up Healthy (GUH, n = 271) and Midwest Infant Development Studies (MIDS, n = 145). Participants smoked an average of half a pack/day in the month immediately before conception (M (SD) = 12(8.1) and 9.5(6.7) cigarettes/day in GUH and MIDS, respectively). We observed within-person declines in smoking after conception, both before (MGUH = -0.9; 95% CI -1.6, -0.2; p = 0.01; MMIDS = -1.1; 95% CI -1.9, -0.3; p = 0.01) and after (MGUH = -4.8; 95% CI -5.5, -4.1; p < 0.001; MMIDS = -3.3; 95% CI -4.4, -2.5; p < 0.001) women were aware of having conceived, even when women who had quit and women who were planning to conceive were excluded from analyses. Pregnancy may interrupt smoking-related processes via mechanisms not previously considered. Plausible candidates and directions for future research are discussed.
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Affiliation(s)
- Suena H. Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay R. Pool
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rachel A. Level
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, Buffalo, New York, USA
| | - Ann M. Stacks
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
| | - Jenae M. Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly A. Espy
- Department of Neuroscience, Developmental and Regenerative Biology; Department of Psychiatry and Behavioral Science, Long School of Medicine, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Lauren S. Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rina D. Eiden
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Norrina B. Allen
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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