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Liu G, Nguyen NQH, Wong KE, Agarwal SK, Boerwinkle E, Chang PP, Claggett BL, Loehr LR, Ma J, Matsushita K, Rodriguez CJ, Rossi JS, Russell SD, Stacey RB, Shah AM, Yu B. Metabolomic Association and Risk Prediction With Heart Failure in Older Adults. Circ Heart Fail 2024; 17:e010896. [PMID: 38426319 PMCID: PMC10942215 DOI: 10.1161/circheartfailure.123.010896] [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: 05/23/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Older adults have markedly increased risks of heart failure (HF), specifically HF with preserved ejection fraction (HFpEF). Identifying novel biomarkers can help in understanding HF pathogenesis and improve at-risk population identification. This study aimed to identify metabolites associated with incident HF, HFpEF, and HF with reduced ejection fraction and examine risk prediction in older adults. METHODS Untargeted metabolomic profiling was performed in Black and White adults from the ARIC study (Atherosclerosis Risk in Communities) visit 5 (n=3719; mean age, 75 years). We applied Cox regressions to identify metabolites associated with incident HF and its subtypes. The metabolite risk score (MRS) was constructed and examined for associations with HF, echocardiographic measures, and HF risk prediction. Independent samples from visit 3 (n=1929; mean age, 58 years) were used for replication. RESULTS Sixty metabolites (hazard ratios range, 0.79-1.49; false discovery rate, <0.05) were associated with incident HF after adjusting for clinical risk factors, eGFR, and NT-proBNP (N-terminal pro-B-type natriuretic peptide). Mannonate, a hydroxy acid, was replicated (hazard ratio, 1.36 [95% CI, 1.19-1.56]) with full adjustments. MRS was associated with an 80% increased risk of HF per SD increment, and the highest MRS quartile had 8.7× the risk of developing HFpEF than the lowest quartile. High MRS was also associated with unfavorable values of cardiac structure and function. Adding MRS over clinical risk factors and NT-proBNP improved 5-year HF risk prediction C statistics from 0.817 to 0.850 (∆C, 0.033 [95% CI, 0.017-0.047]). The association between MRS and incident HF was replicated after accounting for clinical risk factors (P<0.05). CONCLUSIONS Novel metabolites associated with HF risk were identified, elucidating disease pathways, specifically HFpEF. An MRS was associated with HF risk and improved 5-year risk prediction in older adults, which may assist at at-risk population identification.
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Affiliation(s)
- Guning Liu
- Department of Epidemiology, Human Genetics Center and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston (G.L., N.Q.H.N., E.B., J.M., B.Y.)
| | - Ngoc Quynh H. Nguyen
- Department of Epidemiology, Human Genetics Center and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston (G.L., N.Q.H.N., E.B., J.M., B.Y.)
| | - Kari E. Wong
- Metabolon Inc, Research Triangle Park, Morrisville, NC (K.E.W.)
| | - Sunil K. Agarwal
- Interventional Cardiology at St. John’s Hospital, Hospital Sister Health System, Springfield, IL (S.K.A.)
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics Center and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston (G.L., N.Q.H.N., E.B., J.M., B.Y.)
| | - Patricia P. Chang
- Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill (P.P.C., J.S.R.)
| | - Brian L. Claggett
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (B.L.C.)
| | - Laura R. Loehr
- Department of Medicine, University of North Carolina, Chapel Hill (L.R.L.)
| | - Jianzhong Ma
- Department of Epidemiology, Human Genetics Center and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston (G.L., N.Q.H.N., E.B., J.M., B.Y.)
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.)
| | - Carlos J. Rodriguez
- Department of Medicine, Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (C.J.R.)
| | - Joseph S. Rossi
- Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill (P.P.C., J.S.R.)
| | - Stuart D. Russell
- Department of Medicine, Duke University School of Medicine, Durham, NC (S.D.R.)
| | - R. Brandon Stacey
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (R.B.S.)
| | - Amil M. Shah
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.M.S.)
| | - Bing Yu
- Department of Epidemiology, Human Genetics Center and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston (G.L., N.Q.H.N., E.B., J.M., B.Y.)
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Babalola KT, Arora M, Ganugula R, Agarwal SK, Mohan C, Kumar MNVR. Leveraging Lymphatic System Targeting in Systemic Lupus Erythematosus for Improved Clinical Outcomes. Pharmacol Rev 2024; 76:228-250. [PMID: 38351070 PMCID: PMC10877736 DOI: 10.1124/pharmrev.123.000938] [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: 07/20/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 02/16/2024] Open
Abstract
The role of advanced drug delivery strategies in drug repositioning and minimizing drug attrition rates, when applied early in drug discovery, is poised to increase the translational impact of various therapeutic strategies in disease prevention and treatment. In this context, drug delivery to the lymphatic system is gaining prominence not only to improve the systemic bioavailability of various pharmaceutical drugs but also to target certain specific diseases associated with the lymphatic system. Although the role of the lymphatic system in lupus is known, very little is done to target drugs to yield improved clinical benefits. In this review, we discuss recent advances in drug delivery strategies to treat lupus, the various routes of drug administration leading to improved lymph node bioavailability, and the available technologies applied in other areas that can be adapted to lupus treatment. Moreover, this review also presents some recent findings that demonstrate the promise of lymphatic targeting in a preclinical setting, offering renewed hope for certain pharmaceutical drugs that are limited by efficacy in their conventional dosage forms. These findings underscore the potential and feasibility of such lymphatic drug-targeting approaches to enhance therapeutic efficacy in lupus and minimize off-target effects of the pharmaceutical drugs. SIGNIFICANCE STATEMENT: The World Health Organization estimates that there are currently 5 million humans living with some form of lupus. With limited success in lupus drug discovery, turning to effective delivery strategies with existing drug molecules, as well as those in the early stage of discovery, could lead to better clinical outcomes. After all, effective delivery strategies have been proven to improve treatment outcomes.
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Affiliation(s)
- K T Babalola
- The Center for Convergent Bioscience and Medicine (CCBM) (K.T.B., M.A., R.G., M.N.V.R.K.), Division of Translational Science and Medicine, College of Community Health Sciences (K.T.B., M.A., R.G., M.N.V.R.K.), Alabama Life Research Institute (K.T.B., M.A., R.G., M.N.V.R.K.), and Department of Biological Sciences (M.A., R.G., M.N.V.R.K.), The University of Alabama, Tuscaloosa, Alabama; Section of Immunology, Allergy and Rheumatology, Department of Medicine, Biology of Inflammation Baylor College of Medicine, One Baylor Plaza, Houston, Texas (S.K.A.); Department of Biomedical Engineering, University of Houston, Houston, Texas (C.M.); Chemical and Biological Engineering, University of Alabama, Tuscaloosa, Alabama (M.N.V.R.K.); and Center for Free Radical Biology (M.N.V.R.K.) and Nephrology Research and Training Center, Division of Nephrology, Department of Medicine (M.N.V.R.K.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M Arora
- The Center for Convergent Bioscience and Medicine (CCBM) (K.T.B., M.A., R.G., M.N.V.R.K.), Division of Translational Science and Medicine, College of Community Health Sciences (K.T.B., M.A., R.G., M.N.V.R.K.), Alabama Life Research Institute (K.T.B., M.A., R.G., M.N.V.R.K.), and Department of Biological Sciences (M.A., R.G., M.N.V.R.K.), The University of Alabama, Tuscaloosa, Alabama; Section of Immunology, Allergy and Rheumatology, Department of Medicine, Biology of Inflammation Baylor College of Medicine, One Baylor Plaza, Houston, Texas (S.K.A.); Department of Biomedical Engineering, University of Houston, Houston, Texas (C.M.); Chemical and Biological Engineering, University of Alabama, Tuscaloosa, Alabama (M.N.V.R.K.); and Center for Free Radical Biology (M.N.V.R.K.) and Nephrology Research and Training Center, Division of Nephrology, Department of Medicine (M.N.V.R.K.), University of Alabama at Birmingham, Birmingham, Alabama
| | - R Ganugula
- The Center for Convergent Bioscience and Medicine (CCBM) (K.T.B., M.A., R.G., M.N.V.R.K.), Division of Translational Science and Medicine, College of Community Health Sciences (K.T.B., M.A., R.G., M.N.V.R.K.), Alabama Life Research Institute (K.T.B., M.A., R.G., M.N.V.R.K.), and Department of Biological Sciences (M.A., R.G., M.N.V.R.K.), The University of Alabama, Tuscaloosa, Alabama; Section of Immunology, Allergy and Rheumatology, Department of Medicine, Biology of Inflammation Baylor College of Medicine, One Baylor Plaza, Houston, Texas (S.K.A.); Department of Biomedical Engineering, University of Houston, Houston, Texas (C.M.); Chemical and Biological Engineering, University of Alabama, Tuscaloosa, Alabama (M.N.V.R.K.); and Center for Free Radical Biology (M.N.V.R.K.) and Nephrology Research and Training Center, Division of Nephrology, Department of Medicine (M.N.V.R.K.), University of Alabama at Birmingham, Birmingham, Alabama
| | - S K Agarwal
- The Center for Convergent Bioscience and Medicine (CCBM) (K.T.B., M.A., R.G., M.N.V.R.K.), Division of Translational Science and Medicine, College of Community Health Sciences (K.T.B., M.A., R.G., M.N.V.R.K.), Alabama Life Research Institute (K.T.B., M.A., R.G., M.N.V.R.K.), and Department of Biological Sciences (M.A., R.G., M.N.V.R.K.), The University of Alabama, Tuscaloosa, Alabama; Section of Immunology, Allergy and Rheumatology, Department of Medicine, Biology of Inflammation Baylor College of Medicine, One Baylor Plaza, Houston, Texas (S.K.A.); Department of Biomedical Engineering, University of Houston, Houston, Texas (C.M.); Chemical and Biological Engineering, University of Alabama, Tuscaloosa, Alabama (M.N.V.R.K.); and Center for Free Radical Biology (M.N.V.R.K.) and Nephrology Research and Training Center, Division of Nephrology, Department of Medicine (M.N.V.R.K.), University of Alabama at Birmingham, Birmingham, Alabama
| | - C Mohan
- The Center for Convergent Bioscience and Medicine (CCBM) (K.T.B., M.A., R.G., M.N.V.R.K.), Division of Translational Science and Medicine, College of Community Health Sciences (K.T.B., M.A., R.G., M.N.V.R.K.), Alabama Life Research Institute (K.T.B., M.A., R.G., M.N.V.R.K.), and Department of Biological Sciences (M.A., R.G., M.N.V.R.K.), The University of Alabama, Tuscaloosa, Alabama; Section of Immunology, Allergy and Rheumatology, Department of Medicine, Biology of Inflammation Baylor College of Medicine, One Baylor Plaza, Houston, Texas (S.K.A.); Department of Biomedical Engineering, University of Houston, Houston, Texas (C.M.); Chemical and Biological Engineering, University of Alabama, Tuscaloosa, Alabama (M.N.V.R.K.); and Center for Free Radical Biology (M.N.V.R.K.) and Nephrology Research and Training Center, Division of Nephrology, Department of Medicine (M.N.V.R.K.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M N V Ravi Kumar
- The Center for Convergent Bioscience and Medicine (CCBM) (K.T.B., M.A., R.G., M.N.V.R.K.), Division of Translational Science and Medicine, College of Community Health Sciences (K.T.B., M.A., R.G., M.N.V.R.K.), Alabama Life Research Institute (K.T.B., M.A., R.G., M.N.V.R.K.), and Department of Biological Sciences (M.A., R.G., M.N.V.R.K.), The University of Alabama, Tuscaloosa, Alabama; Section of Immunology, Allergy and Rheumatology, Department of Medicine, Biology of Inflammation Baylor College of Medicine, One Baylor Plaza, Houston, Texas (S.K.A.); Department of Biomedical Engineering, University of Houston, Houston, Texas (C.M.); Chemical and Biological Engineering, University of Alabama, Tuscaloosa, Alabama (M.N.V.R.K.); and Center for Free Radical Biology (M.N.V.R.K.) and Nephrology Research and Training Center, Division of Nephrology, Department of Medicine (M.N.V.R.K.), University of Alabama at Birmingham, Birmingham, Alabama
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Kute VB, Guleria S, Bhalla AK, Sharma A, Agarwal SK, Sahay M, Varughese S, Prasad N, Varma PP, Shroff S, Vardhan H, Balwani M, Dave S, Bhadauria D, Rathi M, Agarwal D, Shah P, Prakash J. ISOT Consensus Statement for the Kidney Transplant Recipient and Living Donor with a Previous Diagnosis of COVID-19. Indian J Nephrol 2022; 32:288-290. [PMID: 35967531 PMCID: PMC9365002 DOI: 10.4103/ijn.ijn_120_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Sharma
- Department of Transplantation Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - P P Varma
- Department of Nephrology, Primus Super Speciality Hospital, Delhi, New Delhi, India
| | | | - Harsh Vardhan
- Department of Nephrology, Patna Medical College, Patna, Bihar, India
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Shruti Dave
- Department of Pathology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Dhamendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - Manish Rathi
- Department of Nephrology, PostgraduateInstitute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Pankaj Shah
- Department of Nephrology Gujarat University of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Jai Prakash
- President, Indian Society of Organ Transplantation, Former Professor and Head Nephology Banaras Hindu University, Varanasi, Utter Pradesh, India
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Liu G, Nguyen Q, Agarwal SK, Aguilar D, Boerwinkle E, Chang P, Claggett B, Loehr LR, Matsushita K, Rodriguez C, Rossi J, Russell SD, Stacey B, Heiss GM, Shah A, Yu B. Abstract MP07: Metabolic Signature Improves Heart Failure Risk Prediction In Older Adults. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Circulating metabolome profiling holds promise in predicting HF risk, but its prediction performance among older adults is not well established.
Hypothesis:
We hypothesize that metabolic signatures are associated with the risk of HF and its subtypes (HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)), and they can improve HF risk prediction beyond established risk factors.
Methods:
We measured 828 serum metabolites among 4,030 African and European Americans free of HF from the Atherosclerosis Risk in Communities (ARIC) study visit 5 (2011-2013). We regressed incident HF on each metabolite using Cox proportional hazards models. A metabolite risk score (MRS) was derived by summing individual metabolite levels weighted by beta coefficients estimated from least absolute shrinkage and selection operator (LASSO) regularized regressions. We regressed incident HF, HFpEF and HFrEF on the MRS. Harrell’s C-statistics were calculated to evaluate risk discrimination. We replicated the association between MRS and HF in 3,697 independent ARIC participants with metabolite measured at visit 1 (1987-1989).
Results:
Among 4,030 participants, the mean (SD) age was 76 (5) years. Adjusting for HF risk factors, 302 metabolites were associated with incident HF (false discovery rate < 0.05). One SD increase of the MRS, constructed from 51 metabolites selected by LASSO, was associated with two to three-fold high risk of HF, HFpEF and HFrEF in the fully adjusted models (
Table
). Five-year risk prediction analysis showed that C statistics improved from 0.850 to 0.884 by adding MRS over ARIC HF risk factors, kidney function and NT-proBNP (ΔC (95%CI) = 0.034 (0.017,0.052)). In the replication analysis, a more parsimonious MRS constructed using 15 metabolites, was associated with incident HF (
Table
).
Conclusions:
We identified a metabolic signature that was associated with the risk of HF and improved HF risk prediction. Our findings may shed light on pathways in HF development and at-risk populations.
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Affiliation(s)
- Guning Liu
- Dept of Epidemiology, Human Genetics, and Environmental Sciences, Sch of Public Health, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | - Quynh Nguyen
- Dept of Epidemiology, Human Genetics, and Environmental Sciences, Sch of Public Health, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | | | | | | | | | | | | | | | | | - Joseph Rossi
- Sch of Medicine, Univ of North Carolina, Chapel Hill, NC
| | | | - Brandon Stacey
- Cardiovascular Medicine Section, Dept of Internal Medicine, Wake Forest Sch of Medicine, Winston-Salem, NC
| | | | - Amil Shah
- Div of Cardiovascular Medicine, Brigham and Women’s Hosp, Boston, MA
| | - Bing Yu
- UNIV OF TX HEALTH SCI CTR HOUSTON, Houston, TX
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5
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Sharma K, Mok Y, Kwak L, Agarwal SK, Chang PP, Deswal A, Shah AM, Kitzman DW, Wruck LM, Loehr LR, Heiss G, Coresh J, Rosamond WD, Solomon SD, Matsushita K, Russell SD. Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study. J Am Heart Assoc 2020; 9:e014669. [PMID: 32924735 PMCID: PMC7792380 DOI: 10.1161/jaha.119.014669] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all‐cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. Methods and Results Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1‐year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [P=0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [P=0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. Conclusions In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex‐ and race‐based differences in predictors of mortality may help strategize targeted management of HFpEF.
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Affiliation(s)
- Kavita Sharma
- Division of Cardiology The Johns Hopkins Hospital Baltimore MD
| | - Yejin Mok
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Lucia Kwak
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | | | - Patricia P Chang
- Department of Medicine University of North Carolina Chapel Hill NC
| | - Anita Deswal
- Section of Cardiology Michael E. DeBakey VA Medical Center Baylor College of Medicine Houston TX
| | - Amil M Shah
- Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Dalane W Kitzman
- Cardiology and Geriatrics Sections Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Lisa M Wruck
- Duke Clinical Research InstituteCenter for Predictive Medicine Durham NC
| | - Laura R Loehr
- Department of Epidemiology University of North Carolina Chapel Hill NC
| | - Gerardo Heiss
- Department of Epidemiology University of North Carolina Chapel Hill NC
| | - Josef Coresh
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Wayne D Rosamond
- Department of Epidemiology University of North Carolina Chapel Hill NC
| | - Scott D Solomon
- Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Kunihiro Matsushita
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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Mosher AA, Tsoulis MW, Lim J, Tan C, Agarwal SK, Leyland NA, Foster WG. Melatonin activity and receptor expression in endometrial tissue and endometriosis. Hum Reprod 2020; 34:1215-1224. [PMID: 31211323 DOI: 10.1093/humrep/dez082] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 01/18/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Are melatonin receptors (melatonin receptor 1A (MR1A) and melatonin receptor 1B (MR1B)) expressed in human endometrium and endometriotic tissue, and does melatonin affect endometrial cell proliferation? SUMMARY ANSWER Melatonin receptors are expressed in human eutopic endometrium, endometriomas and peritoneal lesions, although to different extents, and melatonin treatment attenuated estradiol-induced endometrial epithelial cell proliferation in culture. WHAT IS KNOWN ALREADY Melatonin decreased endometriotic lesion volume in a rat model of endometriosis. Melatonin treatment reduced pain scores in and analgesic use by women with endometriosis. STUDY DESIGN, SIZE, DURATION Basic science study using human endometrial tissue and an endometrial epithelial cell line. PARTICIPANTS/MATERIALS, SETTING, METHODS Measurement of melatonin receptor expression (mRNA and protein) in women with surgically confirmed endometriosis (endometrioma (n = 20) or peritoneal lesion (n = 11) alone) and women without surgical evidence of endometriosis (control, n = 15). Collection of endometrial and endometriotic tissue samples, gynecologic history and demographic information. Quantification of estradiol (1.0 nM) and melatonin (0.1 nM-1.0 μM) ± estradiol-induced endometrial epithelial cell proliferation in cultures of endometrial epithelial cells (CRL-1671) following 24 and 48 hours of culture. MAIN RESULTS AND THE ROLE OF CHANCE MR1A and MR1B were localized by immunohistochemistry in glandular epithelial cells of endometrial biopsies from women with and without endometriosis. Both receptors were expressed in eutopic and ectopic endometrial tissue. mRNA expression of MR1A and MR1B was significantly greater in peritoneal lesions than in either endometriomas or eutopic endometrium. However, protein expression of MR1A was decreased in peritoneal lesions compared to control eutopic endometrium, whereas MR1B expression did not differ between the groups. Melatonin (0.1 nM-1.0 μM) treatment inhibited estradiol (1.0 nM)-induced endometrial epithelial cell proliferation at 48 hours but not 24 hours of culture. LIMITATIONS, REASONS FOR CAUTION Beneficial effects of melatonin seen in culture have yet to be comprehensively evaluated in women with endometriosis. WIDER IMPLICATIONS OF THE FINDINGS Our data suggest that melatonin may be useful as an adjunct to current endometriosis treatments. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Canadian Institutes of Health Research (grant MOP142230 to W.G.F.). A.A.M. is supported by a resident research grant through the Physicians Services Incorporated Foundation. The authors have no conflicts of interest.
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Affiliation(s)
- A A Mosher
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - M W Tsoulis
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - J Lim
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - C Tan
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - S K Agarwal
- Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
| | - N A Leyland
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - W G Foster
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada.,Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
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Das C, Ahmad Z, Bagchi S, Naranje P, Agarwal SK. Imaging spectrum of pulmonary infections in renal transplant patients. Indian J Radiol Imaging 2020; 30:273-279. [PMID: 33273760 PMCID: PMC7694710 DOI: 10.4103/ijri.ijri_357_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/24/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022] Open
Abstract
In the post renal transplant setting, pulmonary infections comprise an important set of complications. Microbiological diagnosis although specific is often delayed and insensitive. Radiography is the most common and first imaging test for which patient is referred, however it is relatively insensitive. HRCT is a very useful imaging tool in the scenario where radiography is negative or inconclusive and high clinical suspicion for infection is present. HRCT features vary among the various pathogens and also depend on the level of immunocompromise. Certain HRCT findings are characteristic for specific pathogens and may help narrow diagnosis. In this review article, we will summarize the imaging findings of various pulmonary infections encountered in post renal transplant patients.
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8
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Koton S, Wruck L, Quibrera PM, Gottesman RF, Agarwal SK, Jones SA, Wright JD, Shahar E, Coresh J, Rosamond WD. Temporal trends in validated ischaemic stroke hospitalizations in the USA. Int J Epidemiol 2019; 48:994-1003. [PMID: 30879069 DOI: 10.1093/ije/dyz025] [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] [Accepted: 03/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate assessment of the burden of stroke, a major cause of disability and death, is crucial. We aimed to estimate rates of validated ischaemic stroke hospitalizations in the USA during 1998-2011. METHODS We used the Atherosclerosis Risk in Communities (ARIC) study cohort's adjudicated stroke data for participants aged ≥55 years, to construct validation models for each International Classification of Diseases (ICD)-code group and patient covariates. These models were applied to the Nationwide Inpatient Sample (NIS) data to estimate the probability of validated ischaemic stroke for each eligible hospitalization. Rates and trends in NIS using ICD codes vs estimates of validated ischaemic stroke were compared. RESULTS After applying validation models, the estimated annual average rate of validated ischaemic stroke hospitalizations in the USA during 1998-2011 was 3.37 [95% confidence interval (CI): 3.31, 3.43) per 1000 person-years. Validated rates declined during 1998-2011 from 4.7/1000 to 2.9/1000; however, the decline was limited to 1998-2007, with no further decline subsequently through 2011. Validation models showed that the false-positive (∼23% of strokes) and false-negative rates of ICD-9-CM codes in primary position for ischaemic stroke approximately cancel. Therefore, estimates of ischaemic stroke hospitalizations did not substantially change after applying validation models. CONCLUSIONS Overall, ischaemic stroke hospitalization rates in the USA have declined during 1998-2007, but no further decline was observed from 2007 to 2011. Validated ischaemic stroke hospitalizations estimates were similar to published estimates of hospitalizations with ischaemic stroke ICD codes in primary position. Validation of national discharge data using prospective chart review data is important to estimate the accuracy of reported burden of stroke.
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Affiliation(s)
- Silvia Koton
- Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Pedro Miguel Quibrera
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil K Agarwal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sydney A Jones
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Eyal Shahar
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Sood S, Agarwal SK, Singh R, Gupta S, Sharma VK. In vitro assessment of gentamicin and azithromycin-based combination therapy against Neisseria gonorrhoeae isolates in India. J Med Microbiol 2019; 68:555-559. [PMID: 30869583 DOI: 10.1099/jmm.0.000953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The public health burden of infections caused by Neisseria gonorrhoeae is magnified due to high rates of resistance to traditional antimicrobials. The aim of this study was to evaluate the in vitro efficacy of an alternative dual therapy comprising gentamicin and azithromycin. METHODOLOGY The E-test method was used to determine the minimum inhibitory concentrations (MICs) of gentamicin and azithromycin individually prior to testing in combination using the cross or 90o angle formation method. A total of 70 clinical isolates of N.gonorrhoeae displaying varying ceftriaxone MICs along with 2 reference strains (WHO K and P) and 1 ceftriaxone-resistant QA isolate were examined. The fractional inhibitory concentration index (FICI) was calculated and the results were interpreted using the following criteria: synergy, FICI ≤0.5; indifference or additive, FICI >0.5 to ≤4.0; and antagonism, FICI >4.0. RESULTS A total of 54 (77.1 %) isolates displayed indifference, while 16 (22.9 %) demonstrated synergy. When azithromycin was tested alone, the MICs ranged from 0.016 to 2 µg ml-1 . However, in combination with gentamicin, the mean MIC value of all isolates decreased from 0.275 µg ml-1 to 0.090 µg ml-1 (P=0.05).When gentamicin was tested alone, the MICs ranged from 0.25 to 8 µg ml-1, with a mean MIC of 4.342 µg ml-1, whereas in combination with azithromycin it decreased significantly to 2.042 µg ml-1 (P=0.04). CONCLUSION No antagonism was observed in this combination, suggesting that it could be a future treatment option as we prepare for a post-cephalosporin era. However, comprehensive in vivo evaluations are warranted and recommendations should be made based on clinical trials.
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Affiliation(s)
- S Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - R Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Magnani JW, Norby FL, Agarwal SK, Soliman EZ, Chen LY, Loehr LR, Alonso A. Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities (ARIC) Study. JAMA Cardiol 2018; 1:433-41. [PMID: 27438320 DOI: 10.1001/jamacardio.2016.1025] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The adverse outcomes associated with atrial fibrillation (AF) have been studied in predominantly white cohorts. Racial differences in outcomes associated with AF merit continued investigation. OBJECTIVE To evaluate the race-specific associations of AF with stroke, heart failure, coronary heart disease (CHD), and all-cause mortality in a community-based cohort. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities (ARIC) Study is a prospective, observational cohort. From 1987 through 1989, the ARIC Study enrolled 15 792 men and women and conducted 4 follow-up examinations (2011-2013) with active surveillance for vital status and hospitalizations. Race was determined by self-report and categorized as white, black, or other. MAIN OUTCOMES AND MEASURES Atrial fibrillation (adjudicated using electrocardiograms, hospital discharge codes, and death certificates), stroke, heart failure, CHD, and mortality. RESULTS After exclusions, 15 080 participants (mean [SD] age, 54.2 [5.8] years; 8290 women [55.5%]; 3831 black individuals [25.4%]) were included in this analysis. During a mean (SD) follow-up of 20.6 (6.2) years, there were 2348 cases of incident AF. The incident rates of AF per 1000 person-years were 8.1 (95% CI, 7.7-8.5) in white individuals and 5.8 (95% CI, 5.2-6.3) in black individuals. The rates of stroke, heart failure, CHD, and mortality were higher in black individuals with AF than white individuals with AF. The association of AF with these outcomes, estimated with rate differences (rate of the end point in those with AF minus the rate in those without AF per 1000 person-years), also differed by race. The rate difference for stroke in individuals with AF was 10.2 (95% CI, 6.6-13.9) in white individuals and 21.4 (95% CI, 10.2-32.6) in black individuals. For heart failure and CHD, the rate differences were 1.5- to 2.0-fold higher in black individuals than white individuals. White individuals with AF had a rate difference of 55.9 (95% CI, 48.1-63.7) for mortality compared with black individuals, who had a rate difference of 106.0 (95% CI, 86.0-125.9). CONCLUSIONS AND RELEVANCE In the prospective ARIC Study, the outcome of AF on the rates of stroke, heart failure, CHD, and mortality was considerably larger in black individuals than white individuals. These results indicate the vulnerability and increased risk in black individuals with AF. Continued investigation of racial differences in AF and its related adverse outcomes are essential to identify and mitigate racial disparities in the treatment of AF.
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Affiliation(s)
- Jared W Magnani
- Cardiology Section, Whitaker Cardiovascular Institute, Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts2currently with the Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center Hea
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Sunil K Agarwal
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Laura R Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
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Kaushik A, Kapoor A, Agarwal SK, Pandey S, Kumar S, Khanna R, Garg N, Tewari S, Goel P. P3607Can high-dose statin therapy given before off-pump CABG “recapture” cardioprotection in patients already on chronic statin therapy: Assessment by serial cardiac biomarker assay. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Kaushik
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - A Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - S K Agarwal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - S Pandey
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - S Kumar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - R Khanna
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - N Garg
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - S Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - P Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Chang PP, Wruck LM, Shahar E, Rossi JS, Loehr LR, Russell SD, Agarwal SK, Konety SH, Rodriguez CJ, Rosamond WD. Trends in Hospitalizations and Survival of Acute Decompensated Heart Failure in Four US Communities (2005-2014): ARIC Study Community Surveillance. Circulation 2018; 138:12-24. [PMID: 29519849 PMCID: PMC6030442 DOI: 10.1161/circulationaha.117.027551] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Community trends of acute decompensated heart failure (ADHF) in diverse populations may differ by race and sex. METHODS The ARIC study (Atherosclerosis Risk in Communities) sampled heart failure-related hospitalizations (≥55 years of age) in 4 US communities from 2005 to 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification codes. ADHF hospitalizations were validated by standardized physician review and computer algorithm, yielding 40 173 events after accounting for sampling design (unweighted n=8746). RESULTS Of the ADHF hospitalizations, 50% had reduced ejection fraction, and 39% had preserved EF (HFpEF). HF with reduced ejection fraction was more common in black men and white men, whereas HFpEF was most common in white women. Average age-adjusted rates of ADHF were highest in blacks (38.1 per 1000 black men, 30.5 per 1000 black women), with rates differing by HF type and sex. ADHF rates increased over the 10 years (average annual percentage change: black women +4.3%, black men +3.7%, white women +1.9%, white men +2.6%), mostly reflecting more acute HFpEF. Age-adjusted 28-day and 1-year case fatality proportions were ≈10% and 30%, respectively, similar across race-sex groups and HF types. Only blacks showed decreased 1-year mortality over time (average annual percentage change: black women -5.4%, black men -4.6%), with rates differing by HF type (average annual percentage change: black women HFpEF -7.1%, black men HF with reduced ejection fraction -4.7%). CONCLUSIONS Between 2005 and 2014, trends in ADHF hospitalizations increased in 4 US communities, primarily driven by acute HFpEF. Survival at 1 year was poor regardless of EF but improved over time for black women and black men.
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Affiliation(s)
| | - Lisa M Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC (L.M.W.)
| | - Eyal Shahar
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson (E.S.)
| | | | - Laura R Loehr
- Epidemiology (L.R.L., W.D.R.), University of North Carolina, Chapel Hill
| | - Stuart D Russell
- Department of Medicine, Johns Hopkins University, Baltimore, MD (S.D.R.)
| | - Sunil K Agarwal
- Department of Medicine, Mount Sinai Health Systems, New York (S.K.A.)
| | - Suma H Konety
- Department of Medicine, University of Minnesota, Minneapolis (S.H.K.)
| | - Carlos J Rodriguez
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC (C.J.R.)
| | - Wayne D Rosamond
- Epidemiology (L.R.L., W.D.R.), University of North Carolina, Chapel Hill
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13
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Bekwelem W, Norby FL, Agarwal SK, Matsushita K, Coresh J, Alonso A, Chen LY. Association of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc 2018; 7:JAHA.117.007452. [PMID: 29666066 PMCID: PMC6015443 DOI: 10.1161/jaha.117.007452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Although peripheral artery disease as defined by ankle‐brachial index (ABI) is associated with incident atrial fibrillation (AF), questions remain about the risk of AF in borderline ABI (>0.90 to <1.0) or noncompressible arteries (>1.4). We evaluated the association of borderline ABI and ABI >1.4 in the ARIC (Atherosclerosis Risk in Communities) study, a population‐based prospective cohort study. Methods and Results We included 14 794 participants (age, 54.2±5.8 years, 55% women, 26% blacks) with ABI measured at the baseline (1987–1989) and without AF. AF was identified from hospital records, death certificates, and ECGs. Using Cox proportional hazards, we evaluated the association between ABI and AF. During a median follow‐up of 23.3 years, there were 2288 AF cases. After adjustment for cardiovascular risk factors, hazard ratio (HR) (95% confidence interval) for AF among individuals with ABI <1.0 compared with ABI 1.0 to 1.4, was 1.13 (1.01–1.27). ABI >1.4 was not associated with increased AF risk. ABI ≤0.9 and borderline ABI were associated with a higher risk of AF compared with ABI 1.0 to 1.4. Demographics‐adjusted HRs (95% confidence interval) were 1.43 (1.17–1.75) and 1.32 (1.16–1.50), respectively. However, the associations of ABI ≤0.9 and borderline ABI with AF were attenuated after adjusting for cardiovascular risk factors (HR [95% confidence interval], 1.10 [0.90–1.34] and 1.14 [1.00–1.30]), respectively. Conclusions Peripheral artery disease indicated by low ABI, including borderline ABI, is a weak risk factor for AF. ABI >1.4 is not associated with an increased AF risk. The relationship between peripheral artery disease and AF appears to be mostly explained by traditional atherosclerotic risk factors.
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Affiliation(s)
- Wobo Bekwelem
- Cardiovascular Division, University of Minnesota, Minneapolis, MN
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | | | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
| | - Lin Y Chen
- Cardiovascular Division, University of Minnesota, Minneapolis, MN
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Chen LY, Norby FL, Gottesman RF, Mosley TH, Soliman EZ, Agarwal SK, Loehr LR, Folsom AR, Coresh J, Alonso A. Association of Atrial Fibrillation With Cognitive Decline and Dementia Over 20 Years: The ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study). J Am Heart Assoc 2018. [PMID: 29514809 PMCID: PMC5907543 DOI: 10.1161/jaha.117.007301] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Previous studies have reported that atrial fibrillation (AF) is associated with cognitive decline and dementia. These studies, however, had limited follow‐up, were based mostly on white and highly selected populations, and did not account for attrition. We evaluated the association of incident AF with 20‐year change in cognitive performance (accounting for attrition) and incident dementia in the ARIC (Atherosclerosis Risk in Communities) Study. Methods and Results We analyzed data from 12 515 participants (mean age, 56.9 [SD, 5.7] years in 1990–1992; 56% women and 24% black) from 1990 to 1992 through 2011 to 2013. Incident AF was ascertained from study ECGs and hospital discharge codes. Cognitive tests were performed in 1990 to 1992, 1996 to 1998, and 2011 to 2013. Incident dementia was clinician adjudicated. We used generalized estimating equations and Cox proportional hazards models to assess the association of time‐dependent AF with change in Z scores of cognitive tests and incident dementia, respectively. During 20 years, 2106 participants developed AF and 1157 participants developed dementia. After accounting for cardiovascular risk factors, including ischemic stroke, the average decline over 20 years in global cognitive Z score was 0.115 (95% confidence interval, 0.014–0.215) greater in participants with AF than in those without AF. Further adjustment for attrition by multiple imputation by chained equations strengthened the association. In addition, incident AF was associated with an increased risk of dementia (hazard ratio, 1.23; 95% confidence interval, 1.04–1.45), after adjusting for cardiovascular risk factors, including ischemic stroke. Conclusions AF is associated with greater cognitive decline and increased risk of dementia, independent of ischemic stroke. Because cognitive decline is a precursor to dementia, our findings prompt further investigation to identify specific treatments for AF that will delay the trajectory of cognitive decline and, thus, prevent dementia in patients with AF.
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Affiliation(s)
- Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas H Mosley
- Department of Neurology, University of Mississippi School of Medicine, Jackson, MS
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sunil K Agarwal
- Department of Medicine, Mount Sinai School of Medicine, New York, NY
| | - Laura R Loehr
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina, Chapel Hill, NC
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
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15
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Kothari V, Agarwal AK, Agarwal SK, Agarwal A, Srivastava AK. Erratum to Clinical comparison of 27 size sorin and medtronic mitral prostheses. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-002-0039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Thorvaldsen T, Claggett BL, Shah A, Cheng S, Agarwal SK, Wruck LM, Chang PP, Rosamond WD, Lewis EF, Desai AS, Lund LH, Solomon SD. Predicting Risk in Patients Hospitalized for Acute Decompensated Heart Failure and Preserved Ejection Fraction: The Atherosclerosis Risk in Communities Study Heart Failure Community Surveillance. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.003992. [PMID: 29242352 DOI: 10.1161/circheartfailure.117.003992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/31/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Risk-prediction models specifically for hospitalized heart failure with preserved ejection fraction are lacking. METHODS AND RESULTS We analyzed data from the ARIC (Atherosclerosis Risk in Communities) Study Heart Failure Community Surveillance to create and validate a risk score predicting mortality in patients ≥55 years of age admitted with acute decompensated heart failure with preserved ejection fraction (ejection fraction ≥50%). A modified version of the risk-prediction model for acute heart failure developed from patients in the EFFECT (Enhanced Feedback for Effective Cardiac Treatment) study was used as a composite predictor of 28-day and 1-year mortalities and evaluated together with other potential predictors in a stepwise logistic regression. The derivation sample consisted of 1852 hospitalizations from 2005 to 2011 (mean age, 77 years; 65% women; 74% white). Risk scores were created from the identified predictors and validated in hospitalizations from 2012 to 2013 (n=821). Mortality in the derivation and validation sample was 11% and 8% at 28 days and 34% and 31% at 1 year. The modified EFFECT score, including age, systolic blood pressure, blood urea nitrogen, sodium, cerebrovascular disease, chronic obstructive pulmonary disease, and hemoglobin, was a powerful predictor of mortality. Another important predictor for both 28-day and 1-year mortalities was hypoxia. The risk scores were well calibrated and had good discrimination in the derivation sample (area under the curve: 0.76 for 28-day and 0.72 for 1-year mortalities) and validation sample (area under the curve: 0.73 and 0.71, respectively). CONCLUSIONS Mortality after acute decompensation in patients with heart failure with preserved ejection fraction is high, with one third of patients dying within a year. A prediction tool may allow for greater discrimination of the highest risk patients. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00005131.
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Affiliation(s)
- Tonje Thorvaldsen
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Brian L Claggett
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Amil Shah
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Susan Cheng
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Sunil K Agarwal
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Lisa M Wruck
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Patricia P Chang
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Wayne D Rosamond
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Eldrin F Lewis
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Akshay S Desai
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Lars H Lund
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill
| | - Scott D Solomon
- From the Brigham and Women's Hospital Cardiovascular Division, Boston, MA (T.T., B.L.C., A.S., S.C., E.F.L., A.S.D., S.D.S.); Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (T.T., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.T., L.H.L.); Mount Sinai Health Systems, New York, NY (S.K.A.); Duke Clinical Research Institute, Center for Predictive Medicine, Durham, NC (L.M.W.); Departments of Medicine (P.P.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill.
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Lal C, Kaur M, Jaryal AK, Deepak KK, Bhowmik D, Agarwal SK. Reduced Baroreflex Sensitivity, Decreased Heart Rate Variability with Increased Arterial Stiffness in Predialysis. Indian J Nephrol 2017; 27:446-451. [PMID: 29217881 PMCID: PMC5704409 DOI: 10.4103/ijn.ijn_63_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
High cardiovascular morbidity and mortality is observed in predialytic chronic kidney disease (CKD) patients. The underlying mechanism of cardiovascular dysfunction often remains unclear. The present study was designed to perform multiparametric assessment of baroreflex sensitivity (BRS), arterial stiffness indices, and cardiovascular variabilities (heart rate variability [HRV] and blood pressure variability [BPV]) together in predialytic CKD patients; compare it with normal healthy controls; and determine their relationships in predialytic nondiabetic CKD patients. Thirty CKD Stage 4 and 5 predialytic non-diabetic patients and 30 healthy controls were enrolled in the study. BRS was determined by spontaneous sequence method. Short-term HRV and BPV were assessed using 5 min beat-to-beat data of RR intervals and blood pressure by time domain and frequency domain analysis. Arterial stiffness indices - carotid-femoral pulse wave velocity (PWV) and augmentation index - were measured using SphygmoCor Vx device (AtCor Medical, Australia). Predialytic CKD patients had significantly low BRS, high PWV, and low HRV as compared to healthy controls. Independent predictors of reduced systolic BRS in predialytic CKD patient group on multiple regression analysis emerged to be increase in calcium-phosphate product, increase in BPV, and decrease in HRV. Predialytic nondiabetic CKD Stage 4 and 5 patients have poor hemodynamic profile (higher PWV, lower HRV, and reduced BRS) than healthy controls. Reduced HRV and altered calcium-phosphate homeostasis emerged to be significant independent predictors of reduced BRS.
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Affiliation(s)
- C Lal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - M Kaur
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - A K Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - K K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - D Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Patel S, Kwak L, Agarwal SK, Tereshchenko LG, Coresh J, Soliman EZ, Matsushita K. Counterclockwise and Clockwise Rotation of QRS Transitional Zone: Prospective Correlates of Change and Time-Varying Associations With Cardiovascular Outcomes. J Am Heart Assoc 2017; 6:JAHA.117.006281. [PMID: 29101116 PMCID: PMC5721743 DOI: 10.1161/jaha.117.006281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND A few studies have recently reported clockwise and counterclockwise rotations of QRS transition zone as predictors of mortality. However, their prospective correlates and associations with individual cardiovascular disease (CVD) outcomes are yet to be investigated. METHODS AND RESULTS Among 13 567 ARIC (Atherosclerosis Risk in Communities) study participants aged 45 to 64 years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite CVD (4124 events), 898 CVD deaths, and 3469 non-CVD deaths over 23 years of follow-up. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow-up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20; 95% confidence interval [CI], 1.02-1.41) and non-CVD death (hazard ratio, 1.28; 95% CI, 1.12-1.46) after adjusting for potential confounders including other ECG parameters. On the contrary, counterclockwise rotation was significantly related to lower risk of composite CVD (hazard ratio, 0.93; 95% CI, 0.87-0.99]), CVD mortality (hazard ratio, 0.76; 95% CI, 0.65-0.88), and non-CVD deaths (hazard ratio, 0.92; 95% CI, 0.85-0.99 [borderline significance with heart failure]). CONCLUSIONS Counterclockwise rotation, the most prevalent QRS transition zone pattern, demonstrated the lowest risk of CVD and mortality, whereas clockwise rotation was associated with the highest risk of heart failure and non-CVD mortality. These results have implications on how to interpret QRS transition zone rotation when ECG was recorded.
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Affiliation(s)
- Siddharth Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lucia Kwak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sunil K Agarwal
- Division of Cardiology, Mount Sinai Health System, New York, NY
| | | | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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19
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Agarwal SK, Khan AA, Solan M, Lemon M. Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study. Ann R Coll Surg Engl 2017; 99:641-644. [PMID: 29046102 PMCID: PMC5696939 DOI: 10.1308/rcsann.2017.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Accepted: 08/28/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The National Institute of Health and Care Excellence recommends that people with hip fracture should have surgery on the day of, or the day after, admission. However, there remains unacceptable variation in performance around the country, with a range of 13-91% of patients meeting this target. Dedicated trauma lists have insufficient capacity in many hospitals. We occasionally employ a mixed-use emergency theatre to facilitate early surgery. Increased risk of infection has been raised as a concern owing to microbial surface contamination from a preceding unclean case and lack of laminar flow in these theatres. The objective of this study was to investigate whether there is an increased risk of surgical site infections in patients who had hip fracture surgery in a mixed-use emergency theatre. Methods Between August 2010 and July 2014, 74 patients had hip fracture surgery in a mixed-use emergency theatre without laminar flow. This group was compared with a control group of patients who had hip fracture surgery in dedicated orthopaedic theatres with laminar flow. Infection was the primary outcome measured. Results There was no statistically significant difference in the rate of infection, length of stay or 30-day mortality, readmission or reoperation rates between the two groups. Conclusions Operating on hip fractures in mixed-use theatre did not lead to an increase in infection or other complications in our series. We feel that the risk of infection can be balanced against advantages of timely operation and it may therefore be justified to use these theatres when faced with lack of time on the trauma list. A much larger series would be required to investigate the effects of confounders.
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Affiliation(s)
- S K Agarwal
- Royal Surrey County Hospital , Guildford , UK
| | - A A Khan
- Royal Surrey County Hospital , Guildford , UK
| | - M Solan
- Royal Surrey County Hospital , Guildford , UK
| | - M Lemon
- Royal Surrey County Hospital , Guildford , UK
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20
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Matsushita K, Kwak L, Hyun N, Bessel M, Agarwal SK, Loehr LR, Ni H, Chang PP, Coresh J, Wruck LM, Rosamond W. Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance. PLoS One 2017; 12:e0181373. [PMID: 28793319 PMCID: PMC5549913 DOI: 10.1371/journal.pone.0181373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/29/2017] [Indexed: 12/01/2022] Open
Abstract
Background Kidney dysfunction is prevalent and impacts prognosis in patients with acute decompensated heart failure (ADHF). However, most previous reports were from a single hospital, limiting their generalizability. Also, contemporary data using new equation for estimated glomerular filtration rate (eGFR) are needed. Methods and results We analyzed data from the ARIC Community Surveillance for ADHF conducted for residents aged ≥55 years in four US communities between 2005–2011. All ADHF cases (n = 5, 391) were adjudicated and weighted to represent those communities (24,932 weighted cases). The association of kidney function (creatinine-based eGFR by the CKD-EPI equation and blood urea nitrogen [BUN]) during hospitalization with 1-year mortality was assessed using logistic regression. Based on worst and last serum creatinine, there were 82.5% and 70.6% with reduced eGFR (<60 ml/min/1.73m2) and 37.4% and 26.6% with severely reduced eGFR (<30 ml/min/1.73m2), respectively. Lower eGFR (regardless of last or worst eGFR), particularly eGFR <30 ml/min/1.73m2, was significantly associated with higher 1-year mortality independently of potential confounders (odds ratio 1.60 [95% CI 1.26–2.04] for last eGFR 15–29 ml/min/1.73m2 and 2.30 [1.76–3.00] for <15 compared to eGFR ≥60). The association was largely consistent across demographic subgroups. Of interest, when both eGFR and BUN were modeled together, only BUN remained significant. Conclusions Severely reduced eGFR (<30 ml/min/1.73m2) was observed in ~30% of ADHF cases and was an independent predictor of 1-year mortality in community. For prediction, BUN appeared to be superior to eGFR. These findings suggest the need of close attention to kidney dysfunction among ADHF patients.
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Affiliation(s)
- Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Lucia Kwak
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Noorie Hyun
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Marina Bessel
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Sunil K. Agarwal
- Mount Sinai Health Systems, New York City, New York, United States of America
| | - Laura R. Loehr
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Hanyu Ni
- Centers of Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patricia P. Chang
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lisa M. Wruck
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Wayne Rosamond
- University of North Carolina, Chapel Hill, North Carolina, United States of America
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21
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Singh Y, Mirdha BR, Guleria R, Khalil S, Panda A, Chaudhry R, Mohan A, Kabra SK, Kumar L, Agarwal SK. Circulating genotypes of Pneumocystis jirovecii and its clinical correlation in patients from a single tertiary center in India. Eur J Clin Microbiol Infect Dis 2017; 36:1635-1641. [PMID: 28401321 DOI: 10.1007/s10096-017-2977-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/20/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
The present study was carried out with the objectives of genotyping Pneumocystis jirovecii at three distinct loci, to identify the single nucleotide polymorphisms (SNPs), and to study its clinical implications in patients with Pneumocystis pneumonia (PCP). Analysis of genetic diversity in P. jirovecii from immunocompromised patients was carried out by genotyping at three distinct loci encoding mitochondrial large subunit rRNA (mtLSU rRNA), cytochrome b (CYB), and superoxide dismutase (SOD) using polymerase chain reaction (PCR) assays followed by direct DNA sequencing. Of the 300 patients enrolled in the present study, 31 (10.33%) were positive for PCP by a specific mtLSU rRNA nested PCR assay, whereas only 15 P. jirovecii could be amplified at the other two loci (SOD and CYB). These positives were further subjected to sequence typing. Important genotypic combinations between four SNPs (mt85, SOD110, SOD215, and CYB838) and clinical outcomes could be observed in the present study, and mt85A, mt85T, and SOD110C/SOD215T were frequently associated with "negative follow-up". These SNPs were also noted to be relatively more prevalent amongst circulating genotypes in our study population. The present study is the first of its kind from the Indian subcontinent and demonstrated that potential SNPs of P. jirovecii may possibly be attributed to the clinical outcome of PCP episodes in terms of severity or fatality in different susceptible populations likely to develop PCP during their course of illness.
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Affiliation(s)
- Y Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - B R Mirdha
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - S Khalil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - A Panda
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - R Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - A Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - L Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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22
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Kumar S, Mishra A, Srivastava A, Bhatt M, Garg N, Agarwal SK, Pande S, Mittal B. Role of common sarcomeric gene polymorphisms in genetic susceptibility to left ventricular dysfunction. J Genet 2017; 95:263-72. [PMID: 27350668 DOI: 10.1007/s12041-016-0623-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mutations in sarcomeric genes are common genetic cause of cardiomyopathies. An intronic 25-bp deletion in cardiac myosin binding protein C (MYBPC3) at 3' region is associated with dilated and hypertrophic cardiomyopathies in Southeast Asia. However, the frequency of sarcomeric gene polymorphisms and associated clinical presentation have not been established with left ventricular dysfunction (LVD). Therefore, the aim of the present study was to explore the association of MYBPC3 25-bp deletion, titin (TTN) 18 bp I/D, troponin T type 2 (TNNT2) 5 bp I/D and myospryn K2906N polymorphisms with LVD. This study includes 988 consecutive patients with angiographically confirmed coronary artery disease (CAD) and 300 healthy controls. Among the 988 CAD patients, 253 with reduced left ventricle ejection fraction (LVEF≤45%) were categorized as LVD. MYBPC3 25-bp deletion, TTN 18 bp I/D and TNNT2 5 bp I/D polymorphisms were determined by direct polymerase chain reaction method, while myospryn K2906N polymorphism by TaqMan assay. Our results showed that MYBPC3 25-bp deletion polymorphism was significantly associated with elevated risk of LVD (LVEF <45) (healthy controls versus LVD: OR=3.85, P <0.001; and nonLVD versus LVD: OR=1.65, P = 0.035), while TTN 18 bp I/D, TNNT2 5 bp I/D and myospryn K2906N polymorphisms did not show any significant association with LVD. The results also showed that MYBPC3 25-bp deletion polymorphism was significantly associated with other parameters of LV remodelling, i.e. LV dimensions (LV end diastole dimension, LVEDD: P = 0.037 and LV end systolic dimension, LVESD: P = 0.032). Our data suggests that MYBPC3 25-bp deletion may play significant role in conferring LVD as well as CAD risk in north Indian population.
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Affiliation(s)
- Surendra Kumar
- Department of Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226 014, India.
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Bhowmik D, Yadav S, Kumar L, Agarwal S, Agarwal SK, Gupta S. Sequential, Autologous Hematopoietic Stem Cell Transplant Followed by Renal Transplant in Multiple Myeloma. Indian J Nephrol 2017; 27:324-326. [PMID: 28761239 PMCID: PMC5514833 DOI: 10.4103/ijn.ijn_169_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 30-year-old female was symptomatic with headache, fatigue, and weakness since October 2011 and was told to have anemia. In January 2012, she was admitted outside with pulmonary edema. Investigations revealed advanced azotemia, anemia, and hypercalcemia. Urine showed 2 + proteins and 30–35 red blood cells. There was no history of oral ulcers, rash, Raynaud's phenomenon, or hemoptysis. She was evaluated for causes of rapidly progressive “renal failure.” Hemolytic work-up; antinuclear antibody, double-stranded DNA, and anti-neutrophil cytoplasmic antibody were negative. Kidney biopsy was done and interpreted as acute interstitial nephritis with hyaline casts. She was started on hemodialysis and treated with steroids and cyclophosphamide. She came to our institute in January 2012. Investigations showed evidence of paraproteinemia with kappa restriction. Bone marrow showed 15% plasma cells. Kidney biopsy was reviewed and was diagnostic of cast nephropathy. She was treated with 6 monthly cycles of dexamethasone and bortezomib. She achieved complete remission in July 2012. Maintenance doses of bortezomib were continued until May 2014. Autologous bone marrow transplantation was performed on June 06, 2014. Monthly, bortezomib was continued till April 2015. Subsequently, workup for renal transplantation was started with her father as her donor. Test for sensitization was negative. Renal transplantation was done on January 1, 2016, with prednisolone, mycophenolate, and tacrolimus. She achieved a serum creatinine of 0.6 mg% on the 4th postoperative day. Thereafter, she continues to remain stable.
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Affiliation(s)
- D Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Yadav
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - L Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Agarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Bhowmik D, Yadav S, Kumar L, Agarwal S, Agarwal SK, Gupta S. Sequential, autologous hematopoietic stem cell transplant followed by renal transplant in multiple myeloma. Indian J Nephrol 2017. [DOI: 10.4103/0971-4065.202828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Norby FL, Soliman EZ, Chen LY, Bengtson LGS, Loehr LR, Agarwal SK, Alonso A. Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up: The ARIC Study (Atherosclerosis Risk in Communities). Circulation 2016; 134:599-610. [PMID: 27550968 DOI: 10.1161/circulationaha.115.020090] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/22/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Timing and trajectories of cardiovascular risk factor (CVRF) development in relation to atrial fibrillation (AF) have not been described previously. We assessed trajectories of CVRF and incidence of AF over 25 years in the ARIC study (Atherosclerosis Risk in Communities). METHODS We assessed trajectories of CVRF in 2456 individuals with incident AF and 6414 matched control subjects. Subsequently, we determined the association of CVRF trajectories with the incidence of AF among 10 559 AF-free individuals (mean age, 67 years; 52% men; 20% blacks). Risk factors were measured during 5 examinations between 1987 and 2013. Cardiovascular events, including incident AF, were ascertained continuously. We modeled the prevalence of risk factors and cardiovascular outcomes in the period before and after AF diagnosis and the corresponding index date for control subjects using generalized estimating equations. Trajectories in risk factors were identified with latent mixture modeling. The risk of incident AF by trajectory group was examined with Cox models. RESULTS The prevalence of stroke, myocardial infarction, and heart failure increased steeply during the time close to AF diagnosis. All CVRFs were elevated in AF cases compared with controls >15 years before diagnosis. We identified distinct trajectories for all the assessed CVRFs. In general, individuals with trajectories denoting long-term exposure to CVRFs had increased AF risk even after adjustment for single measurements of the CVRFs. CONCLUSIONS AF patients have increased prevalence of CVRF many years before disease diagnosis. This analysis identified diverse trajectories in the prevalence of these risk factors, highlighting their different roles in AF pathogenesis.
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Affiliation(s)
- Faye L Norby
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.).
| | - Elsayed Z Soliman
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Lin Y Chen
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Lindsay G S Bengtson
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Laura R Loehr
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Sunil K Agarwal
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Alvaro Alonso
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
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Agrawal A, Agarwal SK, Kaleekal T, Gupta YK. Rifampicin and anti-hypertensive drugs in chronic kidney disease: Pharmacokinetic interactions and their clinical impact. Indian J Nephrol 2016; 26:322-328. [PMID: 27795624 PMCID: PMC5015508 DOI: 10.4103/0971-4065.176145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Patients on dialysis have an increased incidence of tuberculosis (TB). Rifampicin, a first-line antitubercular therapy (ATT) drug, is a potent inducer of hepatic cytochrome P450 (CYP). There is potential for pharmacokinetic interaction between rifampicin and anti-hypertensives that are CYP substrates: amlodipine and metoprolol. Therefore, hypertensive patients receiving rifampicin-based ATT are at risk for worsening of hypertension. However, this hypothesis has not yet been systematically studied. In this prospective study, hypertensive CKD 5D patients with TB were followed after rifampicin initiation. Blood pressure (BP) was ≤140/90 mmHg with stable anti-HT requirement at inclusion. Serum amlodipine, metoprolol, and prazosin levels were estimated by high-performance liquid chromatography at baseline and 3, 7, 10, and 14 days after rifampicin initiation. BP and anti-HT requirement were monitored for 2 weeks or until stabilization. All 24 patients in the study had worsening of hypertension after rifampicin and 83.3% required increase in drugs to maintain BP <140/90 mmHg. Serial amlodipine levels were estimated in 16 patients; metoprolol and prazosin in four patients each. Drug levels declined by >50% in all patients and became undetectable in 50-75%. Drug requirement increased from 4.5 ± 3.6 to 8.5 ± 6.4 units (P < 0.0001). Mean time to first increase in dose was 6.5 ± 3.6 days. Eleven (46%) patients experienced a hypertensive crisis at 9.1 ± 3.8 days. Three of them had a hypertensive emergency with acute pulmonary edema. In two patients, rifampicin had to be discontinued to achieve BP control. In conclusion, rifampicin caused a significant decrease in blood levels of commonly used anti hypertensives. This decrease in levels correlated well with worsening of hypertension. Thus, we suggest very close BP monitoring in CKD patients after rifampicin initiation.
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Affiliation(s)
- A Agrawal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - T Kaleekal
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Y K Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Camplain R, Meyer ML, Tanaka H, Palta P, Agarwal SK, Aguilar D, Butler KR, Heiss G. Smoking Behaviors and Arterial Stiffness Measured by Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Hypertens 2016; 29:1268-1275. [PMID: 26657706 DOI: 10.1093/ajh/hpv189] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Though smoking is strongly associated with peripheral vascular disease and arteriosclerosis, smoking's association with arterial stiffness has been inconsistent and mostly limited to a single arterial segment. We examined the relationship between smoking behaviors with arterial stiffness in multiple arterial segments among community dwelling older adults. METHODS The cross-sectional relationship between smoking behavior with carotid-femoral (cfPWV) and femoral-ankle pulse wave velocity (faPWV) was examined in 5,002 men and women, separately, of the Atherosclerosis Risk in Communities (ARIC) cohort study. Brachial-ankle PWV was also assessed and presented in Supplementary Material. Heckman selection models were used to control for selective attrition and death in the ARIC cohort. RESULTS In women, faPWV was lower in current smokers compared to never smokers (-66.0cm/s; 95% confidence interval (95% CI): -94.6, -37.4), and was 1.0cm/s lower (95% CI: -1.8, -0.2) for every additional year a woman smoked, after adjustment for confounders. Among women, cfPWV was not associated with smoking status or cigarette pack-years. Additionally, no associations of smoking status and cigarette pack-years with PWV were observed among men. Years since smoking cessation was not associated with PWV in either gender. CONCLUSION Both smoking status and cumulative smoking exposure were associated with lower peripheral arterial stiffness among women, but not among men. We did not observe an association between central arterial stiffness and smoking status in either gender. The profound and well-documented adverse effects of cigarette smoking on the vasculature may not include a sustained stiffening of the arteries measured at older age.
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Affiliation(s)
- Ricky Camplain
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
| | - Michelle L Meyer
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Priya Palta
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Kenneth R Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Sivaramakrishnan R, Gupta S, Agarwal SK, Bhowmik D, Mahajan S. Comparison of outcomes between surgically placed and percutaneously placed peritoneal dialysis catheters: A retrospective study. Indian J Nephrol 2016; 26:268-74. [PMID: 27512299 PMCID: PMC4964687 DOI: 10.4103/0971-4065.163425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There is lack of adequate data on comparison of outcomes between percutaneously placed peritoneal dialysis (PD) catheters inserted by nephrologists and PD catheters placed by surgeons. The aim of this study is to retrospectively analyze the outcomes of PD catheters inserted by surgeons (by open surgical or laparoscopic technique) and compare them with those inserted by nephrologists among ESRD patients who underwent elective PD catheter insertions between January 2009 and December 2012. The primary outcome measure was the proportion of catheters removed because of primary nonfunction. The secondary outcome measures were catheter survival, patient survival, and incidence of complications of catheter insertion. A total of 143 PD catheter insertions (88 by surgeons and 55 by nephrologists) performed in 132 patients were considered for the analysis. The primary nonfunction rate of PD catheter insertions in both groups was comparable (18.2% and 7.3%, P = 0.08). Break-in period was shorter in Group N (p = <0.001). No differences were noted in patient or catheter survival. Percutaneously placed PD catheters performed by nephrologists have comparable outcomes with surgically placed PD catheters among selected cases and have the advantage of lower costs, avoidance of operation theater scheduling issues, smaller incision length, and shorter break-in period. Therefore, more nephrologists should acquire the expertise on percutaneous PD catheter placement as it leads to lesser waiting times and better utilization of PD.
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Affiliation(s)
- R Sivaramakrishnan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - D Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Agarwal SK, Bhowmik D, Mahajan S, Bagchi S. Pegylated interferon monotherapy for hepatitis C virus infection in patients on hemodialysis: A single center study. Indian J Nephrol 2016; 26:244-51. [PMID: 27512295 PMCID: PMC4964683 DOI: 10.4103/0971-4065.172228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is no published study from India on hepatitis C virus (HCV) treatment in dialysis patients. Patients on dialysis with HCV infection treated with pegylated interferon (Peg-INF) monotherapy were studied. All patients were subjected to HCV-polymerase chain reaction, viral load, genotype, and liver biopsy. Quantitative HCV-RNA was performed monthly. Patients with genotype 1 and 4 were given 12 month therapy while those with genotypes 2 and 3 were given 6 months therapy. Response was classified as per standard criteria of rapid virological response (RVR), early virological response (EVR), end of treatment response (ETR), and sustained virological response (SVR). A total of 85 patients were treated. Mean age was 35.2 ± 10.5 (range 15-67) years, and 77.6% were males. HCV genotypes were 1 in 40.9%, 2 in 12%, 3 in 36.1%, 4 in 3.6%, and others in 7.2%. Mean viral load was 10(6) copies/mL. Mean liver biopsy grade was 4 ± 1.7 and stage 0.8 ± 0.8. Mean time from diagnosis of HCV infection and the treatment start was 10.7 ± 14.3 months. One patient died of unrelated illness, one was lost to follow-up, and three could not sustain treatment due to cost. Forty-three of the 80 (54%) patients had RVR while 49 (61%) patients had EVR and ETR. There was no difference in term of RVR related to genotype. Fifty -four percentage had SVR. Mild flu-like symptoms were seen in all patients. Sixty-four (80%) patients required increase in erythropoietin doses. Twenty-eight (35%) patients developed leukopenia (three treatment-limiting) and 16 (20%) developed thrombocytopenia (one treatment-limiting). Five patients developed tuberculosis, five bacterial pneumonia, and one bacterial knee monoarthritis. None of the patients developed depression. Our study concludes that Peg-INF monotherapy resulted in 54% RVR and SVR in dialysis patients with HCV infection. Therapy was well-tolerated with minimal side effects. There was no effect of viral genotype on response to therapy.
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Affiliation(s)
- S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - D Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Chen LY, Agarwal SK, Norby FL, Gottesman RF, Loehr LR, Soliman EZ, Mosley TH, Folsom AR, Coresh J, Alonso A. Persistent but not Paroxysmal Atrial Fibrillation Is Independently Associated With Lower Cognitive Function: ARIC Study. J Am Coll Cardiol 2016; 67:1379-80. [PMID: 26988962 DOI: 10.1016/j.jacc.2015.11.064] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 11/26/2022]
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Yadav K, Nagpal A, Agarwal SK, Kochhar A. Intricate Assessment and Evaluation of Effect of Bruxism on Long-term Survival and Failure of Dental Implants: A Comparative Study. J Contemp Dent Pract 2016; 17:670-4. [PMID: 27659086 DOI: 10.5005/jp-journals-10024-1910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Dental implants are one of the common lines of treatment used for the treatment of missing tooth. Various risk factors are responsible for the failure of the dental implants and occurrence of postoperative complications. Bruxism is one such factor responsible for the failure of the dental implants. The actual relation between bruxism and dental implants is a subject of long-term controversy. Hence, we carried out this retrospective analysis to assess the complications occurring in dental implants in patients with and without bruxism. MATERIALS AND METHODS The present study included 1100 patients which were treated for rehabilitation by dental implant procedure at 21 dental offices of Ghaziabad (India) from 2004 to 2014. Analyzing the clinical records of the patients along with assessing the photographs of the patients was done for confirming the diagnosis of bruxism. Clinical re-evaluation of the patients, who came back for follow-up, was done to confirm the diagnosis of bruxism. Systemic questionnaires as used by previous workers were used to evaluate the patients about the self-conscience of the condition. Estimation of the mechanical complications was done only in those cases which occurred on the surfaces of the restoration of the dental implants. All the results were analyzed by Statistical Package for Social Sciences (SPSS) software. Student's t-test and Pearson's chi-square test were used to evaluate the level of significance. RESULTS In both bruxer and non-bruxers, maximum number of dental implants was placed in anterior maxillary region. Significant difference was obtained while comparing the two groups for dimensions of the dental implants used. On comparing the total implant failed cases between bruxers and non-bruxers group, statistically significant result was obtained. Statistically significant difference was obtained while comparing the two study groups based on the health parameters, namely hypertension, diabetes, and smoking habit. CONCLUSION Success of dental implant is significantly affected by bruxism. Special attention is required in such patients while doing treatment planning. CLINICAL SIGNIFICANCE For the long-term clinical success and survival of dental implants in patients, special emphasis should be given on the patient's deleterious oral habits, such as bruxism as in long run, they influence the stability of dental implants.
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Affiliation(s)
- Kajal Yadav
- Postgraduate Student, Department of Prosthodontics, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India, Phone: +919451071689, e-mail:
| | - Abhishek Nagpal
- Department of Prosthodontics, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - S K Agarwal
- Department of Prosthodontics, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Aarti Kochhar
- Department of Prosthodontics, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
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Fyfe-Johnson AL, Muller CJ, Alonso A, Folsom AR, Gottesman RF, Rosamond WD, Whitsel EA, Agarwal SK, MacLehose RF. Heart Rate Variability and Incident Stroke: The Atherosclerosis Risk in Communities Study. Stroke 2016. [PMID: 27217501 DOI: 10.1161/strokeaha.116.012662.heart] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND PURPOSE Low heart rate variability (HRV), a marker of cardiac autonomic dysfunction, has been associated with increased all-cause and cardiovascular mortality. We examined the association between reduced HRV and incident stroke in a community-based cohort. METHODS The Atherosclerosis Risk in Communities (ARIC) study measured HRV using 2-minute ECG readings in 12 550 middle-aged adults at baseline (1987-1989). HRV indices were calculated using the SD of RR intervals (SDNN), the mean of all normal RR intervals (meanNN), the root mean square of successive differences of successive RR intervals (RMSSD), low (LF) and high (HF) frequency power, and the LF/HF ratio. All HRV measures were categorized into quintiles. Incident stroke was adjudicated through 2011. Cox regression was used to estimate hazard ratios (HRs) with the lowest HRV quintile as the reference, with and without stratification by prevalent diabetes mellitus. RESULTS Over a median follow-up of 22 years, 816 (6.5%) participants experienced incident stroke. After covariate adjustment, there was no strong evidence of association between HRV and stroke risk. In stratified analyses, the lowest HRV quintile was associated with higher stroke risk compared with the highest quintile for SDNN (HR, 2.0, 95% confidence interval, 1.1-4.0), RMSSD (HR, 1.7; 95% confidence interval, 0.9-3.2), LF (HR, 1.5; 95% confidence interval, 0.8-3.0), and HF (HR, 1.7; 95% confidence interval, 0.9-3.0) only among people with diabetes mellitus. CONCLUSIONS Lower HRV was associated with higher risk of incident stroke among middle-aged adults with prevalent diabetes mellitus but not among people without diabetes mellitus.
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Affiliation(s)
- Amber L Fyfe-Johnson
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
| | - Clemma J Muller
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Alvaro Alonso
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Aaron R Folsom
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Rebecca F Gottesman
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Wayne D Rosamond
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Eric A Whitsel
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Sunil K Agarwal
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Richard F MacLehose
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
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Pandey AK, Ghuman S, Dhaliwal GS, Agarwal SK, Phogat JB. Impact of Buserelin Acetate or hCG Administration on the Day of First Artificial Insemination on Subsequent Luteal Profile and Conception Rate in Murrah Buffalo (Bubalus bubalis). Reprod Domest Anim 2016; 51:478-84. [PMID: 27170495 DOI: 10.1111/rda.12705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/12/2016] [Indexed: 11/27/2022]
Abstract
This study was designed to investigate the impact of buserelin acetate (BA) or human chorionic gonadotropin (hCG) administration on the day of first artificial insemination (AI) on subsequent luteal profile (diameter of corpus luteum (CL) and plasma progesterone) and conception rate in Murrah buffalo. The present experiment was carried out at two locations in 117 buffalo that were oestrus-synchronized using cloprostenol (500 μg) administered (i.m.) 11 days apart followed by AI during standing oestrus. Based on treatment (i.m.) at the time of AI, buffalo were randomly categorized (n = 39 in each group) into control (isotonic saline solution, 5 ml), dAI-BA (buserelin acetate, 20 μg) and dAI-hCG (hCG, 3000 IU) group. Out of these, 14 buffalo of each group were subjected to ovarian ultrasonography on the day of oestrus to monitor the preovulatory follicle and on days 5, 12, 16 and 21 post-ovulation to monitor CL diameter. On the day of each sonography, jugular vein blood samples were collected for the estimation of progesterone concentrations. All the buffalo (n = 117) were confirmed for pregnancy on day 40 post-ovulation. The conception rate was better (p < 0.05) in dAI-BA (51.3%) and dAI-hCG (66.7%) groups as compared to their control counterparts (30.8%). Furthermore, the buffalo of dAI-hCG group had improved (p < 0.05) luteal profile, whereas the buffalo of dAI-BA group failed (p > 0.05) to exhibit stimulatory impact of treatment on luteal profile when compared to control group. In brief, buserelin acetate or hCG treatment on the day of first AI leads to an increase in conception rate; however, an appreciable impact on post-ovulation luteal profile was observed only in hCG-treated Murrah buffalo.
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Affiliation(s)
- A K Pandey
- Department of Veterinary Gynaecology and Obstetrics, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - Sps Ghuman
- Department of Veterinary Gynaecology and Obstetrics, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - G S Dhaliwal
- Department of Veterinary and Animal Husbandry Extension Education, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - S K Agarwal
- Central Institute for Research on Goat, Makhdoom, Farah, Mathura, Uttar Pradesh, India
| | - J B Phogat
- Department of Veterinary Gynaecology and Obstetrics, College of Veterinary Science, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
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Fyfe-Johnson AL, Muller CJ, Alonso A, Folsom AR, Gottesman RF, Rosamond WD, Whitsel EA, Agarwal SK, MacLehose RF. Heart Rate Variability and Incident Stroke: The Atherosclerosis Risk in Communities Study. Stroke 2016; 47:1452-8. [PMID: 27217501 DOI: 10.1161/strokeaha.116.012662] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 01/14/2016] [Accepted: 03/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Low heart rate variability (HRV), a marker of cardiac autonomic dysfunction, has been associated with increased all-cause and cardiovascular mortality. We examined the association between reduced HRV and incident stroke in a community-based cohort. METHODS The Atherosclerosis Risk in Communities (ARIC) study measured HRV using 2-minute ECG readings in 12 550 middle-aged adults at baseline (1987-1989). HRV indices were calculated using the SD of RR intervals (SDNN), the mean of all normal RR intervals (meanNN), the root mean square of successive differences of successive RR intervals (RMSSD), low (LF) and high (HF) frequency power, and the LF/HF ratio. All HRV measures were categorized into quintiles. Incident stroke was adjudicated through 2011. Cox regression was used to estimate hazard ratios (HRs) with the lowest HRV quintile as the reference, with and without stratification by prevalent diabetes mellitus. RESULTS Over a median follow-up of 22 years, 816 (6.5%) participants experienced incident stroke. After covariate adjustment, there was no strong evidence of association between HRV and stroke risk. In stratified analyses, the lowest HRV quintile was associated with higher stroke risk compared with the highest quintile for SDNN (HR, 2.0, 95% confidence interval, 1.1-4.0), RMSSD (HR, 1.7; 95% confidence interval, 0.9-3.2), LF (HR, 1.5; 95% confidence interval, 0.8-3.0), and HF (HR, 1.7; 95% confidence interval, 0.9-3.0) only among people with diabetes mellitus. CONCLUSIONS Lower HRV was associated with higher risk of incident stroke among middle-aged adults with prevalent diabetes mellitus but not among people without diabetes mellitus.
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Affiliation(s)
- Amber L Fyfe-Johnson
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
| | - Clemma J Muller
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Alvaro Alonso
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Aaron R Folsom
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Rebecca F Gottesman
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Wayne D Rosamond
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Eric A Whitsel
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Sunil K Agarwal
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
| | - Richard F MacLehose
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.)
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Bekwelem W, Jensen PN, Norby FL, Soliman EZ, Agarwal SK, Lip GYH, Pan W, Folsom AR, Longstreth WT, Alonso A, Heckbert SR, Chen LY. Carotid Atherosclerosis and Stroke in Atrial Fibrillation: The Atherosclerosis Risk in Communities Study. Stroke 2016; 47:1643-6. [PMID: 27217511 DOI: 10.1161/strokeaha.116.013133] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether consideration of carotid intima-media thickness (cIMT) and carotid plaque would improve risk prediction of ischemic stroke in persons with atrial fibrillation (AF) is unknown. The purpose of this study was to assess the improvement in risk prediction of stroke by adding cIMT and carotid plaque to the CHA2DS2-VASc (variables age, heart failure, hypertension, diabetes mellitus, myocardial infarction, and peripheral arterial disease) score. METHODS We included participants from the Atherosclerosis Risk in Communities (ARIC) study (mean age, 63 years) who developed AF within 5 years after carotid measurement, were not on warfarin, and had no prior stroke at AF diagnosis. AF was ascertained from study ECGs and diagnosis codes, and stroke was physician adjudicated. Multivariable Cox models were used to assess association between carotid indices and ischemic stroke. Improvement in 10-year risk prediction of stroke was assessed by the C-statistic, net reclassification improvement, and relative integrated discrimination improvement. RESULTS There were 81 (11.2%) stroke events that occurred among 724 participants with AF during a mean follow-up of 8.5 years. Increased cIMT and presence of carotid plaque were significantly associated with increased stroke risk. The addition of cIMT+plaque to the CHA2DS2-VASc score marginally increased the C-statistic (95% confidence interval) from 0.685 (0.623-0.747) to 0.698 (0.638-0.759). The net reclassification improvement and integrated discrimination improvement for cIMT+plaque were 0.091 (95% confidence interval, 0.012-0.170) and 0.101 (95% confidence interval, 0.002-0.226), respectively. CONCLUSIONS Increased cIMT and presence of carotid plaque are associated with increased risk of ischemic stroke in individuals with AF. Furthermore, they may improve risk prediction of stroke, over and above the CHA2DS2-VASc score.
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Affiliation(s)
- Wobo Bekwelem
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
| | - Paul N Jensen
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Faye L Norby
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Elsayed Z Soliman
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Sunil K Agarwal
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Gregory Y H Lip
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Wei Pan
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Aaron R Folsom
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - W T Longstreth
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Alvaro Alonso
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Susan R Heckbert
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Lin Y Chen
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
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36
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Bell EJ, Agarwal SK, Cushman M, Heckbert SR, Lutsey PL, Folsom AR. Orthostatic Hypotension and Risk of Venous Thromboembolism in 2 Cohort Studies. Am J Hypertens 2016; 29:634-40. [PMID: 26306405 DOI: 10.1093/ajh/hpv151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/06/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although venous stasis is a risk factor for venous thromboembolism (VTE) and orthostatic hypotension (OH) can cause venous stasis, to our knowledge no study has examined the relationship between OH and VTE risk. We sought to quantify the association between OH and VTE (deep vein thrombosis or pulmonary embolism) using data from 2 large, prospective cohort studies: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) Study. We hypothesized that OH was positively associated with incident VTE. METHODS We measured OH-defined as a drop in systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of at least 10 mm Hg within 3 minutes of standing-in participants aged 45-64 years in ARIC (n = 12,480) and ≥65 years in CHS (n = 5,027) at baseline visits (1987-1989 in ARIC; 1989-1990 and 1992-1993 in CHS), and followed participants for incident VTE (n = 568 in ARIC through 2011 and n = 148 in CHS through 2001). We calculated adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for incident VTE in relation to OH status. RESULTS In CHS, there was a positive association between OH status and incident VTE (HR for VTE = 1.74 (95% CI: 1.20-2.51)). In contrast, there was no association between OH and VTE in the ARIC study (HR for VTE = 0.97 (95% CI: 0.70-1.33)). CONCLUSIONS Community-dwelling older adults with OH had a moderately increased risk of VTE. These results were not seen in a population-based middle-aged cohort.
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Affiliation(s)
- Elizabeth J Bell
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Sunil K Agarwal
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary Cushman
- Department of Medicine, Division of Hematology/Oncology, University of Vermont, Burlington, Vermont, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron R Folsom
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Waks JW, Sitlani CM, Soliman EZ, Kabir M, Ghafoori E, Biggs ML, Henrikson CA, Sotoodehnia N, Biering-Sørensen T, Agarwal SK, Siscovick DS, Post WS, Solomon SD, Buxton AE, Josephson ME, Tereshchenko LG. Global Electric Heterogeneity Risk Score for Prediction of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health (CHS) Studies. Circulation 2016; 133:2222-34. [PMID: 27081116 DOI: 10.1161/circulationaha.116.021306] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Asymptomatic individuals account for the majority of sudden cardiac deaths (SCDs). Development of effective, low-cost, and noninvasive SCD risk stratification tools is necessary. METHODS AND RESULTS Participants from the Atherosclerosis Risk in Communities study and Cardiovascular Health Study (n=20 177; age, 59.3±10.1 years; age range, 44-100 years; 56% female; 77% white) were followed up for 14.0 years (median). Five ECG markers of global electric heterogeneity (GEH; sum absolute QRST integral, spatial QRST angle, spatial ventricular gradient [SVG] magnitude, SVG elevation, and SVG azimuth) were measured on standard 12-lead ECGs. Cox proportional hazards and competing risks models evaluated associations between GEH electrocardiographic parameters and SCD. An SCD competing risks score was derived from demographics, comorbidities, and GEH parameters. SCD incidence was 1.86 per 1000 person-years. After multivariable adjustment, baseline GEH parameters and large increases in GEH parameters over time were independently associated with SCD. Final SCD risk scores included age, sex, race, diabetes mellitus, hypertension, coronary heart disease, stroke, and GEH parameters as continuous variables. When GEH parameters were added to clinical/demographic factors, the C statistic increased from 0.777 to 0.790 (P=0.008), the risk score classified 10-year SCD risk as high (>5%) in 7.2% of participants, 10% of SCD victims were appropriately reclassified into a high-risk category, and only 1.4% of SCD victims were inappropriately reclassified from high to intermediate risk. The net reclassification index was 18.3%. CONCLUSIONS Abnormal electrophysiological substrate quantified by GEH parameters is independently associated with SCD in the general population. The addition of GEH parameters to clinical characteristics improves SCD risk prediction.
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Affiliation(s)
- Jonathan W Waks
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Colleen M Sitlani
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Elsayed Z Soliman
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Muammar Kabir
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Elyar Ghafoori
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Mary L Biggs
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Charles A Henrikson
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Nona Sotoodehnia
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Tor Biering-Sørensen
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Sunil K Agarwal
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - David S Siscovick
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Wendy S Post
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Alfred E Buxton
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Mark E Josephson
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Larisa G Tereshchenko
- From Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., A.E.B., M.E.J.); Cardiovascular Health Research Unit, Division of Cardiology, and Department of Epidemiology(C.M.S., M.L.B., N.S., D.S.S.)and Department of Biostatistics (M.L.B.), University of Washington, Seattle; Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland (M.K., E.G., C.A.H., L.G.T.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., S.D.S.); Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A.); New York Academy of Medicine, New York (D.S.S.); and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.).
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Norby FL, Eryd SA, Niemeijer MN, Rose LM, Smith AV, Yin X, Agarwal SK, Arking DE, Chasman DL, Chen LY, Eijgelsheim M, Engström G, Franco OH, Heeringa J, Hindy G, Hofman A, Lutsey PL, Magnani JW, McManus DD, Orho-Melander M, Pankow JS, Rukh G, Schulz CA, Uitterlinden AG, Albert CM, Benjamin EJ, Gudnason V, Smith JG, Stricker BHC, Alonso A. Association of Lipid-Related Genetic Variants with the Incidence of Atrial Fibrillation: The AFGen Consortium. PLoS One 2016; 11:e0151932. [PMID: 26999784 PMCID: PMC4801208 DOI: 10.1371/journal.pone.0151932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/07/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies have shown associations between blood lipid levels and the risk of atrial fibrillation (AF). To test the potential effect of blood lipids with AF risk, we assessed whether previously developed lipid gene scores, used as instrumental variables, are associated with the incidence of AF in 7 large cohorts. METHODS We analyzed 64,901 individuals of European ancestry without previous AF at baseline and with lipid gene scores. Lipid-specific gene scores, based on loci significantly associated with lipid levels, were calculated. Additionally, non-pleiotropic gene scores for high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc) were calculated using SNPs that were only associated with the specific lipid fraction. Cox models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) of AF per 1-standard deviation (SD) increase of each lipid gene score. RESULTS During a mean follow-up of 12.0 years, 5434 (8.4%) incident AF cases were identified. After meta-analysis, the HDLc, LDLc, total cholesterol, and triglyceride gene scores were not associated with incidence of AF. Multivariable-adjusted HR (95% CI) were 1.01 (0.98-1.03); 0.98 (0.96-1.01); 0.98 (0.95-1.02); 0.99 (0.97-1.02), respectively. Similarly, non-pleiotropic HDLc and LDLc gene scores showed no association with incident AF: HR (95% CI) = 1.00 (0.97-1.03); 1.01 (0.99-1.04). CONCLUSIONS In this large cohort study of individuals of European ancestry, gene scores for lipid fractions were not associated with incident AF.
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Affiliation(s)
- Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | | | - Maartje N. Niemeijer
- Department of Epidemiology, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
| | - Lynda M. Rose
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Albert V. Smith
- Icelandic Heart Association, Research Institute, Kopavogur, Iceland
- The University of Iceland, Reykjavik, Iceland
| | - Xiaoyan Yin
- Cardiology and Preventive Medicine Sections, Department of Biostatistics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Sunil K. Agarwal
- Icahn School of Medicine, Mount Sinai Heart Center, New York, New York, United States of America
| | - Dan E. Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Daniel L. Chasman
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lin Y. Chen
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Mark Eijgelsheim
- Department of Epidemiology, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
| | - Jan Heeringa
- Department of Epidemiology, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
| | - George Hindy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Jared W. Magnani
- Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- The National Heart, Lung and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
| | - David D. McManus
- Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | | | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Gull Rukh
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - André G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
| | - Christine M. Albert
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Emelia J. Benjamin
- Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- The National Heart, Lung and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vilmundur Gudnason
- Icelandic Heart Association, Research Institute, Kopavogur, Iceland
- The University of Iceland, Reykjavik, Iceland
| | - J. Gustav Smith
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Lund University, Lund, Sweden
| | - Bruno H. C. Stricker
- Department of Epidemiology, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center—University Medical Center, Rotterdam, The Netherlands
- Inspectorate of Health Care, Utrecht, the Netherlands
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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Agarwal SK, Wruck L, Quibrera M, Matsushita K, Loehr LR, Chang PP, Rosamond WD, Wright J, Heiss G, Coresh J. Temporal Trends in Hospitalization for Acute Decompensated Heart Failure in the United States, 1998-2011. Am J Epidemiol 2016; 183:462-70. [PMID: 26895710 DOI: 10.1093/aje/kwv455] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/28/2015] [Indexed: 12/15/2022] Open
Abstract
Estimates of the numbers and rates of acute decompensated heart failure (ADHF) hospitalization are central to understanding health-care utilization and efforts to improve patient care. We comprehensively estimated the frequency, rate, and trends of ADHF hospitalization in the United States. Based on Atherosclerosis Risk in Communities (ARIC) Study surveillance adjudicating 12,450 eligible hospitalizations during 2005-2010, we developed prediction models for ADHF separately for 3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 428 discharge diagnosis groups: 428 primary, 428 nonprimary, or 428 absent. We applied the models to data from the National Inpatient Sample (11.5 million hospitalizations of persons aged ≥55 years with eligible ICD-9-CM codes), an all-payer, 20% probability sample of US community hospitals. The average estimated number of ADHF hospitalizations per year was 1.76 million (428 primary, 0.80 million; 428 nonprimary, 0.83 million; 428 absent, 0.13 million). During 1998-2004, the rate of ADHF hospitalization increased by 2.0%/year (95% confidence interval (CI): 1.8, 2.5) versus a 1.4%/year (95% CI: 0.8, 2.1) increase in code 428 primary hospitalizations (P < 0.001). In contrast, during 2005-2011, numbers of ADHF hospitalizations were stable (-0.5%/year; 95% CI: -1.4, 0.3), while the numbers of 428-primary hospitalizations decreased by -1.5%/year (95% CI: -2.2, -0.8) (P for contrast = 0.03). In conclusion, the estimated number of hospitalizations with ADHF is approximately 2 times higher than the number of hospitalizations with ICD-9-CM code 428 in the primary position. The trend increased more steeply prior to 2005 and was relatively flat after 2005.
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Ndumele CE, Matsushita K, Sang Y, Lazo M, Agarwal SK, Nambi V, Deswal A, Blumenthal RS, Ballantyne CM, Coresh J, Selvin E. N-Terminal Pro-Brain Natriuretic Peptide and Heart Failure Risk Among Individuals With and Without Obesity: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2016; 133:631-8. [PMID: 26746175 DOI: 10.1161/circulationaha.115.017298] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/29/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity is a risk factor for heart failure (HF) but is associated with lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. It is unclear whether the prognostic value and implications of NT-proBNP levels for HF risk differ across body mass index (BMI) categories. METHODS AND RESULTS We followed up 12 230 ARIC participants free of prior HF at baseline (visit 2, 1990-1992) with BMI ≥18.5 kg/m(2). We quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across BMI categories. There were 1861 HF events during a median 20.6 years of follow-up. Despite increased HF risk in obesity, a weak inverse association was seen between baseline BMI and NT-proBNP levels (r=-0.10). Nevertheless, higher baseline NT-proBNP was associated with increased HF risk in all BMI categories. NT-proBNP improved HF risk prediction overall, even among those with severe obesity (BMI ≥35 kg/m(2); improvement in C statistic, 0.032; 95% confidence interval, 0.011-0.053). However, given the higher HF rates among those with obesity, at each NT-proBNP level, higher BMI was associated with greater absolute HF risk. Indeed, among those with NT-proBNP of 100 to <200 pg/mL, the average 10-year HF risk was <5% among normal-weight individuals but >10% among the severely obese. CONCLUSIONS Despite its inverse relationship with BMI, NT-proBNP provides significant prognostic information on the risk of developing HF even among individuals with obesity. Given the higher baseline HF risk among persons with obesity, even slight elevations in NT-proBNP may have implications for increased absolute HF risk in this population.
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Affiliation(s)
- Chiadi E Ndumele
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
| | - Kunihiro Matsushita
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Yingying Sang
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Mariana Lazo
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Sunil K Agarwal
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Vijay Nambi
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Anita Deswal
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Roger S Blumenthal
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Christie M Ballantyne
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Josef Coresh
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
| | - Elizabeth Selvin
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.)
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Alonso A, Yu B, Qureshi WT, Grams ME, Selvin E, Soliman EZ, Loehr LR, Chen LY, Agarwal SK, Alexander D, Boerwinkle E. Metabolomics and Incidence of Atrial Fibrillation in African Americans: The Atherosclerosis Risk in Communities (ARIC) Study. PLoS One 2015; 10:e0142610. [PMID: 26544570 PMCID: PMC4636390 DOI: 10.1371/journal.pone.0142610] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia. Application of metabolomic approaches, which may identify novel pathways and biomarkers of disease risk, to a longitudinal epidemiologic study of AF has been limited. METHODS We determined the prospective association of 118 serum metabolites identified through untargeted metabolomics profiling with the incidence of newly-diagnosed AF in 1919 African-American men and women from the Atherosclerosis Risk in Communities study without AF at baseline (1987-1989). Incident AF cases through 2011 were ascertained from study electrocardiograms, hospital discharge codes, and death certificates. RESULTS During a median follow-up of 22 years, we identified 183 incident AF cases. In Cox proportional hazards models adjusted for age, sex, smoking, body mass index, systolic blood pressure, use of antihypertensive medication, diabetes, prevalent heart failure, prevalent coronary heart disease, and kidney function, two conjugated bile acids (glycolithocholate sulfate and glycocholenate sulfate) were significantly associated with AF risk after correcting for multiple comparisons (p<0.0004). Multivariable-adjusted hazard ratios (95% confidence intervals) of AF were 1.22 (1.12-1.32) for glycolithocholate sulfate and 1.22 (1.10-1.35) for glycocholenate sulfate per 1-standard deviation higher levels. Associations were not appreciably different after additional adjustment for alcohol consumption or concentrations of circulating albumin and liver enzymes. CONCLUSION We found an association of higher levels of two bile acids with an increased risk of AF, pointing to a potential novel pathway in AF pathogenesis. Replication of results in independent studies is warranted.
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Affiliation(s)
- Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Bing Yu
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Waqas T. Qureshi
- Division of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Morgan E. Grams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
- Department of Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Laura R. Loehr
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Sunil K. Agarwal
- Mount Sinai Heart Hospital, New York, New York, United States of America
| | - Danny Alexander
- Metabolon, Inc., Durham, North Carolina, United States of America
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, United States of America
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Abstract
The prevalence of heart failure (HF) and its subtype, HF with preserved ejection fraction (HFpEF), is on the rise due to aging of the population. HFpEF is convergence of several pathophysiological processes, which are not yet clearly identified. HFpEF is usually seen in association with systemic diseases, such as diabetes, hypertension, atrial fibrillation, sleep apnea, renal and pulmonary disease. The proportion of HF patients with HFpEF varies by patient demographics, study settings (cohort vs. clinical trial, outpatient clinics vs. hospitalised patients) and cut points used to define preserved function. There is an expanding body of literature about prevalence and prognostic significance of both cardiovascular and non-cardiovascular comorbidities in HFpEF patients. Current therapeutic approaches are targeted towards alleviating the symptoms, treating the associated comorbid conditions, and reducing recurrent hospital admissions. There is lack of evidence-based therapies that show a reduction in the mortality amongst HFpEF patients; however, an improvement in exercise tolerance and quality of life is seen with few interventions. In this review, we highlight the epidemiology and current treatment options for HFpEF.
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Abstract
Hepatitis C virus (HCV) infection is commonest blood borne infection amongst hemodialysis patients. Still, there is paucity of data on liver biopsy in these patients. Our center is doing regular liver biopsy in these patients and thus thought of sharing our experience. In this retrospective study, all patients with HCV infection on hemodialysis were subjected to liver biopsy. Serum bilirubin, liver enzyme, HCV-PCR, genotype and viral load measurement were done in all. Biopsy specimen was stained with H and E, Periodic Acid Schiff, Gomori Stain, Masson Trichrome and Perls Stain. International Working Group scoring system of Ishak et al. was used for Grading and Staging. Of the 270 liver biopsies, mean age of patients was 34.05 ± 10.28 years and 233 (85.3%) were males. Mean duration of hemodialysis was 10.9 ± 7.4 months while of known HCV infection was 5.2 ± 4.0 months. Genotype 3 was commonest followed by 1. All had normal bilirubin and 64 (23.1%) had normal ALT. In 37 (13.3%) patients anti-HCV was not detectable. Mean histology grade was 4.03 ± 1.65 (1-10) and stage was 0.75 ± 0.98 (0-3). Only one patient had cirrhosis on histology. Associated hemosiderosis was seen 10 patients. Only minor complications were observed with no mortality. In conclusion, our study shows that in one-fourth patients with active liver disease, liver enzymes are persistently normal in patients on hemodialysis. Further, carefully performed liver biopsy is reasonably safe procedure though some patients do have non-fatal complications. Liver biopsy helps in assessing disease activity, which otherwise cannot be assessed. Histological grade and stage in these patients is usually mild and cirrhosis is rare. Till such time other non-invasive test is validated, liver biopsy will remain an important test in these patients.
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Affiliation(s)
- S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Agarwal SK, Chao J, Peace F, Judd SE, Kissela B, Kleindorfer D, Howard VJ, Howard G, Soliman EZ. Premature ventricular complexes on screening electrocardiogram and risk of ischemic stroke. Stroke 2015; 46:1365-7. [PMID: 25873602 DOI: 10.1161/strokeaha.114.008447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied. METHODS This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003-2007), and incident stroke cases through 2011 were confirmed by an adjudication committee. RESULTS A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure-lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05-1.81]). CONCLUSIONS PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.
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Affiliation(s)
- Sunil K Agarwal
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.).
| | - Jennifer Chao
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Frederick Peace
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Suzanne E Judd
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Brett Kissela
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Dawn Kleindorfer
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Virginia J Howard
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - George Howard
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Elsayed Z Soliman
- From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
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Agarwal SK, Chen L, Alonso A, Lopez F, Soliman E, Ndumele C, Loehr L, Tereshchenko L, Calkins H, Heiss G, Coresh J. ARRHYTHMIA BURDEN AMONG COMMUNITY DWELLING ELDERLY USING TWO WEEKS OF AMBULATORY ECG RECORDINGS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Waks JW, Soliman EZ, Henrikson CA, Sotoodehnia N, Han L, Agarwal SK, Arking DE, Siscovick DS, Solomon SD, Post WS, Josephson ME, Coresh J, Tereshchenko LG. Beat-to-beat spatiotemporal variability in the T vector is associated with sudden cardiac death in participants without left ventricular hypertrophy: the Atherosclerosis Risk in Communities (ARIC) Study. J Am Heart Assoc 2015; 4:e001357. [PMID: 25600143 PMCID: PMC4330061 DOI: 10.1161/jaha.114.001357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed. Methods and Results Beat‐to‐beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T‐wave vectors (mean TT′ angle) on standard 12‐lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT′ angle was 5.21±3.55°. During a median of 14 years of follow‐up, 235 SCDs occurred (1.24 per 1000 person‐years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT′ angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT′ angle >90th percentile (>9.57°) was associated with a 2‐fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T‐vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT′ angle and age was found: TT′ angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (Pinteraction=0.009). Conclusions In a large, prospective, community‐based cohort of left ventricular hypertrophy–free participants, increased beat‐to‐beat spatiotemporal variability in the T vector, as assessed by increasing TT′ angle, was associated with SCD.
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Affiliation(s)
- Jonathan W Waks
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., M.E.J.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (C.A.H., L.G.T.)
| | | | - Lichy Han
- Whitening School of Engineering, Johns Hopkins University, Baltimore, MD (L.H.)
| | - Sunil K Agarwal
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.E.A.)
| | - David S Siscovick
- University of Washington, Seattle, WA (N.S., D.S.S.) The New York Academy of Medicine, New York, NY (D.S.S.)
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
| | - Mark E Josephson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., M.E.J.)
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (C.A.H., L.G.T.) Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.)
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Magnani JW, Zhu L, Lopez F, Pencina MJ, Agarwal SK, Soliman EZ, Benjamin EJ, Alonso A. P-wave indices and atrial fibrillation: cross-cohort assessments from the Framingham Heart Study (FHS) and Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2015; 169:53-61.e1. [PMID: 25497248 DOI: 10.1016/j.ahj.2014.10.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with increased morbidity. P-wave indices (PWIs) measure atrial electrical function and are associated with AF. Study of PWI has been limited to single-cohort investigations, and their contributions to risk enhancement are unknown. METHODS We examined PWI from the FHS and ARIC study. We calculated 10-year AF risk using adjusted Cox models. We conducted cross-cohort meta-analyses for the PWI estimates and assessed their contributions to risk discrimination (c statistic), net reclassification index, and integrated discrimination improvement. RESULTS After exclusions, the analysis included 3,110 FHS (62.6 ± 9.8 years, 56.9% women) and 8,254 ARIC participants (62.3 ± 5.6 years, 57.3% women, 20.3% black race). Over 10 years, 217 FHS and 458 ARIC participants developed AF. In meta-analysis, P-wave duration >120 milliseconds was significantly associated with AF (hazard ratio 1.55, 95% CI 1.29-1.85) compared with ≤120 milliseconds. P-wave area was marginally but not significantly related to AF (hazard ratio 1.31, 95% CI 0.95-1.80). P-wave terminal force was strongly associated with AF in ARIC but not FHS. P-wave indices had a limited contribution toward predictive risk beyond traditional risk factors and markers. CONCLUSIONS P-wave indices are intermediate phenotypes for AF. They are associated with AF in cross-cohort meta-analyses but contribute minimally toward enhancing risk prediction.
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Tereshchenko LG, Henrikson CA, Sotoodehnia N, Arking DE, Agarwal SK, Siscovick DS, Post WS, Solomon SD, Coresh J, Josephson ME, Soliman EZ. Electrocardiographic deep terminal negativity of the P wave in V(1) and risk of sudden cardiac death: the Atherosclerosis Risk in Communities (ARIC) study. J Am Heart Assoc 2014; 3:e001387. [PMID: 25416036 PMCID: PMC4338733 DOI: 10.1161/jaha.114.001387] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Identifying individuals at risk for sudden cardiac death (SCD) is of critical importance. Electrocardiographic (ECG) deep terminal negativity of P wave in V1 (DTNPV1), a marker of left atrial abnormality, has been associated with increased risk of all‐cause and cardiovascular mortality. We hypothesized that DTNPV1 is associated with increased risk of sudden cardiac death (SCD). Methods and Results This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities (ARIC) study. DTNPV1 was defined from the resting 12‐lead ECG as presence of biphasic P wave (positive/negative) in V1 with the amplitude of the terminal negative phase >100 μV, or one small box on ECG scale. After a median of 14 years of follow‐up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV1 was associated with an 8‐fold increased risk of SCD (HR 8.21; [95%CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (CHD), and ECG risk factors, as well as atrial fibrillation (AF), stroke, CHD, and heart failure (HF) as time‐updated variables, the risk of SCD associated with DTNPV1 remained significant (2.49, [1.51–4.10]). DTNPV1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV1 was associated with increased risk of non‐fatal events: AF (5.02[3.23–7.80]), CHD (2.24[1.43–3.53]), HF (1.90[1.19–3.04]), and trended towards increased risk of stroke (1.88[0.99–3.57]). Conclusion DTNPV1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.
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Affiliation(s)
- Larisa G Tereshchenko
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.G.T., W.S.P.) Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (L.G.T., C.A.H.)
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (L.G.T., C.A.H.)
| | | | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.E.A.)
| | - Sunil K Agarwal
- Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - David S Siscovick
- University of Washington, Seattle, WA (N.S., D.S.S.) The New York Academy of Medicine, New York, NY (D.S.S.)
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.G.T., W.S.P.)
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Josef Coresh
- Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - Mark E Josephson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.E.J.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
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Patel MD, Kalbaugh CA, Chang PP, Matsushita K, Agarwal SK, Caughey MC, Ni H, Rosamond WD, Wruck LM, Loehr LR. Characteristics and outcomes of patients with acute decompensated heart failure developing after hospital admission. Am J Cardiol 2014; 114:1530-6. [PMID: 25248811 DOI: 10.1016/j.amjcard.2014.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/15/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
There are limited data on acute decompensated heart failure (ADHF) that develops after hospital admission. This study sought to compare patient characteristics, co-morbidities, mortality, and length of stay by timing of ADHF onset. The surveillance component of the Atherosclerosis Risk in Communities study (2005 to 2011) sampled, abstracted, and adjudicated hospitalizations with select International Classification of Disease, Ninth Revision, Clinical Modification discharge codes from 4 United States communities among those aged ≥55 years. We included 5,602 validated ADHF hospitalizations further classified as preadmission or postadmission onset. Vital status was assessed up to 1 year since admission. We estimated multivariate-adjusted associations of in-hospital mortality and 28- and 365-day case fatalities with timing of ADHF onset (postadmission vs preadmission). All analyses were weighted to account for the stratified sampling design. Of 25,862 weighted ADHF hospitalizations, 7% had postadmission onset of ADHF. Patients with postadmission ADHF were more likely to be older, white, and women. The most common primary discharge diagnosis codes for those with postadmission ADHF included diseases of the circulatory or digestive systems or infectious diseases. Short-term mortality among postadmission ADHF was almost 3 times that of preadmission ADHF (in-hospital mortality: odds ratio 2.7, 95% confidence interval 1.9 to 3.9; 28-day case fatality: odds ratio 2.6, 95% confidence interval 1.8 to 3.7). The average hospital stay was almost twice as long among postadmission as preadmission ADHF (9.6 vs 5.0 days). In conclusion, postadmission onset of ADHF is characterized by differences in co-morbidities and worse short-term prognosis, and opportunities for reducing postadmission ADHF occurrence and associated risks need to be studied.
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Panda S, Kumar MV, Bagchi S, Singh G, Agarwal SK, Dinda A. Migratory skin lesions in a renal transplant recipient. Nephrology (Carlton) 2014; 19:661-2. [PMID: 25262975 DOI: 10.1111/nep.12314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Sanjay Panda
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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