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Low CG, Merchant M, Hung YY, Liu YH, Vu J, Pursnani S. Assessing Glycosylated Hemoglobin Thresholds for Development of Cardiovascular Disease by Racial and Ethnic Groups. J Am Heart Assoc 2024; 13:e033559. [PMID: 38761085 DOI: 10.1161/jaha.123.033559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Diabetes is the strongest risk factor for cardiovascular disease, and although glycosylated hemoglobin (HbA1c) levels are known to vary by race, no racial and ethnic-specific diagnostic thresholds exist for diabetes in prediction of cardiovascular disease events. The purpose of this study is to determine whether HbA1c thresholds for predicting major adverse cardiovascular events (MACEs) differ among racial and ethnic groups. METHODS AND RESULTS This is a retrospective cohort study of Kaiser Permanente Northern California adult members (n=309 636) with no history of cardiovascular disease who had HbA1c values and race and ethnicity data available between 2014 and 2019. Multivariable logistic regression was used to evaluate the odds of MACEs by the following racial and ethnic groups: Filipino, South Asian, East Asian, Black, White, and Hispanic. A Youden index was used to calculate HbA1c thresholds for MACE prediction by each racial and ethnic group, stratified by sex. Among studied racial and ethnic groups, South Asian race was associated with the greatest odds of MACEs (1.641 [95% CI, 1.456-1.843]; P<0.0001). HbA1c was a positive predictor for MACEs, with an odds ratio of 1.024 (95% CI, 1.022-1.025) for each 0.1% increment increase in HbA1c. HbA1c values varied between 6.0% and 7.6% in MACE prediction by race and ethnicity and sex. White individuals, South Asian individuals, East Asian women, and Black men had HbA1c thresholds for MACE prediction in the prediabetic range, between 6.0% and 6.2%. Black women, Hispanic men, and East Asian men had HbA1c thresholds of 6.2% to 6.6%, less than the typical threshold of 7.0% that is used as a treatment goal. CONCLUSIONS Findings suggest that the use of race and ethnic- and sex-specific HbA1c thresholds may need to be considered in treatment goals and cardiovascular disease risk estimation.
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Affiliation(s)
| | | | - Yun-Yi Hung
- Kaiser Permanente Division of Research Oakland CA
| | - Yu Hsin Liu
- Kaiser Permanente Medical Center Santa Clara CA
| | - Joseph Vu
- Kaiser Permanente Medical Center Santa Clara CA
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Klarenberg H, van der Velde JHPM, Peeters CFW, Dekkers IA, de Mutsert R, Jukema JW, Rosendaal FR, Leiner T, Froeling M, Jorstad H, Boekholdt SM, Strijkers GJ, Lamb HJ. Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health. BMJ Open Sport Exerc Med 2024; 10:e001778. [PMID: 38347856 PMCID: PMC10860076 DOI: 10.1136/bmjsem-2023-001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
Objectives To investigate the association between leisure time physical activity (LTPA) and MRI-based diastolic function and the mediating role of metabolic health. Methods This cross-sectional analysis comprised 901 participants (46% women, mean age (SD): 56 (6) years (The Netherlands, 2008-2012)). LTPA was assessed via questionnaire, quantified in metabolic equivalent of tasks (METs)-minutes per week and participants underwent abdominal and cardiovascular MRI. Confirmatory factor analysis was used to construct the metabolic load factor. Piecewise structural equation model with adjustments for confounders was used to determine associations between LTPA and diastolic function and the mediating effect of metabolic load. Results Significant differences in mitral early/late peak filling rate (E/A) ratio per SD of LTPA (men=1999, women=1870 MET-min/week) of 0.18, (95% CI= 0.03 to 0.33, p=0.021) were observed in men, but not in women: -0.01 (-0.01 to 0.34, p=0.058). Difference in deceleration time of mitral early filling (E-DT) was 0.13 (0.01 to 0.24, p=0.030) in men and 0.17 (0.05 to 0.28, p=0.005) in women. Metabolic load, including MRI-based visceral and subcutaneous adipose tissue, fasting glucose, high-density lipoprotein cholesterol and triglycerides, mediated these associations as follows: E/A-ratio of 0.030 (0.000 to 0.067, 19% mediated, p=0.047) in men but not in women: 0.058 (0.027 to 0.089, p<0.001) and E-DT not in men 0.004 (-0.012 to 0.021, p=0.602) but did in women 0.044 (0.013 to 0.057, 27% mediated, p=0.006). Conclusions A larger amount of LTPA was associated with improved diastolic function where confirmatory factor analysis-based metabolic load partly mediated this effect. Future studies should assess whether improving indicators of metabolic load alongside LTPA will benefit healthy diastolic function even more.
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Affiliation(s)
- Hugo Klarenberg
- Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Carel FW Peeters
- Division of Mathematical & Statistical Methods – Biometris, Wageningen University & Research, Wageningen, The Netherlands
- Department of Epidemiology & Datascience, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tim Leiner
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Harald Jorstad
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Chappell E, Arbour L, Laksman Z. The Inclusion of Underrepresented Populations in Cardiovascular Genetics and Epidemiology. J Cardiovasc Dev Dis 2024; 11:56. [PMID: 38392270 PMCID: PMC10888590 DOI: 10.3390/jcdd11020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Novel genetic risk markers have helped us to advance the field of cardiovascular epidemiology and refine our current understanding and risk stratification paradigms. The discovery and analysis of variants can help us to tailor prognostication and management. However, populations underrepresented in cardiovascular epidemiology and cardiogenetics research may experience inequities in care if prediction tools are not applicable to them clinically. Therefore, the purpose of this article is to outline the barriers that underrepresented populations can face in participating in genetics research, to describe the current efforts to diversify cardiogenetics research, and to outline strategies that researchers in cardiovascular epidemiology can implement to include underrepresented populations. Mistrust, a lack of diverse research teams, the improper use of sensitive biodata, and the constraints of genetic analyses are all barriers for including diverse populations in genetics studies. The current work is beginning to address the paucity of ethnically diverse genetics research and has already begun to shed light on the potential benefits of including underrepresented and diverse populations. Reducing barriers for individuals, utilizing community-driven research processes, adopting novel recruitment strategies, and pushing for organizational support for diverse genetics research are key steps that clinicians and researchers can take to develop equitable risk stratification tools and improve patient care.
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Affiliation(s)
- Elias Chappell
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Zachary Laksman
- Department of Medicine and the School of Biomedical Engineering, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Menotti A, Puddu PE. In Search of Risk Factors: The Origin and Early Stages of Cardiovascular Epidemiology. J Cardiovasc Dev Dis 2024; 11:20. [PMID: 38248890 PMCID: PMC10816974 DOI: 10.3390/jcdd11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Based mainly on their personal experience, the authors try to describe the origin of cardiovascular disease (CVD) epidemiology and the problems and difficulties practitioners attempted to tackle and solve during the first few decades of this discipline, which started around the middle of the last century. Beyond identifying the characteristics of those who became CVD epidemiologists, a description is given of the initial structures of the involved studies, participation rates, risk factors measurements and standardization, clinical measurements and diagnostic criteria, mortality data collection and coding, data loading and analysis, plus a number of problems still unsolved at the beginning of the 2000s. Despite many obstacles, and the initial hostility of the medical-scientific establishment, CVD epidemiology represented a revolution in researching in the bio-medical field. In the end, it also affected clinical research introducing the use of the quantitative approach bound to mathematical-statistical procedures. After decades of hard work and the development of a number of innovative tools, CVD epidemiology received its deserved recognition, eventually being accepted as a reputable and independent scientific discipline. Yet, in several countries, especially those from Southern Europe, an academic recognition of CVD epidemiology is still lacking.
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Ndaba L, Mutyaba A, Mpanya D, Tsabedze N. In-Hospital Mortality Outcomes of ST-Segment Elevation Myocardial Infarction: A Cross-Sectional Study from a Tertiary Academic Hospital in Johannesburg, South Africa. J Cardiovasc Dev Dis 2023; 10:348. [PMID: 37623361 PMCID: PMC10455389 DOI: 10.3390/jcdd10080348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of STEMI patients who underwent diagnostic coronary angiography with or without percutaneous coronary intervention (PCI) between January 2015 and December 2019. We compared demographic and clinical parameters between survivors and non-survivors with descriptive statistics. Univariable and multivariable logistic regression analyses were performed to determine the predictors of all-cause mortality. The study population consisted of 677 patients with a mean age of 55.5 ± 11.3 years. The in-hospital all-cause mortality rate was 6.2% [95% confidence interval (CI): 4.5-8.3%]. Risk factors for ASCVD included smoking (56.1%), hypertension (52.8%), dyslipidemia (40.0%), and a family history of coronary artery disease (32.7%). A pharmaco-invasive management strategy (treatment with thrombolytic therapy and PCI) was implemented in 36.5% of patients and reduced all-cause mortality risk (OR: 0.16; CI: 0.04-0.71, p = 0.015). The in-hospital all-cause mortality rate in STEMI patients was 6.2%, and a pharmaco-invasive management strategy proved to be an effective approach.
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Affiliation(s)
| | | | | | - Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (L.N.); (A.M.); (D.M.)
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Stacey I, Ralph A, de Dassel J, Nedkoff L, Wade V, Francia C, Wyber R, Murray K, Hung J, Katzenellenbogen J. The evidence that rheumatic heart disease control programs in Australia are making an impact. Aust N Z J Public Health 2023; 47:100071. [PMID: 37364309 DOI: 10.1016/j.anzjph.2023.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 02/26/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE Rheumatic heart disease (RHD) comprises heart-valve damage caused by acute rheumatic fever (ARF). The Australian Government Rheumatic Fever Strategy funds RHD Control Programs to support detection and management of ARF and RHD. We assessed epidemiological changes during the years of RHD Control Program operation. METHODS Linked RHD register, hospital and death data from four Australian jurisdictions were used to measure ARF/RHD outcomes between 2010 and 2017, including: 2-year progression to severe RHD/death; ARF recurrence; secondary prophylaxis delivery and earlier disease detection. RESULTS Delivery of secondary prophylaxis improved from 53% median proportion of days covered (95%CI: 46-61%, 2010) to 70% (95%CI: 71-68%, 2017). Secondary prophylaxis adherence protected against progression to severe RHD/death (hazard ratio 0.2, 95% CI 0.1-0.8). Other measures of program effectiveness (ARF recurrences, progression to severe RHD/death) remained stable. ARF case numbers and concurrent ARF/RHD diagnoses increased. CONCLUSIONS RHD Control Programs have contributed to major success in the management of ARF/RHD through increased delivery of secondary prevention yet ARF case numbers, not impacted by secondary prophylaxis and sensitive to increased awareness/surveillance, increased. IMPLICATIONS FOR PUBLIC HEALTH RHD Control Programs have a major role in delivering cost-effective RHD prevention. Sustained investment is needed but with greatly strengthened primordial and primary prevention.
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Affiliation(s)
- Ingrid Stacey
- School of Population and Global Health, The University of Western Australia, Australia.
| | - Anna Ralph
- Menzies School of Health Research, Charles Darwin University, Australia; Department of Medicine, Royal Darwin Hospital, Australia.
| | - Jessica de Dassel
- Rheumatic heart disease Control Program, Northern Territory Health, Australia.
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Australia; Cardiology Population Health Laboratory, Victor Chang Cardiac Research Institute, Australia.
| | - Vicki Wade
- Menzies School of Health Research, Charles Darwin University, Australia; National Heart Foundation of Australia, Australia.
| | - Carl Francia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Department of Physiotherapy, The Prince Charles Hospital, Australia.
| | - Rosemary Wyber
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Australia; Telethon Kids Institute, Australia.
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Australia.
| | - Joseph Hung
- School of Medicine, The University of Western Australia, Australia.
| | - Judith Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Australia; Telethon Kids Institute, Australia.
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Shapira-Daniels A, Kornej J, Spartano NL, Wang X, Zhang Y, Pathiravasan CH, Liu C, Trinquart L, Borrelli B, McManus DD, Murabito JM, Benjamin EJ, Lin H. Step Count, Self-reported Physical Activity, and Predicted 5-Year Risk of Atrial Fibrillation: Cross-sectional Analysis. J Med Internet Res 2023; 25:e43123. [PMID: 36877540 PMCID: PMC10028513 DOI: 10.2196/43123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Physical inactivity is a known risk factor for atrial fibrillation (AF). Wearable devices, such as smartwatches, present an opportunity to investigate the relation between daily step count and AF risk. OBJECTIVE The objective of this study was to investigate the association between daily step count and the predicted 5-year risk of AF. METHODS Participants from the electronic Framingham Heart Study used an Apple smartwatch. Individuals with diagnosed AF were excluded. Daily step count, watch wear time (hours and days), and self-reported physical activity data were collected. Individuals' 5-year risk of AF was estimated, using the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF score. The relation between daily step count and predicted 5-year AF risk was examined via linear regression, adjusting for age, sex, and wear time. Secondary analyses examined effect modification by sex and obesity (BMI≥30 kg/m2), as well as the relation between self-reported physical activity and predicted 5-year AF risk. RESULTS We examined 923 electronic Framingham Heart Study participants (age: mean 53, SD 9 years; female: n=563, 61%) who had a median daily step count of 7227 (IQR 5699-8970). Most participants (n=823, 89.2%) had a <2.5% CHARGE-AF risk. Every 1000 steps were associated with a 0.08% lower CHARGE-AF risk (P<.001). A stronger association was observed in men and individuals with obesity. In contrast, self-reported physical activity was not associated with CHARGE-AF risk. CONCLUSIONS Higher daily step counts were associated with a lower predicted 5-year risk of AF, and this relation was stronger in men and participants with obesity. The utility of a wearable daily step counter for AF risk reduction merits further investigation.
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Affiliation(s)
- Ayelet Shapira-Daniels
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Jelena Kornej
- Boston University's Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, United States
| | - Nicole L Spartano
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Xuzhi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Yuankai Zhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | | | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Belinda Borrelli
- Center for Behavioral Science Research, Henry M Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Joanne M Murabito
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Boston University's Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, United States
| | - Emelia J Benjamin
- Boston University's Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Honghuang Lin
- Boston University's Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, United States
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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8
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Zhang Y, Liu D, Ma Z, Wang C, Gu S, Zhou Z, Zuo H. Plasma β-Alanine is Positively Associated With Risk of Ischemic Stroke: a Nested Case-Control Study. J Nutr 2023; 153:1162-1169. [PMID: 36854355 DOI: 10.1016/j.tjnut.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Previous studies suggested that β-alanine as a neurotransmitter could affect the pathogenesis of ischemic damage. However, the association between circulating β-alanine and risk of ischemic stroke (IS) has not been evaluated in populations. OBJECTIVES We aimed to examine the association between β-alanine and IS risk in a nested case-control study. METHODS We performed a case-control study nested within a prospective community-based cohort (n = 16457; median follow-up time: 5.3 y), which included 321 incident IS cases and 321 controls matched by age and sex. Β-alanine and other metabolites were measured in plasma after overnight fasting by LC-MS/MS. The association of β-alanine with risk of IS was evaluated by conditional logistic regression. BMI, current smoking, educational attainment, physical activity, total energy intake, family history of stroke, hypertension, diabetes, hyperlipidemia, and estimated GFR were adjusted in multivariable models. RESULTS There was a significant Spearman partial correlation between β-alanine and 4-pyridoxic acid (ρ = 0.239; P < 0.001). Participants with elevated β-alanine levels were more likely to develop IS with an adjusted OR of 1.26 (95% CI: 1.06-1.51; P = 0.011) (per standard deviation increment). This association remained significant after excluding the first 2 y of follow-up, and after further adjustment for red meat intake, total protein intake, medication use, or vitamin B6 indicators. CONCLUSIONS Our novel findings revealed that plasma β-alanine at baseline were positively associated with risk of IS and may function as an early biomarker of IS risk.
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Affiliation(s)
- Ya Zhang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Dong Liu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Ze Ma
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Cuicui Wang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Shujun Gu
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Zhengyuan Zhou
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
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Akhabue E, Rua M, Gandhi P, Kim JH, Cantor JC, Setoguchi S. Disparate Cardiovascular Hospitalization Trends Among Young and Middle-Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States. J Am Heart Assoc 2022; 12:e7978. [PMID: 36565205 PMCID: PMC9973609 DOI: 10.1161/jaha.122.027342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Inpatient hospitalizations for cardiovascular disease (CVD) decreased nationally in the past decade. However, data are lacking on whether national declines represent trends within and across race and ethnicity populations from different US regions. Methods and Results Using State Inpatient Databases, Census Bureau and Behavioral Risk Factor Surveillance System data for Florida, Kentucky, New Jersey, and North Carolina, we identified all CVD hospitalizations and population characteristics for adults aged 18 to 64 years between January 1, 2009 and December 31, 2018. We calculated yearly CVD hospitalization rates for each state for the overall population, by sex, race, and ethnicity. We modeled yearly trends in age-adjusted CVD hospitalization rate in each state using negative binomial regression. State base populations were similar by age (mean age: 40-42 years) and sex (50%-51% female) throughout the study period. There were 314 973 and 288 843 total CVD hospitalizations among the 4 states in 2009 and 2018, respectively. Crude hospitalization rates declined in all states (age 18-44 years NJ: -33.4%; KY: -17.0%; FL: -11.9%; NC: -11.2%; age 45-64 years NJ: -29.8%; KY: -20.3%; FL: -12.2%; NC: -11.6%) over the study period. In age-adjusted models, overall hospitalization rates declined significantly in NJ -2.5%/y (95% CI, -2.9 to -2.1) and in KY -1.6%/y (-1.9 to -1.2) with no significant declining trend in FL and NC. Similar findings were present by sex. Among non-Hispanic White populations, mean yearly decline in hospitalization rate was significant in all states except FL, with the greatest declines in NJ (-3.8%/y [-4.4 to -3.2], P values for state-year interaction <0.0001). By contrast, a significant declining trend was present for non-Hispanic Black and Hispanic populations only in NJ (P values for state-year interaction <0.001). We found similar differences in trend between states in sensitivity analyses incorporating additional demographic and comorbid characteristics. Conclusions Decreases in CVD hospitalization rates in the past decade among nonelderly adults varied considerably by state and appeared largely driven by declines among non-Hispanic White populations. Overall declines did not represent divergent trends between states within non-Hispanic Black and Hispanic populations. Recognition of differences not just between but also within race and ethnicity populations should inform national and local policy initiatives aimed at reducing disparities in CVD outcomes.
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Affiliation(s)
- Ehimare Akhabue
- Division of Cardiovascular Diseases and Hypertension, Department of MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJ
| | - Melanie Rua
- Institute for Health, Health Care Policy and Aging Research, Rutgers UniversityNew BrunswickNJ
| | - Poonam Gandhi
- Institute for Health, Health Care Policy and Aging Research, Rutgers UniversityNew BrunswickNJ
| | - Jung Hyun Kim
- Department of Preventive MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Joel C. Cantor
- Institute for Health, Health Care Policy and Aging Research, Rutgers UniversityNew BrunswickNJ
| | - Soko Setoguchi
- Institute for Health, Health Care Policy and Aging Research, Rutgers UniversityNew BrunswickNJ,Department of MedicineRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJ
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10
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López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, García LR, Ojeda-Castillejo E, López-Martín S, Diaz-Cambriles T, Virseda SG, Melgar BA, Pizarro AC, Alcocer HL, Troncoso-Acevedo MF, García TG, Yeste PL, Cano-Pumarega I, García-Sánchez A, Arcos BA, García EZ, Rodríguez PL, Iturricastillo G, Lores Gutiérrez V, Alonso CR, Ortola MV, López-Riolobos C, García-Prieto F, Abad-Fernández A, Baena EM. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study). J Clin Sleep Med 2022; 18:553-561. [PMID: 34534075 PMCID: PMC8804996 DOI: 10.5664/jcsm.9656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) has been associated with cardiovascular events (CVEs), although recent randomized controlled trials have not demonstrated that long-term continuous positive airway pressure (CPAP) prevents CVEs. Our objective was to determine the effect of CPAP on older adults with moderate OSA regarding CVE reduction. METHODS An observational and multicenter study of a cohort of older adults (> 70 years of age) diagnosed with moderate OSA (apnea-hypopnea index 15.0-29.9 events/h) was conducted. Two groups were formed: (1) CPAP treatment and (2) standard of care. The primary endpoint was CVE occurrence after OSA diagnosis. Association with CPAP treatment was assessed by propensity score matching and inverse weighting probability. Secondary endpoints were incidence of CVE separately and time to first CVE. RESULTS A total of 614 patients were included. After matching, 236 older adults (111 men, mean age 75.9 ± 4.7 years) with a follow-up of 47 months (interquartile range: 29.6-64.0 months) were considered for primary and secondary endpoint evaluations. Forty-one patients presented at least 1 CVE (17.4%): 20 were in the standard-of-care group (16.9%) and 21 were in the CPAP group (17.8%), with a relative risk of 1.05 (95% confidence interval [CI], 0.60-1.83; P = .43) for CPAP treatment. Inverse probability weighting of the initial 614 patients determined an adjusted relative risk of 1.24 (95% CI, 0.79-1.96; P = .35) for CPAP treatment. No statistical differences were found in secondary endpoint analyses. CONCLUSIONS CPAP should not be prescribed to reduce CVE probability in older adults with moderate OSA. CITATION López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, et al. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study). J Clin Sleep Med. 2022;18(2):553-561.
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Affiliation(s)
- Daniel López-Padilla
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón,Address correspondence to: Daniel López-Padilla, PhD, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo Street 46, Postal Code 28007, Madrid, Spain;
| | - José Terán-Tinedo
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón,Universidad Complutense de Madrid, Madrid, Spain
| | - Alicia Cerezo-Lajas
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Ramírez García
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Soledad López-Martín
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Begoña Arias Melgar
- Sleep Unit, Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Candel Pizarro
- Sleep Unit, Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Héctor Lozano Alcocer
- Sleep Unit, Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Teresa Gómez García
- Respiratory Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Pablo López Yeste
- Respiratory Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Irene Cano-Pumarega
- Sleep Unit, Respiratory Department, Hospital Universitario Ramon y Cajal, Madrid, Spain,CIBERES
| | - Aldara García-Sánchez
- Sleep Unit, Respiratory Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Beatriz Arias Arcos
- Respiratory Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Eva Mañas Baena
- Sleep Unit, Respiratory Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
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Krefman AE, Labarthe D, Greenland P, Pool L, Aguayo L, Juonala M, Kähönen M, Lehtimäki T, Day RS, Bazzano L, Muggeo VMR, Van Horn L, Liu L, Webber LS, Pahkala K, Laitinen TT, Raitakari O, Lloyd-Jones DM, Allen NB. Influential Periods in Longitudinal Clinical Cardiovascular Health Scores. Am J Epidemiol 2021; 190:2384-2394. [PMID: 34010956 PMCID: PMC8561125 DOI: 10.1093/aje/kwab149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 01/08/2023] Open
Abstract
The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. Data were pooled from 5 longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults, Special Turku Coronary Risk Factor Intervention Project) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (i.e., body mass index, blood pressure, cholesterol, blood glucose) measured from ages 8 to 55 years were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted, segmented, linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9,461 (52%) were female and 12,346 (67%) were White. The baseline mean (standard deviation) clinical CVH score was 6.9 (1.2) at an average age of 17.6 (8.1) years. Two inflection points were estimated: at 16.9 years (95% confidence interval: 16.4, 17.4) and at 37.2 years (95% confidence interval: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods during which the loss of CVH accelerates.
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Affiliation(s)
- Amy E Krefman
- Correspondence to Amy Krefman, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611 (e-mail: )
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12
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Hedman K, Kaminsky LA, Sabbahi A, Arena R, Myers J. Low but not high exercise systolic blood pressure is associated with long-term all-cause mortality. BMJ Open Sport Exerc Med 2021; 7:e001106. [PMID: 34178375 PMCID: PMC8190063 DOI: 10.1136/bmjsem-2021-001106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives The risks associated with achieving a high peak systolic blood pressure (SBP) during clinical exercise testing remain controversial, although this issue has not been evaluated in relation to predicted SBP standards. This cohort study aimed to evaluate the long-term risk of all-cause mortality in males in relation to reference values of peak SBP and the increase in SBP during exercise from the Fitness Registry and the Importance of Exercise: A National Database (FRIEND). Methods We followed 7164 males (mean age: 58.2±10.6 years) over 95 998 person-years of follow-up (mean 13.4±5.4 years), who performed a maximal treadmill exercise test at baseline. SBP was measured at rest and at peak exercise. Risk of all-cause mortality over 20 years (Cox regression) was determined in relation to reference percentiles of peak SBP and increase in SBP with exercise: <10th (low), 10th-90th, >90th (high) percentiles. Results A high peak or a large increase in SBP with exercise was not associated with all-cause mortality. Subjects with a low peak SBP had a 20% higher unadjusted risk for all-cause death compared with those with a normal value (1.20 (1.11-1.31)), and a statistically non-significant 7% higher risk after adjustment for all baseline risk factors (1.07 (0.97-1.18)). The corresponding unadjusted and adjusted risks associated with a low increase in SBP were 1.24 (1.15-1.35) and 1.11 (1.02-1.21), respectively. Conclusions A low-but not high-peak SBP is associated with increased unadjusted risk of all-cause mortality. The FRIEND percentiles of exercise SBP can aid clinicians in individualising risk assessment.
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Affiliation(s)
- Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana, USA
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.,School of Physical Therapy, South College, Knoxville, Tennessee, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System, Stanford University, Palo Alto, California, USA
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13
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Andersson C, Nayor M, Tsao CW, Levy D, Vasan RS. Framingham Heart Study: JACC Focus Seminar, 1/8. J Am Coll Cardiol 2021; 77:2680-92. [PMID: 34045026 DOI: 10.1016/j.jacc.2021.01.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 01/12/2023]
Abstract
The Framingham Heart Study is the longest-running cardiovascular epidemiological study, starting in 1948. This paper gives an overview of the various cohorts, collected data, and most important research findings to date. In brief, the Framingham Heart Study, funded by the National Institutes of Health and managed by Boston University, spans 3 generations of well phenotyped White persons and 2 cohorts comprised of racial and ethnic minority groups. These cohorts are densely phenotyped, with extensive longitudinal follow-up, and they continue to provide us with important information on human cardiovascular and noncardiovascular physiology over the lifespan, as well as to identify major risk factors for cardiovascular disease. This paper also summarizes some of the more recent progress in molecular epidemiology and discusses the future of the study.
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14
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Björkelund A, Ohlsson M, Lundager Forberg J, Mokhtari A, Olsson de Capretz P, Ekelund U, Björk J. Machine learning compared with rule-in/rule-out algorithms and logistic regression to predict acute myocardial infarction based on troponin T concentrations. J Am Coll Emerg Physicians Open 2021; 2:e12363. [PMID: 33778804 PMCID: PMC7984484 DOI: 10.1002/emp2.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Computerized decision-support tools may improve diagnosis of acute myocardial infarction (AMI) among patients presenting with chest pain at the emergency department (ED). The primary aim was to assess the predictive accuracy of machine learning algorithms based on paired high-sensitivity cardiac troponin T (hs-cTnT) concentrations with varying sampling times, age, and sex in order to rule in or out AMI. METHODS In this register-based, cross-sectional diagnostic study conducted retrospectively based on 5695 chest pain patients at 2 hospitals in Sweden 2013-2014 we used 5-fold cross-validation 200 times in order to compare the performance of an artificial neural network (ANN) with European guideline-recommended 0/1- and 0/3-hour algorithms for hs-cTnT and with logistic regression without interaction terms. Primary outcome was the size of the intermediate risk group where AMI could not be ruled in or out, while holding the sensitivity (rule-out) and specificity (rule-in) constant across models. RESULTS ANN and logistic regression had similar (95%) areas under the receiver operating characteristics curve. In patients (n = 4171) where the timing requirements (0/1 or 0/3 hour) for the sampling were met, using ANN led to a relative decrease of 9.2% (95% confidence interval 4.4% to 13.8%; from 24.5% to 22.2% of all tested patients) in the size of the intermediate group compared to the recommended algorithms. By contrast, using logistic regression did not substantially decrease the size of the intermediate group. CONCLUSION Machine learning algorithms allow for flexibility in sampling and have the potential to improve risk assessment among chest pain patients at the ED.
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Affiliation(s)
- Anders Björkelund
- Department of Astronomy and Theoretical PhysicsLund UniversityLundSweden
| | - Mattias Ohlsson
- Department of Astronomy and Theoretical PhysicsLund UniversityLundSweden
| | | | - Arash Mokhtari
- Department of CardiologySkåne University HospitalLundSweden
- Department of Clinical Sciences at LundLund UniversityLundSweden
| | - Pontus Olsson de Capretz
- Department of Clinical Sciences at LundLund UniversityLundSweden
- Department of Emergency MedicineSkåne University HospitalLundSweden
| | - Ulf Ekelund
- Department of Clinical Sciences at LundLund UniversityLundSweden
- Department of Emergency MedicineSkåne University HospitalLundSweden
| | - Jonas Björk
- Division of Occupational and Environmental MedicineLund UniversityLundSweden
- Clinical Studies SwedenForum SouthSkåne University HospitalLundSweden
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15
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Salier Eriksson J, Ekblom B, Andersson G, Wallin P, Ekblom-Bak E. Scaling VO 2max to body size differences to evaluate associations to CVD incidence and all-cause mortality risk. BMJ Open Sport Exerc Med 2021; 7:e000854. [PMID: 33537151 PMCID: PMC7849897 DOI: 10.1136/bmjsem-2020-000854] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate and compare ratio and allometric scaling models of maximal oxygen consumption (VO2max) for different body size measurements in relation to cardiovascular disease (CVD) incidence and all-cause mortality. Methods 316 116 individuals participating in occupational health screenings, initially free from CVD, were included. VO2max was estimated using submaximal cycle test. Height, body mass and waist circumference (WC) were assessed, and eight different scaling models (two evaluated in a restricted sample with WC data) were derived. Participants were followed in national registers for first-time CVD event or all-cause mortality from their health screening to first CVD event, death or 31 December 2015. Results Increasing deciles of VO2max showed lower CVD risk and all-cause mortality for all six models in the full sample (p<0.001) as well as with increasing quintiles in the restricted sample (eight models) (p<0.001). For CVD risk and all-cause mortality, significantly weaker associations with increasing deciles for models 1 (L·min−1) and 5 (mL·min−1·height−2) were seen compared with model 2 (mL·min−1·kg−1), (CVD, p<0.00001; p<0.00001: all-cause mortality, p=0.008; p=0.001) and in some subgroups. For CVD, model 6 (mL·min−1·(kg1·height−1)−1) had a stronger association compared with model 2 (p<0.00001) and in some subgroups. In the restricted sample, trends for significantly stronger associations for models including WC compared with model 2 were seen in women for both CVD and all-cause mortality, and those under 50 for CVD. Conclusion In association to CVD and all-cause mortality, only small differences were found between ratio scaling and allometric scaling models where body dimensions were added, with some stronger associations when adding WC in the models.
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Affiliation(s)
- Jane Salier Eriksson
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Björn Ekblom
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Gunnar Andersson
- Research Department, HPI Health Profile Institute, Danderyd, Sweden
| | - Peter Wallin
- Research Department, HPI Health Profile Institute, Danderyd, Sweden
| | - Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden
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Honigberg MC, Natarajan P. Women's Cardiovascular Health After Hypertensive Pregnancy: The Long View From Labor and Delivery Becomes Clearer. J Am Coll Cardiol 2020; 75:2335-2337. [PMID: 32381165 DOI: 10.1016/j.jacc.2020.01.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Michael C Honigberg
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts.
| | - Pradeep Natarajan
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Vaara JP, Vasankari T, Fogelholm M, Koski H, Kyröläinen H. Cycling but not walking to work or study is associated with physical fitness, body composition and clustered cardiometabolic risk in young men. BMJ Open Sport Exerc Med 2020; 6:e000668. [PMID: 32153983 PMCID: PMC7047505 DOI: 10.1136/bmjsem-2019-000668] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction Active commuting is an inexpensive and accessible form of physical activity and may be beneficial to health. The aim of this study was to investigate the association of active commuting and its subcomponents, cycling and walking, with cardiometabolic risk factors, physical fitness and body composition in young men. Methods Participants were 776 Finnish young (26±7 years), healthy adult men. Active commuting was measured with self-report. Waist circumference was measured and body mass index (BMI) calculated. Aerobic fitness was measured with bicycle ergometer and muscular fitness with maximal leg and bench press, sit-ups, push-ups and standing long jump. Cardiometabolic risk factors were analysed from blood samples and selected variables (glucose, insulin, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, as well as systolic and diastolic blood pressure) were further converted to z-score to form clustered cardiometabolic risk. Results A total of 24% used active commuting consisting of 10% of walkers and 14% of cyclists. After adjustments for age, smoking, time of year, leisure-time and occupational physical activities, cycling was inversely associated with the clustered cardiometabolic risk (β=−0.11, 95% CI −0.22 to −0.01), while walking was not (β=−0.04, 95% CI −0.16 to 0.08). However, further adjustment for waist circumference attenuated the associations to non-significant. Moreover, cycling but not walking was inversely associated with BMI, waist circumference and maximal strength, while a positive association was observed with aerobic fitness (p<0.05). Conclusion This study shows that cycling to work or study has beneficial associations to clustered cardiometabolic risk, body composition and aerobic fitness in young, healthy adult men.
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Affiliation(s)
- Jani P Vaara
- The Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Harri Koski
- Training Division, Defence Command, Finnish Defence Forces, Helsinki, Finland
| | - Heikki Kyröläinen
- University of Jyväskylä, Faculty of Sports and Health Sciences, Jyvaskyla, Finland
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Gouttebarge V, Andersen TE, Cowie C, Goedhart E, Jorstad H, Kemp S, Königs M, Maas M, Orhant E, Rantanen J, Salo J, Serratosa L, Stokes K, Tol JL, Verhagen E, Weber A, Kerkhoffs G. Monitoring the health of transitioning professional footballers: protocol of an observational prospective cohort study. BMJ Open Sport Exerc Med 2019; 5:e000680. [PMID: 31908839 PMCID: PMC6937067 DOI: 10.1136/bmjsem-2019-000680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Transitioning out of professional football is a challenging time in most players' lives. During these preretirement and postretirement years, professional footballers may struggle with their mental, musculoskeletal, neurocognitive and cardiovascular health. Currently, longitudinal data about these health conditions are lacking. This article presents the design of a prospective cohort study with the primary aim of gathering epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their preretirement and postretirement years and evaluating the associations between risk indicators and the health conditions under study in these players. METHODS AND ANALYSIS An observational prospective cohort study with repeated measurements over a follow-up period of 10 years will be conducted among at least 200 professional footballers (male; 27 (±1) years old). Mental health will be explored by assessing symptoms of distress, anxiety, depression, sleep disturbance, alcohol misuse, drug misuse and disordered eating. Musculoskeletal health will be explored by assessing severe joint injury and related surgery, clinical and radiological osteoarthritis, and joint function (hips, knees and ankles). Neurocognitive health will be explored by assessing the concussion, brain structure and functioning, and neurocognitive functioning. Cardiovascular health will be explored by assessing blood pressure, lipid profile and ECG abnormalities. ETHICS AND DISSEMINATION Ethical approval for the study was provided by the Medical Ethics Review Committee of the Amsterdam University Medical Centers. The results of the study will be submitted to peer-reviewed journals, will be presented at scientific conferences and will be released in the media (postpublication). TRIAL REGISTRATION NUMBER The Dutch Trial Registry (Drake Football Study NL7999).
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Affiliation(s)
- Vincent Gouttebarge
- Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- FIFPRO (Football Players Worldwide), Hoofddorp, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- The Norwegian FA Medical Center, The Football Association of Norway, Oslo, Norway
| | - Charlotte Cowie
- The Football Association, National Football Centre, St George’s Park, Needwood, United Kingdom
| | - Edwin Goedhart
- Royal Netherlands Football Association (KNVB), FIFA Medical Center of Excellence, Zeist, The Netherlands
| | - Harald Jorstad
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Amsterdam UMC, Univ of Amsterdam, Department of Cardiology, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Marsh Königs
- Royal Netherlands Football Association (KNVB), FIFA Medical Center of Excellence, Zeist, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, Amsterdam, The Netherlands
| | - Mario Maas
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Amsterdam UMC, Univ of Amsterdam, Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Emmanuel Orhant
- French Football Federation (FFF), Clairefontaine Medical Centre, FIFA Medical Center of Excellence, Clairefontaine, France
| | - Jussi Rantanen
- Orthopaedics and Sports Clinic, Mehiläinen NEO Hospital, Turku, Finland
| | - Jari Salo
- Sports Hospital Mehiläinen, Helsinki, Finland
| | - Luis Serratosa
- Ripoll & De Prado Sport Clinic, FIFA Medical Centre of Excellence, Madrid, Spain
- Hospital Universitario Quironsalud, Madrid, Spain
| | - Keith Stokes
- Rugby Football Union, Twickenham, UK
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, United Kingdom
| | - Johannes L Tol
- Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
| | - Alexis Weber
- Fédération Internationale de Football Association (FIFA), Zurich, The Netherlands
| | - Gino Kerkhoffs
- Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
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Affiliation(s)
- Janet W Rich-Edwards
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Honigberg MC, Zekavat SM, Aragam K, Klarin D, Bhatt DL, Scott NS, Peloso GM, Natarajan P. Long-Term Cardiovascular Risk in Women With Hypertension During Pregnancy. J Am Coll Cardiol 2019; 74:2743-2754. [PMID: 31727424 DOI: 10.1016/j.jacc.2019.09.052] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND History of a hypertensive disorder of pregnancy (HDP) among women may be useful to refine atherosclerotic cardiovascular disease risk assessments. However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown. OBJECTIVES The purpose of this study was to examine the long-term incidence of diverse cardiovascular conditions among middle-aged women with and without prior HDP. METHODS Women in the prospective, observational UK Biobank age 40 to 69 years who reported ≥1 live birth were included. Noninvasive arterial stiffness measurement was performed in a subset of women. Cox models were fitted to associate HDP with incident cardiovascular diseases. Causal mediation analyses estimated the contribution of conventional risk factors to observed associations. RESULTS Of 220,024 women included, 2,808 (1.3%) had prior HDP. The mean age at baseline was 57.4 ± 7.8 years, and women were followed for median 7 years (interquartile range: 6.3 to 7.7 years). Women with HDP had elevated arterial stiffness indexes and greater prevalence of chronic hypertension compared with women without HDP. Overall, 7.0 versus 5.3 age-adjusted incident cardiovascular conditions occurred per 1,000 women-years for women with versus without prior HDP, respectively (p = 0.001). In analysis of time-to-first incident cardiovascular diagnosis, prior HDP was associated with a hazard ratio (HR) of 1.3 (95% CI: 1.04 to 1.60; p = 0.02). HDP was associated with greater incidence of CAD (HR: 1.8; 95% CI: 1.3 to 2.6; p < 0.001), heart failure (HR: 1.7; 95% CI: 1.04 to 2.60; p = 0.03), aortic stenosis (HR: 2.9; 95% CI: 1.5 to 5.4; p < 0.001), and mitral regurgitation (HR: 5.0; 95% CI: 1.5 to 17.1; p = 0.01). In causal mediation analyses, chronic hypertension explained 64% of HDP's association with CAD and 49% of HDP's association with heart failure. CONCLUSIONS Hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated, including valvular heart disease. Cardiovascular risk after HDP is largely but incompletely mediated by development of chronic hypertension.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Seyedeh Maryam Zekavat
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts; Yale University School of Medicine, New Haven, Connecticut
| | - Krishna Aragam
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Derek Klarin
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nandita S Scott
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Pradeep Natarajan
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Aguilar-Palacio I, Malo S, Lallana M, Feja C, González J, Moreno-Franco B, Rabanaque M. Co-prescription patterns of cardiovascular preventive treatments: a cross-sectional study in the Aragon worker' health study (Spain). BMJ Open 2019; 9:e023571. [PMID: 30987984 PMCID: PMC6500350 DOI: 10.1136/bmjopen-2018-023571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To identify cardiovascular disease (CVD) preventive treatments combinations, among them and with other drugs, and to determine their prevalence in a cohort of Spanish workers. DESIGN Cross-sectional study. SETTING Aragon Workers' Health Study (AWHS) cohort in Spain. PARTICIPANTS 5577 workers belonging to AWHS cohort. From these subjects, we selected those that had, at least, three prescriptions of the same therapeutic subgroup in 2014 (n=4605). PRIMARY AND SECONDARY OUTCOME MEASURES Drug consumption was obtained from the Aragon Pharmaceutical Consumption Registry (Farmasalud). In order to know treatment utilisation, prevalence analyses were conducted. Frequent item set mining techniques were applied to identify drugs co-prescription patterns. All the results were stratified by sex and age. RESULTS 42.3% of men and 18.8% of women in the cohort received, at least, three prescriptions of a CVD preventive treatment in 2014. The most prescribed CVD treatment were antihypertensives (men: 28.2%, women 9.2%). The most frequent association observed among CVD preventive treatment was agents acting on the renin-angiotensin system and lipid-lowering drugs (5.1% of treated subjects). Co-prescription increased with age, especially after 50 years old, both in frequency and number of associations, and was higher in men. Regarding the association between CVD preventive treatments and other drugs, the most frequent pattern observed was lipid-lowering drugs and drugs used for acid related disorders (4.2% of treated subjects). CONCLUSIONS There is an important number of co-prescription patterns that involve CVD preventive treatments. These patterns increase with age and are more frequent in men. Mining techniques are a useful tool to identify pharmacological patterns that are not evident in the individual clinical practice, in order to improve drug prescription appropriateness.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Sara Malo
- Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - MªJesús Lallana
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
- Primary Health Care, Aragon Health Service, Zaragoza, Spain
| | - Cristina Feja
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Juan González
- Biocomputing Unit. Health Services and Policy Research Group (ARiHSP), Institute of Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Belén Moreno-Franco
- Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Unidad de Investigación en Prevención Cardiovascular, Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - MªJosé Rabanaque
- Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
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Simsek MA, Degertekin M, Turer Cabbar A, Aslanger E, Ozveren O, Aydın S, Mutlu B, Erol C. NT-proBNP levels and mortality in a general population-based cohort from Turkey: a long-term follow-up study. Biomark Med 2018; 12:1073-1081. [PMID: 30191742 DOI: 10.2217/bmm-2018-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/21/2022] Open
Abstract
AIM We investigated the relationship between NT-ProBNP and mortality in a general population-based cohort. METHODS & RESULTS A total of 2021 out of 4650 participants from previously published HAPPY study were included. Mean follow-up was 84.5 ± 10.4 months. After adjusting for risk factors, high levels of LogNT-proBNP predicted all-cause death (HR: 3.23; 95% CI: 2.20-4.75; p < 0.001) and cardiovascular death (HR: 3.85; 95% CI: 2.37-6.26; p < 0.001). Regression analysis revealed that LogNT-proBNP was an independent predictor of all-cause death (HR: 2.85; 95% CI: 1.91-4.24; p < 0.001) and cardiovascular death (HR: 3.02; 95% CI: 1.84-4.95; p < 0.001). Conclusıon: Our study showed that in long term follow-up, NT-proBNP is associated with increased all-cause and cardiovascular mortality.
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Affiliation(s)
| | | | - Ayca Turer Cabbar
- Cardiology Department, Yeditepe University Hospital, Istanbul, Turkey
| | - Emre Aslanger
- Cardiology Department, Yeditepe University Hospital, Istanbul, Turkey
| | - Olcay Ozveren
- Cardiology Department, Yeditepe University Hospital, Istanbul, Turkey
| | - Sinan Aydın
- Cardiology Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Bulent Mutlu
- Cardiology Department, Marmara University Hospital, Istanbul, Turkey
| | - Cetin Erol
- Cardiology Department, Ankara University Hospital, Istanbul Turkey
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Campbell Jenkins BW, Addison C, Wilson G, Young L, Fields R, Woodberry C, Payton M. Implementing a Graduate Certificate Program in Cardiovascular Epidemiology: The Jackson Heart Study. Int J Environ Res Public Health 2015; 13:ijerph13010026. [PMID: 26703701 PMCID: PMC4730417 DOI: 10.3390/ijerph13010026] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 11/16/2022]
Abstract
The Jackson Heart Study (JHS) is committed to providing opportunities for expanding the understanding of the epidemiology, diagnosis, prevention, and treatment of cardiovascular diseases. The JHS Graduate Training and Education Center (GTEC) has initiated the Daniel Hale Williams Scholar (DHWS) program where students are afforded the opportunity to interact with epidemiologists and other biomedical scientists to learn to identify, predict, and prevent cardiovascular disease using the Jackson Heart Study data. This study describes the structured programs developed by JHS GTEC seeking to alleviate the shortage of trained professionals in cardiovascular epidemiology by training graduate students while they complete their academic degrees. The DHWS program provides: (1) an enrichment curriculum; (2) a learning community; (3) quarterly seminars; and (4) a Summer Institute. Students attend enrichment activities comprising: (1) Applied Biostatistics; (2) Cardiovascular Disease Epidemiology; (3) Social Epidemiology; (4) Emerging Topics; and (5) Research Writing. Training focuses on developing proficiency in cardiovascular health knowledge. The DHWS program is a unique strategy for incorporating rigorous academic and career-focused training to graduate students and has enabled the acquisition of competencies needed to impact cardiovascular disease management programs.
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Affiliation(s)
- Brenda W Campbell Jenkins
- Jackson Heart Study, School of Public Health, Jackson State University, 350 West Woodrow Wilson Drive, Suite 2900B, Jackson, MS 39213, USA.
| | - Clifton Addison
- Jackson Heart Study, School of Public Health, Jackson State University, 350 West Woodrow Wilson Drive, Suite 2900B, Jackson, MS 39213, USA.
| | - Gregory Wilson
- Jackson Heart Study, School of Public Health, Jackson State University, 350 West Woodrow Wilson Drive, Suite 2900B, Jackson, MS 39213, USA.
| | - Lavon Young
- Jackson Heart Study, School of Public Health, Jackson State University, 350 West Woodrow Wilson Drive, Suite 2900B, Jackson, MS 39213, USA.
| | - Regina Fields
- Jackson Heart Study, School of Public Health, Jackson State University, 350 West Woodrow Wilson Drive, Suite 2900B, Jackson, MS 39213, USA.
| | - Clevette Woodberry
- Jackson Heart Study, School of Public Health, Jackson State University, 350 West Woodrow Wilson Drive, Suite 2900B, Jackson, MS 39213, USA.
| | - Marinelle Payton
- Jackson Heart Study, School of Public Health, Jackson State University, 350 West Woodrow Wilson Drive, Suite 2900B, Jackson, MS 39213, USA.
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Berge T, Vigen T, Pervez MO, Ihle-Hansen H, Lyngbakken MN, Omland T, Smith P, Steine K, Røsjø H, Tveit A. Heart and Brain Interactions--the Akershus Cardiac Examination (ACE) 1950 Study Design. SCAND CARDIOVASC J 2015; 49:308-15. [PMID: 26364744 DOI: 10.3109/14017431.2015.1086813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of the Akershus Cardiac Examination (ACE) 1950 Study is to investigate the development and progression of cardiovascular and cerebrovascular disease (CVD/CeVD) in an extensively characterized age cohort of middle-aged subjects with longitudinal long-term follow-up. DESIGN The ACE 1950 Study is a prospective, population-based, age-cohort study of all men and women born in 1950 in Akershus County, Norway. The study involves a comprehensive baseline examination, especially for CVD/CeVD, including advanced ultrasound imaging and biobanking ("deep phenotyping"). We expect to obtain an inclusion rate of > 60% from the total study population of 5,827 eligible subjects. Enrollment will be completed during 2015. CONCLUSIONS The ACE 1950 Study will have potential to generate new and relevant insight into identification of subclinical disease progression. Extensive phenotyping will enable identification of novel disease markers and mechanisms for subclinical disease, which can prove important for future disease prevention.
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Affiliation(s)
- Trygve Berge
- a Department of Medical Research , Baerum Hospital, Vestre Viken Hospital Trust , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Thea Vigen
- b Division of Medicine, Akershus University Hospital , Lørenskog , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Mohammad Osman Pervez
- b Division of Medicine, Akershus University Hospital , Lørenskog , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Haakon Ihle-Hansen
- a Department of Medical Research , Baerum Hospital, Vestre Viken Hospital Trust , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Magnus Nakrem Lyngbakken
- b Division of Medicine, Akershus University Hospital , Lørenskog , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Torbjørn Omland
- b Division of Medicine, Akershus University Hospital , Lørenskog , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Pål Smith
- b Division of Medicine, Akershus University Hospital , Lørenskog , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Kjetil Steine
- b Division of Medicine, Akershus University Hospital , Lørenskog , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Helge Røsjø
- b Division of Medicine, Akershus University Hospital , Lørenskog , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Arnljot Tveit
- a Department of Medical Research , Baerum Hospital, Vestre Viken Hospital Trust , Norway
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Schnabel RB, Wild PS, Prochaska JH, Ojeda FM, Zeller T, Rzayeva N, Ebrahim A, Lackner KJ, Beutel ME, Pfeiffer N, Sinning CR, Oertelt-Prigione S, Regitz-Zagrosek V, Binder H, Münzel T, Blankenberg S. Sex Differences in Correlates of Intermediate Phenotypes and Prevalent Cardiovascular Disease in the General Population. Front Cardiovasc Med 2015; 2:15. [PMID: 26664887 PMCID: PMC4671364 DOI: 10.3389/fcvm.2015.00015] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/16/2015] [Indexed: 01/04/2023] Open
Abstract
Background There are marked sex differences in cardiovascular disease (CVD) manifestation. It is largely unknown how the distribution of CVD risk factors or intermediate phenotypes explain sex-specific differences. Methods and Results In 5000 individuals of the population-based Gutenberg Health Study, mean age 55 ± 11 years, 51% males, we examined sex-specific associations of classical CVD risk factors with intima-media thickness, ankle-brachial index, flow-mediated dilation, peripheral arterial tonometry, echocardiographic, and electrocardiographic variables. Intermediate cardiovascular phenotypes were related to prevalent CVD [coronary artery disease, heart failure, stroke, myocardial infarction, lower extremity artery disease (LEAD) N = 561]. We observed differential distributions of CVD risk factors with a higher risk factor burden in men. Manifest coronary artery disease, stroke, myocardial infarction, and LEAD were more frequent in men; the proportion of heart failure was higher in women. Intermediate phenotypes showed clear sex differences with more beneficial values in women. Fairly linear changes toward less beneficial values with age were observed in both sexes. In multivariable-adjusted regression analyses, age, systolic blood pressure, and body mass index were consistently associated with intermediate phenotypes in both sexes with different ranking according to random forests, maximum model R2 0.43. Risk factor-adjusted associations with prevalent CVD showed some differences by sex. No interactions by menopausal status were observed. Conclusion In a population-based cohort, we observed sex differences in risk factors and a broad range of intermediate phenotypes of non-invasive cardiovascular structure and function. Their relation to prevalent CVD differed markedly. Our results indicate the need of future investigations to understand sex differences in CVD manifestation.
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Affiliation(s)
- Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf , Hamburg , Germany
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz , Mainz , Germany ; Department of Medicine 2, University Medical Center Mainz , Mainz , Germany ; German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain , Germany
| | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis, University Medical Center Mainz , Mainz , Germany ; Department of Medicine 2, University Medical Center Mainz , Mainz , Germany
| | - Francisco M Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf , Hamburg , Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf , Hamburg , Germany
| | - Nargiz Rzayeva
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf , Hamburg , Germany
| | - Ariana Ebrahim
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf , Hamburg , Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz , Mainz , Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz , Mainz , Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz , Mainz , Germany
| | - Christoph R Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf , Hamburg , Germany
| | - Sabine Oertelt-Prigione
- Institute of Gender in Medicine (GiM), Center for Cardiovascular Research (CCR), Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM), Center for Cardiovascular Research (CCR), Charité-Universitätsmedizin Berlin , Berlin , Germany ; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin , Germany
| | - Harald Binder
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz , Mainz , Germany
| | - Thomas Münzel
- Department of Medicine 2, University Medical Center Mainz , Mainz , Germany ; German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain , Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf , Hamburg , Germany
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Buck Louis GM, Bloom MS, Gatto NM, Hogue CR, Westreich DJ, Zhang C. Epidemiology's continuing contribution to public health: The power of "Then and Now". Am J Epidemiol 2015; 181:e1-8. [PMID: 25810458 DOI: 10.1093/aje/kwv043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 12/19/2014] [Accepted: 02/03/2015] [Indexed: 11/13/2022] Open
Abstract
The 47th annual meeting of the Society for Epidemiologic Research hosted 17 invited speakers charged by the Executive Committee with presenting some of the many ways that epidemiologists have improved the health of the general population. There were 9 "Then and Now" sessions that were structured to focus on how early epidemiologists overcame research hurdles and advanced health through innovative strategies. For most topics, a longstanding expert was paired with an excellent contemporary epidemiologist working in the area, and both were given the freedom to deliver an integrated story about epidemiology's temporal role in protecting and promoting public health. Epidemiologic discoveries in cardiovascular, cancer, and perinatal epidemiology were discussed on day 1, followed by discussions of accomplishments in reducing exposures that adversely impact health (nutrition, environment/occupation, and tobacco use) on day 2. Topics with relevancy for many aspects of epidemiology were presented on day 3, including infectious diseases, social forces, and causal thinking in epidemiologic research. Given the large number of outstanding senior and junior epidemiologists that attended the meeting, choosing speakers was a unique challenge. What became evident from all sessions was the passion that epidemiologists have for population health, tempered with concerns for remaining true to epidemiologic principles, the timely adoption of innovative methods, and the responsible interpretation of research findings.
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Affiliation(s)
- Philip D Houck
- Division of Cardiology, Department of Medicine, Scott & White Healthcare, Texas A&M University System Health Science Center College of Medicine, Texas, USA
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Tharkar S, Viswanathan V. Effect of obesity on cardiovascular risk factors in urban population in South India. Heart Asia 2010; 2:145-9. [PMID: 27325967 PMCID: PMC4898498 DOI: 10.1136/ha.2009.000950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/07/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Non-communicable diseases are on the rise globally, and developing countries are also witnessing the burden. Rising obesity levels are a matter of serious concern owing to the well-established link between obesity and non-communicable diseases. The objective of this study was to determine the effect of obesity on the prevalence of cardiovascular risk factors among the Indian population. METHODS Data on blood pressure, anthropometric and biochemical measurements were collected for 2021 subjects aged above 20 years. Measurements were restricted to only anthropometrics for those below 20 years (N=1289). The study population was categorised into three groups according to body mass index for statistical analysis. RESULTS The prevalence of overweight and obesity was 29.5% and 11.1%, respectively, which shows significant rising trends since 1995. Glucose intolerance, dyslipidaemia, hypertension and metabolic syndrome were significantly higher among the overweight and obese subjects than among normal subjects. The prevalence of metabolic syndrome was 59% among the obese group, showing the highest risk for that group. Overweight and obesity, increasing age, hypercholesterolaemia and family history of hypertension showed a strong association with metabolic syndrome. CONCLUSION All the cardiometabolic abnormalities showed an increasing trend with increase in body mass index. The morbidity and mortality associated with cardiovascular diseases can be reduced by curbing the obesity epidemic.
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Affiliation(s)
- Shabana Tharkar
- MV Hospital for Diabetes and Diabetes Research Center, WHO Collaborating Centre for Research, Education and Training in Diabetes, Royapuram, Chennai, India
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Diabetes Research Center, WHO Collaborating Centre for Research, Education and Training in Diabetes, Royapuram, Chennai, India
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