2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Circulation (Impact Factor: 14.43). 12/2010; 122(25):2748-64. DOI: 10.1161/CIR.0b013e3182051bab
Source: PubMed
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    • "Few studies have assessed the prevalence and determinants of ECG abnormalities in AAs with type 2 diabetes (T2D). It is currently recommended by the American Heart Association/American College of Cardiology Foundation (AHA/ACCF) guidelines to obtain ECGs for those with diabetes [12]. However , it remains unclear how best to use the results of the ECG to improve patient care. "
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    ABSTRACT: Background Electrocardiographic (ECG) abnormalities are independently associated with poor outcomes in the general population. Their prevalence and determinants were assessed in the understudied African American population with type 2 diabetes. Methods Standard 12-lead ECGs were digitally recorded in 635 unrelated African American-Diabetes Heart Study (AA-DHS) participants, automatically processed at a central lab, read, and coded using standard Minnesota ECG Classification. Age- and sex-specific prevalence rates of ECG abnormalities were calculated and logistic regression models were fitted to examine cross-sectional associations between participant characteristics and ECG abnormalities. Results Participants were 56% women with a mean age of 56 years; 60% had at least one minor or major ECG abnormality [23% ⩾1 major (or major plus minor), and 37% ⩾1 minor (with no major)]. Men had a higher prevalence of ⩾1 minor or major ECG abnormality (66.1% men vs. 55.6% women, p = 0.0089). In univariate analysis, age, past history of cardiovascular disease, diabetes duration, systolic blood pressure, sex and statin use were associated with the presence of any (major or minor) ECG abnormalities. In a multivariate model including variables, female sex (OR [95% CI] 0.79 [0.67, 0.93]), statin use (0.79 [0.67, 0.93]) and diabetes duration (1.03 [1.0, 1.05]) remained statistically significant. Conclusions Nearly three out of five African Americans with diabetes had at least one ECG abnormality. Female sex and statin use were significantly associated with lower odds of any ECG abnormality and diabetes duration was significantly associated with higher odds of any ECG abnormality in the multivariable model.
    Journal of Epidemiology and Global Health 05/2014; 4(4). DOI:10.1016/j.jegh.2014.04.003
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    • "In addition, the high resolution of RNA-Seq can facilitate discoveries of transcript dysregulation that have been missed by previous technologies. Here, we present results from a pilot application of RNA-Seq on human cases and controls chosen to reflect extremes for coronary artery calcification (CAC), a clinical marker for advanced CAD that is highly correlated with future adverse cardiovascular events [7]. As a patient surrogate for gene expression, we used Epstein-Barr virus transformed lymphoblastoid cell lines (LCLs), which have been shown in multiple studies to reliably reflect gene expression signatures [8], particularly those associated with nearby cis-acting genomic polymorphisms (expression quantitative trait loci or eQTLs) [9]. "
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    ABSTRACT: Massively-parallel cDNA sequencing (RNA-Seq) is a new technique that holds great promise for cardiovascular genomics. Here, we used RNA-Seq to study the transcriptomes of matched coronary artery disease cases and controls in the ClinSeq(R) study, using cell lines as tissue surrogates. Lymphoblastoid cell lines (LCLs) from 16 cases and controls representing phenotypic extremes for coronary calcification were cultured and analyzed using RNA-Seq. All cell lines were then independently re-cultured and along with another set of 16 independent cases and controls, were profiled with Affymetrix microarrays to perform a technical validation of the RNA-Seq results. Statistically significant changes (p < 0.05) were detected in 186 transcripts, many of which are expressed at extremely low levels (5-10 copies/cell), which we confirmed through a separate spike-in control RNA-Seq experiment. Next, by fitting a linear model to exon-level RNA-Seq read counts, we detected signals of alternative splicing in 18 transcripts. Finally, we used the RNA-Seq data to identify differential expression (p < 0.0001) in eight previously unannotated regions that may represent novel transcripts. Overall, differentially expressed genes showed strong enrichment (p = 0.0002) for prior association with cardiovascular disease. At the network level, we found evidence for perturbation in pathways involving both cardiovascular system development and function as well as lipid metabolism. We present a pilot study for transcriptome involvement in coronary artery calcification and demonstrate how RNA-Seq analyses using LCLs as a tissue surrogate may yield fruitful results in a clinical sequencing project. In addition to canonical gene expression, we present candidate variants from alternative splicing and novel transcript detection, which have been unexplored in the context of this disease.
    BMC Genomics 03/2014; 15(1):198. DOI:10.1186/1471-2164-15-198 · 3.99 Impact Factor
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    • "Risk assessment and prognosis for individuals with known CHD Prognostic assessment after acute coronary syndrome (ACS) Cardiac surveillance after revascularization (percutaneous coronary intervention or coronary artery bypass graft) Investigation of cardiac arrhythmias Evaluation of clinical response to exercise in individuals with valvular heart disease Preoperative cardiac risk evaluation Evaluation in asymptomatic individuals with high risk for CHD Assessment of individuals in high-risk occupations Evaluation prior to initiation of vigorous exercise regimen Determination of pacemaker responsiveness and function Estimation of pulmonary hypertension Assessment of syncope or risk assessment (Greenland et al., 2010). While there are numerous indications for NCST (Table 2), common indications include the evaluation of ischemia in individuals who are symptomatic or at high risk for CHD (Greenland et al., 2010). "
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    ABSTRACT: To provide advanced practice nurses (APNs) with practice recommendations for noninvasive cardiac stress testing (NCST) to enhance diagnostic test selection and to improve the interpretation of the test results. A review and synthesis of current scientific literature on noninvasive cardiac stress tests was conducted including a review of pertinent guidelines, indications, contraindications, procedures and findings of exercise, pharmacological, echocardiographic, and myocardial perfusion imaging studies. Noninvasive cardiac stress testing is an integral component in the care of men and women for the diagnosis, prognosis, and management of individuals at risk for cardiovascular conditions or with known histories of cardiovascular disorders. Cardiovascular disorders are common in our society. APNs care for a variety of individuals in the inpatient and outpatient settings that may require noninvasive cardiac stress tests for the evaluation of significant health histories and clinical presentations. An enhanced understanding of NCST improves test selection, preparation and education of patients, interpretation of test results, and implications for future patient care.
    Journal of the American Association of Nurse Practitioners 02/2014; 26(2). DOI:10.1002/2327-6924.12096
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