[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to determine the effects of the latency period on the performance of free-breathing coronary wall MRI. With the approval of IRB, 70 participants were recruited for coronary wall magnetic resonance imaging (MRI) and provided written informed consent. In 35 subjects, right coronary segments (RCA1–3) were imaged first; in the remaining subjects, the left coronary segments (LM and LAD1–3) were imaged first. The images were classified into groups; group 1 contained right coronary images from the subjects whose right coronary segments were imaged first and left coronary images from the subjects whose left coronary segments were imaged first. Group 2 contained the other coronary segments. The image scores (ranked1–3), latency periods, drift of the position of the navigator (NAV), scan efficiency were compared between image groups. Image group 1 has higher scores (1.66 ± 0.55 vs. 1.46 ± 0.51), shorter latency periods (32.04 ± 4.24 vs. 44.22 ± 5.57 min), lower drift in the location of the NAV (1.90 ± 1.27 mm vs. 2.61 ± 1.71 mm) and higher scan efficiency (32.7 ± 7.6 vs. 29.9 ± 7.9 %) than group 2. Long latency periods have a significantly negative impact on the image quality of coronary wall MRI.
The International Journal of Cardiovascular Imaging 01/2015; · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: We examined the association between optimism and cardiovascular health (CVH). Methods: We used data collected from adults aged 52-84 who participated in the Multi-Ethnic Study of Atherosclerosis (MESA) (N = 5134) during the first follow-up visit (2002-2004). Multinomial logistic regression was used to examine associations of optimism with ideal and intermediate CVH (with reference being poor CVH), after adjusting for socio-demographic factors and psychological ill-being. Results: Participants in the highest quartile of optimism were more likely to have intermediate [OR = 1.51, 95% CI = 1.25, 1.82] and ideal [OR = 1.92, 95% CI = 1.30, 2.85] CVH when compared to the least optimistic group. Individual CVH metrics of diet, physical activity, body mass index, smoking, blood sugar, and total cholesterol contributed to the overall association. Conclusions: We offer evidence for a cross-sectional association between optimism and CVH.
[Show abstract][Hide abstract] ABSTRACT: Five years ago, the American Heart Association (AHA) launched a bold new initiative to begin promoting "cardiovascular health" in individuals and the population, in addition to continuing its decades-long fight to reduce cardiovascular and stroke mortality and decrease cardiovascular disease (CVD) risk. This shift in priorities came as a result of a "quiet revolution,"(1) turning the adverse-outcomes-oriented and risk-focused perspective on its head, and instead focusing on creating the opportunity for promoting and preserving attributes associated with healthy, CVD-free longevity. The first-ever formal definition for this construct of cardiovascular health, published in 2010,(2) was based on a broad review of the literature designed to determine groups of factors associated with excellent prognosis in long-term CVD-free survival and quality of life. It was designed to be simple, accessible and actionable, allowing all patients, clinicians and communities to focus on improving cardiovascular health. And it was crafted in a way so that it could be measured in the broad US population and major subgroups, monitored over time, and influenced by AHA's portfolio of programs.(2) Although the entire spectrum of cardiovascular health was captured (from birth through living with CVD), a critical observation was the recognition of an "ideal cardiovascular health" phenotype that consisted of the simultaneous presence of ideal levels of seven health behaviors and health factors: smoking status, physical activity, eating pattern, body weight, and blood cholesterol, blood glucose and blood pressure levels.
[Show abstract][Hide abstract] ABSTRACT: The 2013 American College of Cardiology/American Heart Association updated cholesterol guidelines recommend the use of Pooled Cohort Equations to estimate 10-year absolute risk for atherosclerotic cardiovascular disease (ASCVD) in primary prevention.
Journal of the American College of Cardiology 09/2014; 64(10):959-68. · 15.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry.
Journal of the American Heart Association. 09/2014; 3(5).
[Show abstract][Hide abstract] ABSTRACT: Whether long-term blood pressure (BP) variability throughout young adulthood is associated with cognitive function in midlife remains uncertain. Using data from the Coronary Artery Risk Development in Young Adults (CARDIA), which recruited healthy young adults aged 18 to 30 years (mean age, 25 years) at baseline (Y0), we assessed BP variability by SD and average real variability (ARV) for 25 years (8 visits). Cognitive function was assessed with the Digit Symbol Substitution Test (psychomotor speed test), the Rey Auditory Verbal Learning Test (verbal memory test), and the modified Stroop test (executive function test) at follow-up (Y25). At the Y25 examination, participants (n=2326) had a mean age of 50.4 years, 43% were men, and 40% were black. In multivariable-adjusted linear regression models, higher ARVSBP, ARVDBP, and SDDBP were significantly associated with lower scores of Digit Symbol Substitution Test (β [SE]: -0.025 [0.006], -0.029 [0.007], and -0.029 [0.007], respectively; all P<0.001) and Rey Auditory Verbal Learning Test (β [SE]: -0.016 [0.006], -0.021 [0.007], and -0.019 [0.007], respectively; all P<0.05) after adjustment for demographic and clinical characteristics and with cumulative exposure to BP through Y0 to Y25. Neither SDBP nor ARVBP was associated with the Stroop score. The associations between ARVBP or SDBP and each cognitive function test were similar between blacks and whites except for 1 significant interaction between race and SDSBP on the Digit Symbol Substitution Test (P<0.05). Long-term BP variability for 25 years beginning in young adulthood was associated with worse psychomotor speed and verbal memory tests in midlife, independent of cumulative exposure to BP during follow-up.
[Show abstract][Hide abstract] ABSTRACT: The concept of cardiovascular health (CVH) was introduced as a global measure of one's burden of cardiovsacular risk factors. Previous studies established the relationship between neighborhood characteristics and individual cardiovascular risk factors. However, the relationship between neighborhood environment and overall CVH remains unknown.
Circulation Cardiovascular Quality and Outcomes 07/2014; · 5.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lifetime risk estimation for cardiovascular disease (CVD) has been proposed as a useful strategy to improve risk communication in the primary prevention setting. However, the perception of lifetime risk for CVD is unknown. We included 2,998 individuals from the Dallas Heart Study. Lifetime risk for developing CVD was classified as high (≥39%) vs. low (<39%) according to risk factor burden as described in our previously published algorithm. Perception of lifetime risk for myocardial infarction was assessed via a 5-point scale. Baseline characteristics were compared across levels of perceived lifetime risk. Multivariable logistic regression analyses were performed to determine the association of participant characteristics with level of perceived lifetime risk for CVD and with correctness of perceptions. 64.8% (1942/2998) of participants were classified as high predicted lifetime risk for CVD. There was significant discordance between perceived and predicted lifetime risk. After multivariable adjustment, family history of premature MI, high self-reported stress, and low perceived health were all strongly associated with high perceived lifetime risk (OR [95% CI]: 2.37 [1.72-3.27], 2.17 [1.66-2.83], and 2.71 [2.09-3.53]). However, the association between traditional CVD risk factors and high perceived lifetime risk was more modest. In conclusion, misperception of lifetime risk for CVD is common and frequently reflects the influence of factors other than traditional risk factor levels. These findings highlight the importance of effectively communicating the significance of traditional risk factors in determining the lifetime risk for CVD.
The American Journal of Cardiology 07/2014; · 3.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is an obesity-related condition associated with cardiovascular mortality. Yet, whether or not NAFLD is independently related to atherosclerosis is unclear. In a population-based cross-sectional sample of middle-aged adults free from liver or heart disease, we tested the hypothesis that NAFLD is associated with subclinical atherosclerosis (coronary artery (CAC) and abdominal aortic calcification (AAC)) independent of obesity.
[Show abstract][Hide abstract] ABSTRACT: The American Heart Association introduced the concept of cardiovascular health (CVH) in its 2020 Strategic lmpact Goals. Defined by the presence of four health behaviors (smoking, weight, diet, and physical activity) and three health factors (glucose, blood pressure, and cholesterol), CVH reflects an expansion of preventive efforts to the entire population and a reframing of disease prevention to health promotion. Recent evidence has confirmed the relevance of the seven CVH metrics in cardiovascular outcomes, highlighting the critical role of a healthy lifestyle in achieving and maintaining CVH through the lifespan. Primordial prevention efforts geared towards health promotion and healthy behaviors, sustained over the life course, and fostered by public health and health policy will be the key to achieving and maintaining CVH and improving the cardiovascular health of the nation.
[Show abstract][Hide abstract] ABSTRACT: To test the hypothesis that biomechanical changes are quantitatively related to morphological features of coronary arteries in heart transplant (HTx) recipients.
[Show abstract][Hide abstract] ABSTRACT: -Early repolarization (ER), a common electrocardiographic phenotype, has been associated with increased mortality risk in middle-aged adults. Data are sparse on long-term follow-up and outcomes associated with ER in younger adults.
-We prospectively examined 5,039 participants (mean age 25 years at baseline, 40% black) from the CARDIA cohort over 23 years. Twelve-lead electrocardiograms were recorded and analyzed at Years 0, 7 and 20 and coded as definite or probable ER using a standardized algorithm. Cox regression was used, and models were adjusted for important baseline and clinical covariates. Kaplan-Meier curves were created for presence of ER and total mortality and cardiovascular (CV) mortality. Participants with ER were more likely to be black, male, smoke, have higher systolic blood pressure, lower heart rate, and BMI, and also higher exercise duration, and longer PR, QRS and QT intervals. ER was associated with total mortality (HR1.77, 1.38-2.28, p<0.01), and CV mortality (HR 1.59, 1.01-2.50, p=0.04) in unadjusted analyses, but adjustment for age, sex, and race attenuated associations almost completely. Sex-race stratified analyses showed no significant associations between ER and outcome for any of the subgroups except blacks.
-The presence of ER at any time point over 23 years of follow-up was not associated with adverse outcomes. Black race and male sex confound the unadjusted association of ER and outcomes, with no race-sex interactions noted. Further studies are necessary to understand the factors associated with heightened risk of death in those who maintain ER into and beyond middle age.
Circulation Arrhythmia and Electrophysiology 04/2014; · 5.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Basic research suggests that rapid increases in circulating inflammatory and hemostatic blood markers may trigger or indicate impending plaque rupture and coronary thrombosis, resulting in acute ischemic heart disease (IHD) events. However, these associations are not established in humans.
The Biomarker Risk Assessment in Vulnerable Outpatients (BRAVO) Study will determine whether levels of inflammatory and hemostatic biomarkers rapidly increase during the weeks prior to an acute IHD event in people with lower extremity peripheral artery disease (PAD). The BRAVO Study will determine whether biomarker levels measured immediately prior to an IHD event are higher than levels not preceding an IHD event; whether participants who experience an IHD event (cases) have higher biomarker levels immediately prior to the event and higher biomarker levels at each time point leading up to the IHD event than participants without an IHD event (controls); and whether case participants have greater increases in biomarkers during the months leading up to the event than controls. BRAVO enrolled 595 patients with PAD, a population at high risk for acute IHD events. After a baseline visit, participants returned every two months for blood collection, underwent an electrocardiogram to identify new silent myocardial infarctions, and were queried about new hospitalizations since their prior study visit. Mortality data were also collected. Participants were followed prospectively for up to three years.
BRAVO results will provide important information about the pathophysiology of IHD events and may lead to improved therapies for preventing IHD events in high-risk patients.
[Show abstract][Hide abstract] ABSTRACT: IMPORTANCE The American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort risk equations were developed to estimate atherosclerotic cardiovascular disease (CVD) risk and guide statin initiation. OBJECTIVE To assess calibration and discrimination of the Pooled Cohort risk equations in a contemporary US population. DESIGN, SETTING, AND PARTICIPANTS Adults aged 45 to 79 years enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study between January 2003 and October 2007 and followed up through December 2010. We studied participants for whom atherosclerotic CVD risk may trigger a discussion of statin initiation (those without clinical atherosclerotic CVD or diabetes, low-density lipoprotein cholesterol level between 70 and 189 mg/dL, and not taking statins; n = 10 997). MAIN OUTCOMES AND MEASURES Predicted risk and observed adjudicated atherosclerotic CVD incidence (nonfatal myocardial infarction, coronary heart disease [CHD] death, nonfatal or fatal stroke) at 5 years because REGARDS participants have not been followed up for 10 years. Additional analyses, limited to Medicare beneficiaries (n = 3333), added atherosclerotic CVD events identified in Medicare claims data. RESULTS There were 338 adjudicated events (192 CHD events, 146 strokes). The observed and predicted 5-year atherosclerotic CVD incidence per 1000 person-years for participants with a 10-year predicted atherosclerotic CVD risk of less than 5% was 1.9 (95% CI, 1.3-2.7) and 1.9, respectively, risk of 5% to less than 7.5% was 4.8 (95% CI, 3.4-6.7) and 4.8, risk of 7.5% to less than 10% was 6.1 (95% CI, 4.4-8.6) and 6.9, and risk of 10% or greater was 12.0 (95% CI, 10.6-13.6) and 15.1 (Hosmer-Lemeshow χ2 = 19.9, P = .01). The C index was 0.72 (95% CI, 0.70-0.75). There were 234 atherosclerotic CVD events (120 CHD events, 114 strokes) among Medicare-linked participants and the observed and predicted 5-year atherosclerotic CVD incidence per 1000 person-years for participants with a predicted risk of less than 7.5% was 5.3 (95% CI, 2.8-10.1) and 4.0, respectively, risk of 7.5% to less than 10% was 7.9 (95% CI, 4.6-13.5) and 6.4, and risk of 10% or greater was 17.4 (95% CI, 15.3-19.8) and 16.4 (Hosmer-Lemeshow χ2 = 5.4, P = .71). The C index was 0.67 (95% CI, 0.64-0.71). CONCLUSIONS AND RELEVANCE In this cohort of US adults for whom statin initiation is considered based on the ACC/AHA Pooled Cohort risk equations, observed and predicted 5-year atherosclerotic CVD risks were similar, indicating that these risk equations were well calibrated in the population for which they were designed to be used, and demonstrated moderate to good discrimination.
JAMA The Journal of the American Medical Association 03/2014; · 29.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Single measures of blood pressure (BP) levels are associated with the development of atherosclerosis; however, long-term patterns in BP and their effect on cardiovascular disease risk are poorly characterized.
To identify common BP trajectories throughout early adulthood and to determine their association with presence of coronary artery calcification (CAC) during middle age.
Prospective cohort data from 4681 participants in the CARDIA study, who were black and white men and women aged 18 to 30 years at baseline in 1985-1986 at 4 urban US sites, collected through 25 years of follow-up (2010-2011). We examined systolic BP, diastolic BP, and mid-BP (calculated as [SBP+DBP]/2, an important marker of coronary heart disease risk among younger populations) at baseline and years 2, 5, 7, 10, 15, 20, and 25. Latent mixture modeling was used to identify trajectories in systolic, diastolic, and mid-BP over time.
Coronary artery calcification greater than or equal to Agatston score of 100 Hounsfield units (HU) at year 25.
We identified 5 distinct mid-BP trajectories: low-stable (21.8%; 95% CI, 19.9%-23.7%; n=987), moderate-stable (42.3%; 40.3%-44.3%; n=2085), moderate-increasing (12.2%; 10.4%-14.0%; n=489), elevated-stable (19.0%; 17.1%-20.0%; n=903), and elevated-increasing (4.8%; 4.0%-5.5%; n=217). Compared with the low-stable group, trajectories with elevated BP levels had greater odds of having a CAC score of 100 HU or greater. Adjusted odds ratios were 1.44 (95% CI, 0.83-2.49) for moderate-stable, 1.86 (95% CI, 0.91-3.82) for moderate-increasing, 2.28 (95% CI, 1.24-4.18), for elevated-stable, and 3.70 (95% CI, 1.66-8.20) for elevated-increasing groups. The adjusted prevalence of a CAC score of 100 HU or higher was 5.8% in the low-stable group. These odds ratios represent an absolute increase of 2.7%, 5%, 6.3%, and 12.9% for the prevalence of a CAC score of 100 HU or higher for the moderate-stable, moderate-increasing, elevated-stable and elevated-increasing groups, respectively, compared with the low-stable group. Associations were not altered after adjustment for baseline and year 25 BP. Findings were similar for trajectories of isolated systolic BP trajectories but were attenuated for diastolic BP trajectories.
Blood pressure trajectories throughout young adulthood vary, and higher BP trajectories were associated with an increased risk of CAC in middle age. Long-term trajectories in BP may assist in more accurate identification of individuals with subclinical atherosclerosis.
JAMA The Journal of the American Medical Association 02/2014; 311(5):490-7. · 29.98 Impact Factor