[Show abstract][Hide abstract] ABSTRACT: : Examine associations of favorable levels of all cardiovascular disease (CVD) risk factors (RFs) [i.e., low risk (LR)] at younger ages with high sensitivity C-reactive protein (hs-CRP) at older ages.
[Show abstract][Hide abstract] ABSTRACT: Non-alcoholic steatohepatitis (NASH) is an independent risk factor for cardiovascular disease (CVD) morbidity after liver transplantation, but its impact on CVD mortality is unknown. We sought to assess the impact of NASH on CVD mortality after liver transplantation and to predict which NASH recipients are at highest risk of a CVD-related death following a liver transplant.
Using the Organ Procurement and Transplantation Network database we examined associations between NASH and post liver transplant CVD mortality, defined as primary cause of death from thromboembolism, arrhythmia, heart failure, myocardial infarction, or stroke. A physician panel reviewed cause of death.
Of 48,360 liver transplants (2/2002-12/2011), 5,057 (10.5%) were performed for NASH cirrhosis. NASH recipients were more likely to be older, female, obese, diabetic, and have history of renal failure or prior CVD versus non-NASH (p<0.001 for all). Although there was no difference in overall all-cause mortality (log-rank p=0.96), both early (30-day) and long-term CVD-specific mortality was increased among NASH recipients (Odds ratio=1.30, 95% Confidence interval (CI): 1.02-1.66; Hazard ratio=1.42, 95% CI: 1.07-1.41, respectively). These associations were no longer significant after adjustment for pre-transplant diabetes, renal impairment or CVD. A risk score comprising age ≥ 55, male sex, diabetes and renal impairment was developed for prediction of post liver transplant CVD mortality (c-statistic 0.60).
NASH recipients have an increased risk of CVD mortality after liver transplantation explained by a high prevalence of co-morbid cardiometabolic risk factors that in aggregate identify those at highest risk of post-transplant CVD mortality. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Liver international: official journal of the International Association for the Study of the Liver 05/2015; DOI:10.1111/liv.12872 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chronic lung diseases are associated with cardiovascular disease. How these associations evolve from young adulthood forward is unknown. Understanding the preclinical history of these associations could inform prevention strategies for common heart-lung conditions.
Utilize the Coronary Artery Risk Development in Young Adults (CARDIA) Study to explore the development of heart lung interactions.
We analyzed cardiac structural and functional measurements determined by echocardiography at year 25 of CARDIA and measures of pulmonary function over 20 years in 3000 participants.
Decline in forced vital capacity (FVC) from peak was associated with larger left ventricular (LV) mass (β = 6.05 grams/ standard deviation (SD) of FVC decline, p< 0.0001) and greater cardiac output (β = 0.109 L/min per SD of FVC decline, p=0.001). Decline in forced expiratory volume in 1 second (FEV1)/FVC ratio was associated with smaller left atrial internal dimension (β= -0.038 cm / SD FEV1/FVC decline, p=<0.0001) and lower cardiac output (β = -0.070 L/min per SD of FEV1/FVC decline, p=0.03). Decline in FVC was associated with diastolic dysfunction (odds ratio 3.39, 95% confidence interval 1.37, 8.36, p=0.006).
Patterns of loss of lung health are associated with specific cardiovascular phenotypes in middle age. Decline in FEV1/FVC ratio is associated with under-filling of the left heart and low cardiac output. Decline in FVC with preserved FEV1/FVC ratio is associated with LV hypertrophy and diastolic dysfunction. Cardiopulmonary interactions apparent with common complex heart and lung diseases evolve concurrently from early adulthood forward.
American Journal of Respiratory and Critical Care Medicine 04/2015; 192(1). DOI:10.1164/rccm.201501-0116OC · 11.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Health care practitioners who care for adolescents transitioning to adulthood often face incongruent recommendations from pediatric and adult guidelines for treatment of lipid levels.
To compare the proportion of young people aged 17 to 21 years who meet criteria for pharmacologic treatment of elevated low-density lipoprotein cholesterol (LDL-C) levels under pediatric vs adult guidelines.
We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) population. Surveys were administered from January 1, 1999, through December 31, 2012, and the analysis was performed from June through December 2014. Participants included 6338 individuals aged 17 to 21 years in the United States.
To estimate the number and proportion of individuals aged 17 to 21 years in the NHANES population who were eligible for statin therapy, we applied treatment algorithms from the 2011 Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents of the National Heart, Lung, and Blood Institute and the 2013 Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults from the American College of Cardiology and American Heart Association. After imputing missing data and applying NHANES sampling weights, we extrapolated the results to 20.4 million noninstitutionalized young people aged 17 to 21 years living in the United States.
Of the 6338 young people aged 17 to 21 years in the NHANES population, 2.5% (95% CI, 1.8%-3.2%) would qualify for statin treatment under the pediatric guidelines compared with 0.4% (95% CI, 0.1%-0.8%) under the adult guidelines. Participants who met pediatric criteria had lower mean (SD) LDL-C levels (167.3 [3.8] vs 210.0 [7.1] mg/dL) but higher proportions of other cardiovascular risk factors, including hypertension (10.8% vs 8.4%), smoking (55.0% vs 23.9%), and obesity (67.7% vs 18.2%) compared with those who met the adult guidelines. Extrapolating to the US population of individuals aged 17 to 21 years represented by the NHANES sample, 483 500 (95% CI, 482 100-484 800) young people would be eligible for treatment of LDL-C levels if the pediatric guidelines were applied compared with only 78 200 (95% CI, 77 600-78 700) if the adult guidelines were applied.
Application of pediatric vs adult guidelines for lipid levels, which consider additional cardiovascular risk factors beyond age and LDL-C concentration, might result in statin treatment for more than 400 000 additional adolescents and young adults.