Paul Muntner

University of Vermont, Burlington, Vermont, United States

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Publications (439)2801.46 Total impact

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    ABSTRACT: Objective: To evaluate the impact of comorbid depressive symptoms and/or stress on adverse cardiovascular (CV) outcomes in individuals with diabetes compared with those without diabetes. Research design and methods: Investigators examined the relationship between baseline depressive symptoms and/or stress in adults with and without diabetes and physician-adjudicated incident CV outcomes including stroke, myocardial infarction/acute coronary heart disease, and CV death over a median follow-up of 5.95 years in the national REGARDS cohort study. Results: Subjects included 22,003 adults (4,090 with diabetes) (mean age 64 years, 58% female, 42% black, and 56% living in the southeastern "Stroke Belt"). Elevated stress and/or depressive symptoms were more common in subjects with diabetes (36.8% vs. 29.5%; P < 0.001). In fully adjusted models, reporting either elevated stress or depressive symptoms was associated with a significantly increased incidence of stroke (HR 1.57 [95% CI 1.05, 2.33] vs. 1.01 [0.79, 1.30]) and CV death (1.53 [1.08, 2.17] vs. 1.12 [0.90, 1.38]) in subjects with diabetes but not in those without diabetes. The combination of both elevated stress and depressive symptoms in subjects with diabetes was associated with a higher incidence of CV death (2.15 [1.33, 3.47]) than either behavioral comorbidity alone (1.53 [1.08, 2.17]) and higher than in those with both elevated stress and depressive symptoms but without diabetes (1.27 [0.86, 1.88]). Conclusions: Comorbid stress and/or depressive symptoms are common in individuals with diabetes and together are associated with progressively increased risks for adverse CV outcomes.
    Diabetes care 11/2015; DOI:10.2337/dc15-1174 · 8.42 Impact Factor
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    ABSTRACT: Background: In the Systolic Blood Pressure Intervention Trial (SPRINT), a systolic blood pressure (SBP) goal of <120 mmHg resulted in lower cardiovascular disease (CVD) risk compared with a SBP goal of <140 mmHg. Objectives: To estimate the prevalence, number, and characteristics of US adults meeting SPRINT eligibility criteria and a broader population to whom SPRINT could be generalized. Methods: We conducted a cross-sectional, population-based study using data from the National Health and Nutrition Examination Survey 2007-2012. SPRINT eligibility included the following: inclusion criteria were age ≥ 50 years, SBP of 130 to 180 mmHg depending on the number of antihypertensive medication classes being taken, high CVD risk (history of coronary heart disease, estimated glomerular filtration rate of 20 to 59 ml/min/1.73 m(2), 10-year CVD risk ≥15%, or age ≥ 75 years); exclusion criteria were diabetes, history of stroke, >1 gram of proteinuria daily, heart failure, estimated glomerular filtration rate < 20 ml/min/1.73m(2) or receiving dialysis. Treated hypertension was defined by self-reported use of medication to lower blood pressure with one or more classes of antihypertensive medication identified through a pill bottle review. Results: Overall, 7.6% (95%CI 7.0%-8.3%) or 16.8 million (95%CI 15.7-17.8) of US adults, and 16.7% (95%CI 15.2%-18.3%) or 8.2 million (95%CI 7.6-8.8) of those with treated hypertension, met the SPRINT eligibility criteria. Among both the overall US population and adults with treated hypertension, the percentage meeting SPRINT eligibility criteria increased with older age, was higher among males than females, and was higher among non-Hispanic whites compared with non-Hispanic blacks or Hispanics. Of US adults eligible for SPRINT, 51.0% (95%CI 47.8%-54.1%) or 8.6 million (95%CI 8.0-9.1) were not treated for hypertension. Conclusions: A substantial percentage of US adults meet the eligibility criteria for SPRINT.
    Journal of the American College of Cardiology 11/2015; DOI:10.1016/j.jacc.2015.10.037 · 16.50 Impact Factor
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    ABSTRACT: Objective: We previously developed an 8-item self-assessment tool to identify individuals with a high probability of having albuminuria. This tool was developed and externally validated among non-Hispanic Whites and non-Hispanic Blacks. We sought to validate it in a multi-ethnic cohort that also included Hispanics and Chinese Americans.Design: This is a cross-sectional study.Setting: Data were collected using stan­dardized questionnaires and spot urine samples at a baseline examination in 2000- 2002. The 8 items in the self-assessment tool include age, race, gender, current ciga­rette smoking, history of diabetes, hyperten­sion, or stroke, and self-rated health.Participants: Of 6,814 community-dwelling adults aged 45-84 years participating in the Multi-Ethnic Study of Atherosclerosis (MESA), 6,542 were included in the primary analysis.Main Outcome Measures: Albuminuria was defined as urine albumin-to-creatinine ratio ≥30 mg/g at baseline.Results: Among non-Hispanic Whites, non- Hispanic Blacks, Hispanics, and Chinese Americans, the prevalence of albuminuria was 6.0%, 11.3%, 11.6%, and 10.8%, respectively. The c-statistic for discriminating participants with and without albuminuria was .731 (95% CI: .692, .771), .728 (95% CI: .687, .761), .747 (95% CI: .709, .784), and .761 (95% CI: .699, .814) for non-His­panic Whites, non-Hispanic Blacks, Hispan­ics, and Chinese Americans, respectively. The self-assessment tool over-estimated the probability of albuminuria for non-Hispanic Whites and Blacks, but was well-calibrated for Hispanics and Chinese Americans.Conclusions: The albuminuria self-assess­ment tool maintained good test charac­teristics in this large multi-ethnic cohort, suggesting it may be helpful for increasing awareness of albuminuria in an ethnically diverse population. Ethn Dis.2015;25(4):427- 434; doi:10.18865/ed.25.4.427
    Ethnicity & disease 11/2015; 25(4):427. DOI:10.18865/ed.25.4.427 · 1.00 Impact Factor
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    ABSTRACT: HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.
    Current Hypertension Reports 11/2015; 17(11). DOI:10.1007/s11906-015-0598-1 · 3.44 Impact Factor
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    ABSTRACT: Hypertension, a common risk factor for cardiovascular disease, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured inside versus outside of the clinic setting. Over the past several decades, evidence has accumulated on the following 2 approaches for measuring blood pressure outside of the clinic: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Both of these methods have a stronger association with cardiovascular disease outcomes than clinic blood pressure measurement. Controversy exists about whether ABPM or HBPM is superior for estimating risk for cardiovascular disease and under what circumstances these methods should be used in clinical practice for assessing blood pressure outside of the clinic. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measurements that can be ascertained, and the evidence that supports the use of each approach to measuring blood pressure outside of the clinic. It also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research.
    Annals of internal medicine 10/2015; DOI:10.7326/M15-1270 · 17.81 Impact Factor
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    ABSTRACT: We examined claims-based approaches for identifying a study population free of coronary heart disease (CHD) using data from 8,937 US blacks and whites enrolled during 2003–2007 in a prospective cohort study linked to Medicare claims. Our goal was to minimize the percentage of persons at study entry with self-reported CHD (previous myocardial infarction or coronary revascularization). We assembled 6 cohorts without CHD claims by requiring 6 months, 1 year, or 2 years of continuous Medicare fee-for-service insurance coverage prior to study entry and using either a fixed-window or all-available look-back period. We examined adding CHD-related claims to our “base algorithm,” which included claims for myocardial infarction and coronary revascularization. Using a 6-month fixed-window look-back period, 17.8% of participants without claims in the base algorithm reported having CHD. This was reduced to 3.6% using an all-available look-back period and adding other CHD claims to the base algorithm. Among cohorts using all-available look-back periods, increasing the length of continuous coverage from 6 months to 1 or 2 years reduced the sample size available without lowering the percentage of persons with self-reported CHD. This analysis demonstrates approaches for developing a CHD-free cohort using Medicare claims.
    American journal of epidemiology 10/2015; 182(9). DOI:10.1093/aje/kwv116 · 5.23 Impact Factor

  • Journal of the American College of Cardiology 10/2015; 66(17):1864-1872. DOI:10.1016/j.jacc.2015.08.042 · 16.50 Impact Factor
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    ABSTRACT: Background/aims: Persons with occult-reduced estimated glomerular filtration rate (eGFR <60 ml/min/1.73 m2 detected by serum cystatin C but missed by creatinine) have high risk for complications. Among persons with preserved kidney function by creatinine-based eGFR (eGFRcreat >60 ml/min/1.73 m2), tools to guide cystatin C testing are needed. Methods: We developed a risk score to estimate an individual's probability of reduced eGFR by cystatin C (eGFRcys <60 ml/min/1.73 m2) in The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and externally validated in the Third National Health and Nutrition Examination Survey (NHANES III). We used logistic regression with Bayesian model averaging and variables available in practice. We assessed performance characteristics using calibration and discrimination measures. Results: Among 24,877 adults with preserved kidney function by creatinine, 13.5% had reduced eGFRcys. Older and Black participants, current smokers and those with higher body mass index, lower eGFRcreat, diabetes, hypertension and history of cardiovascular disease were more likely to have occult-reduced eGFR (p < 0.001). The final risk function had a c-statistic of 0.87 in REGARDS and 0.84 in NHANES. By risk score, 72% of occult-reduced eGFR cases were detected by screening only 22% of participants. Conclusions: A risk score using characteristics readily accessible in clinical practice can identify the majority of persons with reduced eGFRcys, which is missed by creatinine.
    American Journal of Nephrology 09/2015; 42(2):141-147. DOI:10.1159/000439231 · 2.67 Impact Factor
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    ABSTRACT: Objective Despite unknown risks, prescription opioid use (POU) for nonmalignant chronic pain has grown in the US over the last decade. The objective of this study was to examine associations between POU and coronary heart disease (CHD), stroke, and cardiovascular disease (CVD) death in a large cohort.Design, Setting, SubjectsPOU was assessed in the prospective cohort study of 29,025 participants of the REasons for Geographic and Racial Differences in Stroke study, enrolled between 2003 and 2007 from the continental United States and followed through December 31, 2010. CHD, stroke, and CVD death were expert adjudicated outcome measures.Methods Cox proportional hazards models adjusted for CVD risk factors were used.ResultsOver a median (SD) of 5.2 (1.8) years of follow-up, 1,362 CHD events, 749 strokes, and 1,120 CVD death occurred (105, 55, and 104, respectively, in the 1,851 opioid users). POU was not associated with CHD (adjusted hazard ratio [aHR]) 1.03 [95% CI 0.83–1.26] or stroke (aHR 1.04 [95% CI 0.78–1.38]), but was associated with CVD death (aHR 1.24 [95% CI 1.00–1.53]) in the overall sample. In the sex-stratified analyses, POU was associated with increased risk of CHD (aHR 1.38 [95% CI 1.05–1.82]) and CVD death (aHR 1.66 [95% CI 1.27–2.17]) among females but not males (aHR 0.70 [95% CI 0.50-0.97] for CHD and 0.78 [95% CI 0.54–1.11] for CVD death).Conclusion Female but not male POU were at higher risk of CHD and CVD death. POU was not associated with stroke in overall or sex-stratified analyses.
    Pain Medicine 09/2015; DOI:10.1111/pme.12916 · 2.30 Impact Factor
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    ABSTRACT: Introduction: A previous meta-analysis has not suggested any benefit of CoQ10 supplementation in improving muscle pain and plasma creatine kinase (CK) levels, two main measures of statin-induced myopathy (SIM). However, new studies have been published. Purpose: To re-evaluate the efficacy of CoQ10 supplementation on SIM. Methods: We searched the MEDLINE, Cochrane Library, Scopus, and EMBASE databases (up to 10 February 2015) to identify RCTs investigating the impact of CoQ10 on muscle pain and plasma CK activity. Results: We included 10 RCTs with 446 participants. The results of the metaanalysis did not provide compelling evidence as to a significant effect of CoQ10 supplementation in reducing either the severity of myopathic pain (SMD: −0.36, 95% CI: −0.82–0.09, p=0.117) (figure) or plasma CK activity (WMD: 3.47 U/L, 95% CI: −2.32–9.26, p=0.240). These findings were robust in the leave-one-out analysis, and the calculated effect sizes were not sensitive to any single study included in the meta-analysis. A subgroup analysis was performed to assess the impact of dose (<200 vs ≥200 mg/day) and duration (<12 weeks vs ≥12 weeks) of supplementation with CoQ10 on the calculated effect sizes. The results suggest that changes in both efficacy measures were independent of dose and duration of supplementation. Likewise, large doses of CoQ10 - <400 and ≥400 mg - had also no significant effect both on myalgia and plasma CK activity (SMD −0.45, 95% CI: −1.02–0.13; p=0.13 and −0.08; 95% CI: −0.52–0.36; p=0.721, and WMD 5.06 U/L, 95% CI: −5.34–15.46; p=0.34, and −3.52 U/L −72.04–65.00; p=0.92, respectively). Conclusion: The results of this meta-analysis support the lack of any significant benefit of CoQ10 supplementation in improving statin-induced myopathy, even using higher CoQ10 doses.
    European Heart Journal 09/2015; 36(Suppl. 1):1047. · 15.20 Impact Factor
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    ABSTRACT: Background: Virtual histology intravascular ultrasound (VH-IVUS) imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. Evidence for the effects of statin therapy on VH-IVUS parameters have been inconclusive. Consequently, we performed a systematic review and meta-analysis to investigate the impact of statin therapy on plaque volume and its composition using VH-IVUS. Methods: The search included PUBMED, Cochrane Library, Scopus, and EMBASE (through November 30, 2014) to identify prospective studies investigating the effects of statin therapy on plaque volume and its composition using VH-IVUS. Results: We identified 9 studies with 16 statin-treatment arms and 830 participants. There was a significant effect of statin therapy in reducing plaque volume (standard mean difference [SMD]: -0.137, 95% confidence interval [CI]: -0.255, -0.019; p = 0.023), external elastic membrane volume (SMD: -0.097, 95% CI: -0.183, -0.011; p = 0.027) but not lumen volume (SMD: -0.025, 95% CI: -0.110, +0.061; p = 0.574). There was a significant reduction in fibrous plaque volume (SMD: -0.129, 95% CI: -0.255, -0.003; p = 0.045) and an increase of dense calcium volume (SMD: +0.229, 95% CI: +0.008, +0.450; p = 0.043), whilst changes in fibro-fatty (SMD: -0.247, 95% CI: -0.592, +0.098; p = 0.16) and necrotic core (SMD: +0.011, 95% CI: -0.144, +0.165; p = 0.892) tissue volumes were not statistically significant. Conclusions: In conclusion, this meta-analysis indicates a significant effect of statin therapy on plaque and external elastic membrane volumes and fibrous and dense calcium volumes. There was no effect on lumen volume, fibro-fatty and necrotic tissue volumes.
    BMC Medicine 08/2015; 13(1). DOI:10.1186/s12916-015-0459-4 · 7.25 Impact Factor
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    ABSTRACT: Introduction: Increased von Willebrand factor antigen levels (vWF:Ag) are associated with a high risk of coronary artery disease (CAD). The effect of statin therapy on VWF:Ag has not been conclusively investigated. Purpose: The aim of the meta-analysis was to evaluate the effect of statin therapy on VWF:Ag levels. Methods: The search comprised PUBMED, Cochrane Library, Scopus, and EMBASE databases up to 31 January, 2015, to identify randomized controlled trials (RCTs) that investigate the effect of statin therapy on plasma VWF:Ag levels. Results: Random-effect meta-analysis of 21 treatment arms with 1434 individuals revealed a significant decrease in plasma VWF:Ag levels following statin therapy (standardized mean difference [SMD]: −0.54 IU/dl, 95% confidence interval [CI]: −0.87, −0.21, p=0.001). This effect size was robust and removing each of the included treatment arms from analysis did not change statistical significance of the pooled estimate. In subgroup analysis, the greatest effect was observed with simvastatin (SMD: −1.54 IU/dl, 95% CI: −2.92, −0.17, p=0.028), followed by pravastatin (SMD: −0.61 IU/dl, 95% CI: −1.18, −0.04, p=0.035), fluvastatin (SMD: −0.34 IU/dl, 95% CI: −0.69, 0.02, p=0.065), atorvastatin (SMD: −0.23 IU/dl, 95% CI: −0.57, 0.11, p=0.179), with the lowest effect for rosuvastatin (SMD: −0.20 IU/dl, 95% CI: −0.71, 0.30, p=0.431). Overall, the effect size calculated for lipophilic statins (atorvastatin, simvastatin and fluvastatin) (SMD: −0.56 IU/dl, 95% CI: −0.94, −0.19, p=0.003) was greater than that of hydrophilic statins (rosuvastatin and pravastatin) (SMD: −0.38 IU/dl, 95% CI: −0.76, −0.01, p=0.046). The lowering effect of statins on plasma VWF:Ag levels was greater in the subset of studies lasting ≥12 weeks (SMD: −0.70 IU/dl, 95% CI: −1.19,−0.22, p=0.005) compared with the ones <12 weeks (SMD: −0.34 IU/dl, 95% CI: −0.67, 0.003, p=0.052). Finally, low-intensity statin therapy was associated with a significant reduction in VWF:Ag levels (SMD: −0.66 IU/dl, 95% CI: −1.07, −0.24, p=0.002) while the impact of high-intensity treatment was modest (SMD: −0.28 IU/dl, 95% CI: −0.82, 0.27, p=0.320). Conclusion: This meta-analysis showed a significant association between plasma VWF:Ag levels and statin therapy, with the largest effect for low-intensity, lipophilic statins administered for at least 12 weeks.
    European Heart Journal 08/2015; 36(Suppl. 1):224-224. · 15.20 Impact Factor
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    ABSTRACT: Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the "white-coat effect," may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white-coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2-15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7-11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1-20.2 and 8.6 mm Hg, 95% CI, 5.0-12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white-coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults. ©2015 Wiley Periodicals, Inc.
    Journal of Clinical Hypertension 08/2015; DOI:10.1111/jch.12644 · 2.85 Impact Factor
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    ABSTRACT: Introduction: Recently it has been suggested that statin therapy might have an unfavourable effect on healthy lifestyle, including diet, physical activity, weight and smoking, compared with statin non-users. Purpose: We assessed the differences in the temporal trends of healthy lifestyle parameters between statin users and non-users among Polish adults included to the LIPIDOGRAM survey. Methods: Through 675 primary care centres in 444 Polish cities, 17,065 individuals were included to cross-sectional nationwide population-based survey in 2004 (LIPIDOGRAM 2004 survey). A separate prospective randomized sample of 1,842 individuals recruited in 2004 had a 5-year follow-up (LIPIDOGRAM 5- YEARS survey). The parameters of healthy lifestyle – changes in diet, physical activity, body mass index (BMI) and waist circumference (WC), as well as smoking habits - were evaluated 3 times (in 2004, 2006 and 2010). Results: 1190 patients (65%) completed the LIPIDOGRAM 5-YEARS study in 2010. Within this group there were 520 patients with dyslipidaemia (43.7%) in 2004, of whom 189 (36.3%) were treated non-pharmacologically, and for the rest (n=331; 63.7%) statins were administered. In 2010 (compared with 2004) there were almost 2 times fewer patients on diet in the group of statin users compared with statin non-users (25.7 vs 49.2%; p<0.001). At study baseline (2004) regular physical activity was declared by 40.2% dyslipidaemia patients without statin therapy and by 23.9% by statin users (p<0.001). After 5-year follow-up, regular physical activity was continued only in 3.7% statin non-users and 6.3% of patients on statin therapy (p=0.199). In 2010 there were numerically less individuals with BMI <25 kg/m2 (who kept a normal BMI compared with 2004) in statin users than patients without statin therapy (15.4 vs 21.2%; p=0.097). Similarly there were significantly more patients who kept the correct values of WC in the group of statin non-users (47.1%) compared with statin users (36.6%; p=0.019). Opposite results were observed for smoking habits, as significantly more statin users stopped smoking after 5-year follow - there were 6 vs 12.2% smoking patients in 2010 in statin users and non-users, respectively (p=0.015). Conclusions: A small proportion of patients with dyslipidaemia, both on and not on statin therapy, complies with a healthy lifestyle; a great challenge for physicians. The application of healthy diet and the number patients with correct BMI/WC was reduced among statin users over time. Statin therapy does not seem to affect physical activity and might positively influence quitting smoking.
    European Heart Journal 08/2015; 36(suppl. 1):1155-1155. · 15.20 Impact Factor
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    ABSTRACT: Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient's underlying BP. To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with cardiovascular disease (CVD) and mortality outcomes. Prospective cohort study. Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). 25 814 ALLHAT participants. The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction (MI), all-cause mortality, stroke, and heart failure. During follow-up, 1194 fatal CHD or nonfatal MI events, 1948 deaths, 606 strokes, and 921 heart failure events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for stroke, and 1.25 (CI, 0.97 to 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality. Long-term outcomes were not available. Higher VVV of SBP is associated with an increased risk for CVD and mortality. Future studies should examine whether reducing VVV of BP lowers this risk. National Institutes of Health.
    Annals of internal medicine 07/2015; 163(5). DOI:10.7326/M14-2803 · 17.81 Impact Factor
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    ABSTRACT: Statin therapy may lower plasma coenzyme Q10 (CoQ10) concentrations, but the evidence as to the significance of this effect is unclear. We assessed the impact of statin therapy on plasma CoQ10 concentrations through the meta-analysis of available RCTs. The literature search included selected databases up to April 30, 2015. The meta-analysis was performed using either a fixed-effects or random-effect model according to I2 statistic. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence interval (CI). The data from 8 placebo-controlled treatment arms suggested a significant reduction in plasma CoQ10 concentrations following treatment with statins (WMD: −0.44 μmol/L, 95%CI: −0.52, −0.37, p < 0.001). The pooled effect size was robust and remained significant in the leave-one-out sensitivity analysis. Subgroup analysis suggested that the impact of statins on plasma CoQ10 concentrations is significant for all 4 types of statins studied i.e. atorvastatin (WMD: −0.41 μmol/L, 95%CI: −0.53, −0.29, p < 0.001), simvastatin (WMD: −0.47 μmol/L, 95% CI: −0.61, −0.33, p < 0.001), rosuvastatin (WMD: −0.49 μmol/L, 95%CI: −0.67, −0.31, p < 0.001) and pravastatin (WMD: −0.43 μmol/L, 95%CI: −0.69, −0.16, p = 0.001). Likewise, there was no differential effect of lipophilic (WMD: −0.43 μmol/L, 95%CI: −0.53, −0.34, p < 0.001) and hydrophilic statins (WMD: −0.47 μmol/L, 95%CI: −0.62, −0.32, p < 0.001). With respect to treatment duration, a significant effect was observed in both subsets of trials lasting <12 weeks (WMD: −0.51 μmol/L, 95%CI: −0.64, −0.39, p < 0.001) and ≥12 weeks (WMD: −0.40 μmol/L, 95%CI: −0.50, −0.30, p < 0.001). The meta-analysis showed a significant reduction in plasma CoQ10 concentrations following treatment with statins. Further well-designed trials are required to confirm our findings and elucidate their clinical relevance.
    Pharmacological Research 07/2015; 99. DOI:10.1016/j.phrs.2015.07.008 · 4.41 Impact Factor
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    ABSTRACT: The American Heart Association developed the Life's Simple 7 metric for defining cardiovascular health. Little is known about the association of co-occurring social risk factors on ideal cardiovascular health. Using data on 11,467 adults aged ≥25years from the National Health and Nutrition Examination Survey 1999-2006, we examined the association between cumulative social risk and ideal cardiovascular health in US adults. A cumulative risk score (range 0 to 3 or 4) was created by summing four social risk factors (low family income, low education level, minority race, and single-living status). Ideal levels for each component in Life's Simple 7 (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, and diet) were used to create an ideal Life's Simple 7 score [0-1 (low), 2, 3, 4, and 5-7 (high)]. Adults with low income (odds ratio [OR]=0.30 [95% CI 0.23-0.39]), low education [0.22 (0.16-0.28)], who are non-white (0.44 [0.36-0.54]) and single-living [0.79 (0.67-0.95)] were less likely to have 5-7 versus 0 ideal Life's Simple 7 scores after adjustment for age and sex. Adults were less likely to attain 5-7 versus 0 ideal Life's Simple 7 scores as exposure to the number of social risk factors increased [OR (95% CI) of 0.58 (0.49-0.68); 0.27 (0.21-0.35); and 0.19 (0.14-0.27) for cumulative social risk scores of 1, 2, and 3 or 4, respectively, each versus 0]. US adults with an increasing number of socially risk factors, were progressively less likely to attain ideal levels of cardiovascular health factors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 07/2015; 191. DOI:10.1016/j.ijcard.2015.05.007 · 4.04 Impact Factor
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    ABSTRACT: The association between waist circumference and end-stage renal disease (ESRD) remains poorly explored. Longitudinal population-based cohort. Participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study (n=30,239) with information for body mass index (BMI), waist circumference, spot urine albumin-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR; n=26,960). Elevated waist circumference or BMI. Incident cases of ESRD were identified through linkage of REGARDS participants with the US Renal Data System. Mean baseline age was 64.8 years, 45.8% were men, and 40.3% were black. Overall, 297 (1.1%) individuals developed ESRD during a median of 6.3 years. After adjustment for all covariates including waist circumference, no significant association was noted between BMI categories and ESRD incidence compared to BMI of 18.5 to 24.9kg/m(2) (referent). Higher waist circumference categories showed significantly increased hazard rates of ESRD, with waist circumference ≥ 108cm in women and ≥122cm in men (highest category) showing a 3.97-fold higher hazard rate (95% CI, 2.10-6.86) for ESRD compared to waist circumference < 80cm in women and <94cm in men (referent) after adjusting for demographic factors and BMI. However, no significant association was noted between any waist circumference category and ESRD incidence after adjustment for obesity-associated comorbid conditions and baseline ACR and eGFR. Short follow-up period (6.3 years) to assess ESRD risk among adults with eGFRs>60mL/min/1.73m(2). In this cohort of older adults, obesity as measured by waist circumference is associated with higher ESRD risk even with adjustment for BMI, whereas obesity as measured by BMI is not associated with higher ESRD risk after adjustment for waist circumference. However, no significant association is noted between increased waist circumference and ESRD risk after adjustment for obesity-related comorbid conditions, eGFR, and ACR. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Kidney Diseases 07/2015; DOI:10.1053/j.ajkd.2015.05.023 · 5.90 Impact Factor
  • Source

    Atherosclerosis 07/2015; 241(1):e190. DOI:10.1016/j.atherosclerosis.2015.04.932 · 3.99 Impact Factor
  • Robert S Rosenson · Michael E Farkouh · Paul Muntner ·

    Journal of the American College of Cardiology 06/2015; 65(25):2770. DOI:10.1016/j.jacc.2015.04.036 · 16.50 Impact Factor

Publication Stats

18k Citations
2,801.46 Total Impact Points


  • 2015
    • University of Vermont
      • Department of Pathology
      Burlington, Vermont, United States
  • 2009-2015
    • University of Alabama at Birmingham
      • Department of Epidemiology
      Birmingham, Alabama, United States
    • Sinai Hospital
      New York, New York, United States
  • 2007-2014
    • Icahn School of Medicine at Mount Sinai
      • Department of Medicine
      Borough of Manhattan, New York, United States
    • University of Alabama in Huntsville
      Huntsville, Alabama, United States
    • Ochsner
      • Center for Health Research
      New Orleans, Louisiana, United States
  • 2013
    • Columbia University
      • Department of Medicine
      New York, New York, United States
  • 2011
    • University of Alabama
      Tuscaloosa, Alabama, United States
    • Tufts University
      • Tufts Center for Conservation Medicine
      Medford, MA, United States
  • 2002-2010
    • Tulane University
      • • Department of Epidemiology
      • • Department of Medicine
      New Orleans, Louisiana, United States
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2008-2009
    • Mount Sinai Medical Center
      New York, New York, United States
  • 2007-2009
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2005
    • Beijing Fuwai Hospital
      Peping, Beijing, China
  • 2004
    • University of North Carolina at Chapel Hill
      • Department of Epidemiology
      North Carolina, United States
  • 2000-2002
    • University of Geneva
      • Institute of Social and Preventive Medicine
      Genève, Geneva, Switzerland
    • University of Mississippi Medical Center
      • Department of Pediatrics
      Jackson, Mississippi, United States