Emelia Benjamin

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Verified

Emelia verified their affiliation via an institutional email.

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• MD, ScM
• Associate Provost for Faculty Development Boston University Medical Campus at Boston University

Background Abnormal exercise blood pressure (BP) responses are associated with hypertension and cardiovascular disease, but their relationship with home BP over a mid‐ to long‐term time span is unknown. Methods At an FHS (Framingham Heart Study) research examination (2016–2019), participants underwent maximum incremental ramp cycle ergometry cardi...

Background There is a paucity of data assessing the relation of sex differences in healthcare utilisation in patients with atrial fibrillation (AF). Purpose We therefore sought to examine the association of age and sex with healthcare utilization in patients with AF. Methods We conducted a retrospective analysis of electronic health records from...

BACKGROUND We have previously reported a novel clinical risk score (risk prediction score for shockable sudden cardiac arrest [VFRisk]) for the prediction of shockable sudden cardiac arrest, discovered and validated in 2 US west coast communities. We hypothesized that VFRisk predicts sudden cardiac death (SCD) risk in the geographically distinct FH...

Background and Aims While advancements in care may improve the clinical course of atrial fibrillation (AF), data on trends in lost lifetime after developing cardiovascular complications are sparse. Methods In this nationwide registry-based matched cohort study (January 1, 2000-December 31, 2022), we followed patients with ischemic stroke, gastroin...

Atrial fibrillation (AF) is the most common arrhythmia experienced by critically ill patients. It has been associated with adverse short-and long-term outcomes, including an increased risk of thromboembolic events, heart failure, and death. Due to complex and multifactorial pathophysiology, a heterogenous patient population, and a lack of clinical...

Importance Research biobanks of human cells and tissues, particularly tissues accessible only after death, are crucial for advancing the understanding of human pathophysiological function. Research biobanks are bereft of tissues from individuals of diverse races and ethnicities, thus limiting the generalizability of biobank findings. Objective To...

Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compa...

Introduction Although several potential respiratory and cardiovascular health effects of e-cigarettes have been reported, their association with incident cardiometabolic conditions remains unclear. Aims and Methods We used longitudinal data from the All of Us research program to investigate the association between current exclusive e-cigarette use...

Background: Osteoprotegerin (OPG), a protein involved in bone metabolism, is associated with left ventricular remodeling and fibrosis. Circulating OPG levels correlate with left ventricular mass index and plasma brain natriuretic peptide levels in humans. The association with incident heart failure (HF) has not been elucidated. Methods: Among 7581...

Atrial fibrillation (AF) is the most common heart rhythm abnormality and is a leading cause of heart failure and stroke. This large-scale meta-analysis of genome-wide association studies increased the power to detect single-nucleotide variant associations and found more than 350 AF-associated genetic loci. We identified candidate genes related to m...

Atrial fibrillation (AF) is a prevalent and morbid abnormality of the heart rhythm with a strong genetic component. Here, we meta-analyzed genome and exome sequencing data from 36 studies that included 52,416 AF cases and 277,762 controls. In burden tests of rare coding variation, we identified novel associations between AF and the genes MYBPC3, LM...

Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown promising results in reducing hospitalizations from heart failure (HF) and cardiovascular mortality. However, their effect on arrhythmia and sudden cardiac death (SCD) is not well established. Objectives The authors sought to evaluate the association between SGLT2i and the ri...

Background Tobacco use remains a leading cause of disability-adjusted life years lost in the United States. Cardiovascular harm varies by tobacco product type and usage patterns, yet reliable methods for assessing exposure and harm across different products, especially novel tobacco products, are limited. Objectives The authors aimed to identify d...

Background Genome‐wide association studies have identified several hundred susceptibility single nucleotide variants for coronary artery disease (CAD). Despite single nucleotide variant‐based genome‐wide association studies improving our understanding of the genetics of CAD, the contribution of structural variants (SVs) to the risk of CAD remains l...

Large-scale whole-genome sequencing (WGS) studies have improved our understanding of the contributions of coding and noncoding rare variants to complex human traits. Leveraging association effect sizes across multiple traits in WGS rare variant association analysis can improve statistical power over single-trait analysis, and also detect pleiotropi...

Aims: To assess the cross-sectional and longitudinal associations of smoking behaviour with central arterial haemodynamic measures in samples of the Framingham Heart Study. Methods and results: In 6597 participants [3606 (55%) women, 51.5% never smoked, 34.8% formerly quit, 4.3% recently quit, and 9.3% currently smoking], we assessed relations o...

Introduction: Perivascular Spaces (PVS) visible on brain magnetic resonance imaging (MRI) are markers of Cerebral Small Vessel Disease (CSVD). Recent evidence suggests a potential role of inflammatory biomarkers in the pathogenesis of PVS. This study aimed to examine the relation between inflammation markers and progression of PVS burden in communi...

Background: Since treatment with anticoagulants can prevent recurrent strokes, identification of patients at risk for incident AF after stroke is crucial. We aimed to investigate whether the addition of AF polygenic risk scores (PRS) to existing clinical risk predictors could improve prediction of AF after stroke. Methods: Patients diagnosed with i...

BACKGROUND Understanding the association of tobacco product use with subclinical markers is essential in evaluating health effects to inform regulatory policy. This is particularly relevant for noncigarette products (eg, cigars, pipes, and smokeless tobacco), which have been understudied because of their low prevalence in individual cohort studies....

Background Atrial fibrillation (AF) and acute myocardial infarction (AMI) share risk factors and are bidirectionally associated. Several studies found higher risks of outcomes in individuals with both conditions. Whether the risks of outcomes differ according to temporal order of AF and AMI is unclear. Methods The study was based on the Danish Die...

Objective This study assesses whether longitudinal quantitative pupillometry predicts neurological deterioration after large middle cerebral artery (MCA) stroke and determines how early changes are detectable. Methods This prospective, single‐center observational cohort study included patients with large MCA stroke admitted to Boston Medical Cente...

Importance Cardiovascular health outcomes associated with noncigarette tobacco products (cigar, pipe, and smokeless tobacco) remain unclear, yet such data are required for evidence-based regulation. Objective To investigate the association of noncigarette tobacco products with cardiovascular health outcomes. Design, Setting, and Participants This...

To broaden our understanding of bradyarrhythmias and conduction disease, we performed common variant genome-wide association analyses in up to 1.3 million individuals and rare variant burden testing in 460,000 individuals for sinus node dysfunction (SND), distal conduction disease (DCD) and pacemaker (PM) implantation. We identified 13, 31 and 21 c...

Importance In the US, approximately 10.55 million adults have atrial fibrillation (AF). AF is associated with significantly increased risk of stroke, heart failure, myocardial infarction, dementia, chronic kidney disease, and mortality. Observations Symptoms of AF include palpitations, dyspnea, chest pain, presyncope, exertional intolerance, and f...

Introduction Adults increasingly use e-cigarettes for cigarette cessation because of the perceived reduced risk. While e-cigarette use is associated with reduced toxicant exposure compared with smoking, it is unclear whether transitioning from cigarettes to e-cigarettes is associated with resolution of respiratory symptoms. Methods Data were obtai...

Introduction: The biology of early human hypertensive heart disease (HHD) is largely unexplored due to limited cardiac tissue access. Site-specific transcriptomics of human cardiac tissue before development of overt HHD offers a unique vantage to understand the biology of HHD in human cardiac tissue. Hypothesis: We hypothesize that transcriptomic s...

Background: Higher arterial stiffness contributes to atherogenesis and arterial calcification, resulting in cardiovascular morbidity and mortality. Research Question: The relations of lifestyle, measured by the AHA Life’s Essential 8 (LE8), with arterial health (AH) and CVD outcomes are incompletely understood. Aims: To examine the association of L...

Introduction Individuals with shockable sudden cardiac arrest (SCA) have higher survival if treated with an implantable cardioverter defibrillator or automated external defibrillator. We previously developed VFRisk Score from an ongoing US West Coast study, which performs significantly better than left ventricular ejection fraction<35% (C-statistic...

Background: Electrographic age (ECG-age), obtained by the estimation of age through deep neural networks, has been useful in predicting cardiovascular outcomes. Given the wide availability of echocardiograms and known associations of metrics with age, we sought to amplify the applicability of ECG-age, by exploring the association of echocardiograph...

Background: Primary care after pregnancy is recommended, especially for individuals with recent adverse pregnancy outcomes (APOs, such as preeclampsia or gestational diabetes), who are at increased risk for future heart disease. Health-related social needs (HRSNs) are recognized barriers to care, yet their pregnancy-related prevalence and associati...

Diversity in academic medicine and research enhance the quality of the science produced and the efficacy of patient care. Diversity, equity, inclusion, and accessibility (DEIA) statements have recently been suggested or required by academic job postings as a way to measure candidate's commitments to fostering DEIA in their role. In this perspective...

Importance Resting heart rate (RHR) is a widely available measure of cardiovascular fitness that has been associated with several cardiovascular outcomes. RHR has previously been associated with the risk of atrial fibrillation (AF) among individuals of European ancestry, but little is known about this association in Black adults. Objective To eval...

Importance Synthetic nicotine is increasingly used in e-cigarette liquids along with flavors to appeal to youths. Regulatory loopholes have allowed tobacco manufacturers to use social media to target youths. Objective To analyze the extent to which synthetic nicotine e-cigarette brands have implemented US Food and Drug Administration (FDA) health...

Background Exhaled carbon monoxide (eCO) is associated with subclinical and overt cardiovascular disease and stroke. The association between eCO with left atrial size, prevalent, or incident atrial fibrillation (AF) are uncertain. Methods eCO was measured using an Ecolyzer instrument among Framingham Heart Study Offspring and Omni participants who...

Background and Aims This study assessed whether a model incorporating clinical features and a polygenic score for ascending aortic diameter would improve diameter estimation and prediction of adverse thoracic aortic events over clinical features alone. Methods Aortic diameter estimation models were built with a 1.1 million-variant polygenic score...

Introduction Concerns exist of women underrepresentation in atrial fibrillation (AF) studies, potentially limiting the generalisability of study findings to women with AF. We assessed the participation of women in AF clinical studies performed at a tertiary care centre in the Northern Netherlands. Methods Eight AF clinical studies with screening l...

The importance of social drivers of health (SDOH) in the occurrence, detection, treatment, and outcome of atrial fibrillation (AF) has attracted increasing attention. Addressing SDOH factors may suggest opportunities to prevent AF and its complications. We aimed to conduct a structured narrative review and summarize current knowledge on the associa...

BACKGROUND Smartphone applications (apps) can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. OBJECTIVE To describe a new electronic cohort (eCohort) of older adults embedded in the Framingham Heart Study (FHS) including baseline smartphone s...

Background Smartphone apps can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective We aim to describe a new electronic cohort of older adults embedded in the Framingham Heart Study including baseline smartphone survey return rates and s...

Background Step counting is comparable among many research-grade and consumer-grade accelerometers in laboratory settings. Objective The purpose of this study was to compare the agreement between Actical and Apple Watch step-counting in a community setting. Methods Among Third Generation Framingham Heart Study participants (N=3486), we examined t...

Atrial fibrillation (AF) is a globally prevalent cardiac arrhythmia with significant genetic underpinnings, as highlighted by recent large-scale genetic studies. A prominent clinical and genetic overlap exists between AF, heritable ventricular cardiomyopathies, and arrhythmia syndromes, underlining the potential of AF as an early indicator of sever...

Life-threatening, space-occupying mass effect due to cerebral edema and/or hemorrhagic transformation is an early complication of patients with middle cerebral artery stroke. Little is known about longitudinal trajectories of laboratory and vital signs leading up to radiographic and clinical deterioration related to this mass effect. We curated a r...

Background Disorders affecting cardiac conduction are associated with substantial morbidity. Understanding the epidemiology and risk factors for conduction disorders may enable earlier diagnosis and preventive efforts. Objectives The purpose of this study was to quantify contemporary frequency and risk factors for electrocardiogram (ECG)-defined c...

Background Cigarette smoking is a leading modifiable cardiovascular disease risk factor. Cross-sectional studies demonstrated variable relations of smoking behavior with measures of vascular function. Additionally, the impact of persistent versus changes in smoking behaviors on alterations in central arterial function is unclear. Methods and Resul...

Background Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step count recording in real-world settings over long periods of time, but the relationship between smartwatch-measured HR and daily steps to cardiorespiratory fitness remains...

Background Atrial fibrillation (AF) and acute myocardial infarction (AMI) share risk factors and are bidirectionally associated. Several studies found higher risks of outcomes in individuals with both conditions. Whether the risks of outcomes differ according to temporal order of AF and AMI is unclear. Purpose We aimed to assess the risks of heart...

Background Individuals with both atrial fibrillation (AF) and myocardial infarction (MI) have higher mortality compared with individuals with only 1 condition. Whether mortality differs according to the temporal order of AF and MI is unclear. Methods and Results We included participants from the FHS (Framingham Heart Study) from 1960 and onwards....

BACKGROUND Arterial stiffening may contribute to the pathogenesis of metabolic dysfunction–associated steatotic liver disease. We aimed to assess relations of vascular hemodynamic measures with measures of hepatic steatosis and fibrosis in the community. METHODS Our sample was drawn from the Framingham Offspring, New Offspring Spouse, Third Genera...

Inflammation biomarkers can provide valuable insight into the role of inflammatory processes in many diseases and conditions. Sequencing based analyses of such biomarkers can also serve as an exemplar of the genetic architecture of quantitative traits. To evaluate the biological insight, which can be provided by a multi-ancestry, whole-genome based...

Importance Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants Individua...

Historically, investigators have not differentiated between patients with and without hemorrhagic transformation (HT) in large core ischemic stroke at risk for life-threatening mass effect (LTME) from cerebral edema. Our objective was to determine whether LTME occurs faster in those with HT compared to those without. We conducted a two-center retro...

There has been increased awareness of the linkage between environmental exposures and cardiovascular health and disease. Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting millions of people worldwide and contributing to substantial morbidity and mortality. Although numerous studies have explored the role of genetic and...

Objectives To examine how the lifetime risks of atrial fibrillation and of complications after atrial fibrillation changed over time. Design Danish, nationwide, population based cohort study. Setting Population of Denmark from 1 January 2000 to 31 December 2022. Participants 3.5 million individuals (51.7% women and 48.3% men) who did not have at...

Systemic low-grade inflammation is a feature of chronic disease. C-reactive protein (CRP) is a common biomarker of inflammation and used as an indicator of disease risk; however, the role of inflammation in disease is not completely understood. Methylation is an epigenetic modification in the DNA which plays a pivotal role in gene expression. In th...

Abstract Objective While e-cigarette use is associated with adverse cardiopulmonary health effects, the mortality risks associated with e-cigarette use alone and combined with smoking remain unexamined. Methods Data between 2014 and 2018 were obtained from the National Health Interview Survey (NHIS), an annual cross-sectional survey of US adults....

Background/Objective Space occupying cerebral edema is the most feared early complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion, and is reported to peak 2-4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially when it occ...

Background: There is limited understanding of the association of the AHA's Life's Essential 8 (LE8), reflecting cardiovascular health (CVH) behaviors and factors, with vascular stiffness and hemodynamics in adults without cardiovascular diseases (CVD). Methods: In 2330 Framingham Heart Study Offspring participants (Exam 7, 1998-2002) with applanati...

Background The incidence of atrial fibrillation (AF) shows substantial temporal trends, but the contribution of birth cohort effects is unknown. These effects refer to the relationship between birth year and the likelihood of developing AF. We aimed to assess trends in cumulative incidence of diagnosed AF across birth cohorts and to disentangle the...

Background: Cardiovascular diseases (CVD) contribute to stroke and dementia, which can be due to cerebral small vessel disease (CSVD) detectable on brain MRI. Aim: To determine the association between prevalent CVD and atrial fibrillation (AF) with CSVD. Methods: We assessed a composite of CVD including coronary heart disease, intermittent claudica...

Background Depressive symptoms are common and share many biopsychosocial mechanisms with hypertension. Association studies between depressive symptoms and blood pressure (BP) have been inconsistent. Home BP monitoring may provide insight. Objective To investigate the association between depressive symptoms and digital home BP. Methods Electronic...

BACKGROUND Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step count recording in real-world settings over long periods of time, but the relationship between smartwatch-measured HR and daily steps to cardiorespiratory fitness remains...

Background We aim to determine the added value of carotid intima-media thickness (cIMT) in stroke risk assessment for hypertensive Black adults. Methods We examined 1647 participants with hypertension without a history of cardiovascular disease, from the Jackson Heart Study. Cox regression analysis estimated hazard ratios (HR) for incident stroke...

Most prior studies on the prognostic significance of newly-diagnosed atrial fibrillation (AF) in COVID-19 did not differentiate newly-diagnosed AF from pre-existing AF. To determine the association between newly-diagnosed AF and in-hospital and 30-day mortality among regular users of Veterans Health Administration using data linked to Medicare. We...

Background The COVID-19 pandemic profoundly disrupted the delivery of medical care. It remains unclear whether individuals diagnosed with new onset disease during the pandemic were less likely to initiate treatments after diagnosis. We sought to evaluate changes in the treatment initiation of patients newly diagnosed with atrial fibrillation (AF) a...

The depletion of disruptive variation caused by purifying natural selection (constraint) has been widely used to investigate protein-coding genes underlying human disorders1-4, but attempts to assess constraint for non-protein-coding regions have proved more difficult. Here we aggregate, process and release a dataset of 76,156 human genomes from th...

Recessive diseases arise when both copies of a gene are impacted by a damaging genetic variant. When a patient carries two potentially causal variants in a gene, accurate diagnosis requires determining that these variants occur on different copies of the chromosome (that is, are in trans) rather than on the same copy (that is, in cis). However, cur...

Aim The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. Methods A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence condu...

Background The relationship between combined genetic predisposition and lifestyle and the risk of incident atrial fibrillation (AF) is unclear. Therefore, we aimed to assess a possible interaction between lifestyle and genetics on AF risk. Methods We included AF cases and a randomly drawn subcohort of 4040 participants from the Danish Diet, Cancer...

BACKGROUND Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term timespan. OBJECTIVE We aimed to investigate if arterial stiffness traits are associated with subsequent mid- to l...

Background Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. Objective This study aims to investigate if arterial stiffnes...

Background Life-threatening, space-occupying mass effect due to cerebral edema and/or hemorrhagic transformation is an early complication of patients with middle cerebral artery (MCA) stroke. Little is known about longitudinal trajectories of laboratory and vital signs leading up to radiographic and clinical deterioration related to this mass effec...

Background Overweight and obesity are causal risk factors for atrial fibrillation (AF).(1) Mendelian randomization studies indicated a higher risk of AF with each unit increase in body mass index (BMI).(1) In observational studies, weight gain was associated with a higher risk of incident AF compared to stable weight.(2,3) However, the results are...

Background The etiology of AF is multifactorial. Genetic susceptibility and lifestyle contribute to atrial fibrillation (AF) risk.(1,2) However, the relationship between combined genetic predisposition and lifestyle risk factors on AF risk is unclear. Purpose We aimed to assess a possible interaction between modifiable risk factors and genetics on...

Introduction: The association of habitual physical activity (PA) with subclinical cardiovascular remodeling and their modifications by age and sex are not well understood in community-dwelling adults. Methods: We studied 5685 (mean age 49±15 y, 53% F) participants of the Framingham Heart Study 2 nd generation Exam 8 (2005-2008) and 3 rd generation...

Background: Atherosclerotic cardiovascular disease (ASCVD) risk is significantly affected by sex; however, the increasing impact of gender identify is unclear. Hypothesis: We hypothesized that transgender and gender diverse (TGD) adults had higher prevalence of ASCVD risk factors and higher incidence of ASCVD outcomes compared to cisgender persons....

Introduction: Abnormal blood pressure (BP) responses during exercise are associated with incident hypertension and cardiovascular disease, but how exercise BP responses relate to average home BP and home BP variability (BPV) over one-year follow-up is unknown. Objective: We investigated whether exercise BP was associated with average home BP and ho...

Background: Studies from the Framingham Heart Study (FHS) have reported that exhaled carbon monoxide (eCO) is associated with cardiovascular disease (CVD) and stroke. To our knowledge, no study has assessed the association between eCO with atrial fibrillation (AF) and left atrial (LA) size. We related eCO to AF and LA size. Methods: eCO was measure...