Paul Whelton

Tulane University | TU · Department of Epidemiology

Aims To assess the association of traditional risk factor burden and Life’s Simple 7 (LS7) score with incident atherosclerotic cardiovascular disease (ASCVD) across Lp(a) levels. Methods There were 6,676 participants without clinical ASCVD from the Multi-Ethnic Study of Atherosclerosis who underwent Lp(a) testing and were followed for incident ASC...

BACKGROUND Coronary artery calcium (CAC) is heterogeneous in older age and is incompletely explained by traditional atherosclerotic cardiovascular disease risk factors. The extremes of subclinical atherosclerosis burden are strongly associated with either a low or high 10-year risk of incident atherosclerotic cardiovascular disease, respectively. H...

Background: Aortic valve calcium (AVC) is associated with an increased risk of cardiovascular disease, non-cardiovascular disease such as dementia, and all-cause mortality. Traditional atherosclerotic cardiovascular disease risk factors are associated with both AVC and chronic kidney disease (CKD), but whether there is an association between AVC an...

Background: Lipoprotein (a) (Lp[a]) is associated with an increased risk of cardiovascular disease and mortality, as well as heart failure and myocardial fibrosis. However, the link between Lp(a) and cardiac remodeling as a pathway to adverse cardiac outcomes remains unknown. Objectives: This study investigated the relationship between Lp(a) levels...

Introduction: One in five individuals have elevated lipoprotein(a) [Lp(a)], an inheritable risk factor that is causally associated with atherosclerotic cardiovascular disease (ASCVD). Whether individuals with elevated Lp(a) derive similar benefit from control of ASCVD risk factors has not been well-studied. Hypothesis: The magnitude of benefit asso...

Background: Aortic valve calcium (AVC) is strongly associated with an increased risk for severe aortic stenosis (AS). The prevalence of AVC increases with age affecting 40-50% of individuals ≥80 years. The impact of age on the progression of AVC and its association with incident AS remains unknown. Methods: Our study included 6,810 participants (52...

Introduction Cumulative exposure to LDL-C over time is independently associated with incident atherosclerotic cardiovascular disease (ASCVD), while the absence of coronary artery calcium (CAC) is associated with a low risk of ASCVD events regardless of baseline LDL-C. Whether cumulative LDL-C exposure influences clinical risk stratification in indi...

Background: The 2013 Pooled Cohort Equation (PCE) has been a useful starting point to assess atherosclerotic cardiovascular disease (ASCVD) risk. In 2023, the PREVENT risk calculator was developed and validated as a contemporary calculator considering the cardiovascular-kidney-metabolic health paradigm. Coronary artery calcium (CAC), measured on no...

Background Lowering blood pressure (BP) in persons with low diastolic BP could be harmful. Hence, we examined whether baseline diastolic BP modifies the effects of BP lowering on clinical outcomes in a meta-analysis of five large BP lowering trials. Methods In a study-level meta-analysis based on individual participant data of the Systolic Blood P...

Coronary artery calcium (CAC) is measured using non-contrast cardiac computed tomography. CAC scoring is simple to perform, low cost, and the associated radiation dose is generally low. Higher CAC scores are associated with an increasing risk of cardiovascular disease, while the absence of CAC (CAC = 0) is associated with a low 10-year risk for car...

Background People living with HIV have greater risk of cardiovascular diseases (CVD) than people without HIV and tend to have different risk profiles, including higher serum triglycerides and lower LDL cholesterol levels. Nuclear magnetic resonance (NMR) provides a detailed phenotype of lipoproteins. Purpose To examine the associations between lip...

Purpose of review To review the current evidence and highlight future strategies regarding consideration of coronary artery calcium (CAC) density in cardiovascular disease (CVD) risk stratification. Recent findings Expressed as the product of plaque area and a peak calcium density weighting factor, the Agatston method is the gold-standard for meas...

BACKGROUND Systolic blood pressure (SBP) lowering reduces major cardiovascular disease (CVD) and all-cause mortality. However, the optimal target for SBP lowering remains controversial. METHODS We included trials with random allocation to an SBP <130 mm Hg treatment target and CVD as the primary outcome. Data were extracted from each study indepen...

BACKGROUND Antihypertensive medication use patterns have likely been influenced by changing costs and accessibility over the past 3 decades. This study examines the relationships between patent exclusivity loss, medication costs, and national health policies on antihypertensive medication use. METHODS Using 1996 to 2021 Medical Expenditure Panel S...

Background Compared to normal high-density lipoprotein (HDL) cholesterol values, very high HDL cholesterol is associated with a higher incidence of mortality and atherosclerotic cardiovascular disease (ASCVD). As such, clinical risk stratification among persons with very high HDL cholesterol is challenging. Objectives Among persons with very high...

Background The Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive lowering of systolic blood pressure (BP) increased the risk of incident chronic kidney disease and episodes of acute kidney injury. Whether intensive treatment changes the risk of kidney failure is unknown. The goal of this study was to estimate the legacy effe...

The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame th...

BACKGROUND Alcohol consumption has been associated with higher blood pressure and an increased risk of hypertension. However, the possible exposure thresholds and effect-modifiers are uncertain. METHODS We assessed the dose-response relationship between usual alcohol intake and hypertension incidence in nonexperimental cohort studies. After perfor...

BACKGROUND Aortic valve calcification (AVC), Lp(a) [lipoprotein(a)], and low-density lipoprotein cholesterol (LDL-C) are associated with severe aortic stenosis (AS). We aimed to determine which of these risk factors were most strongly associated with the risk of incident severe AS. METHODS A total of 6792 participants from the MESA study (Multi-Et...

Objective Estimate the incremental costs and benefits of scaling up hypertension care in adults in 24 select countries, using three different systolic blood pressure (SBP) treatment cut-off points—≥140, ≥150 and ≥160 mm Hg. Intervention Strengthening the hypertension care cascade compared with status quo levels, with pharmacological treatment admi...

BACKGROUND It is unknown whether maintaining normal blood pressure (BP) from middle to older age is associated with improved health outcomes. METHODS We estimated the proportion of Atherosclerosis Risk in Communities study participants who maintained normal BP from 1987 to 1989 (visit 1) through 1996 to 1998 and 2011 to 2013 (over 4 and 5 visits,...

Objective Lipoprotein(a) [Lp(a)] is an atherogenic and prothrombotic lipoprotein associated with atherosclerotic cardiovascular disease (ASCVD). We assessed the association between regular aspirin use and ASCVD mortality among individuals with versus without elevated Lp(a) in a nationally representative US cohort. Methods Eligible participants wer...

Introduction: Individuals living in rural areas have a disproportionately high rate of cardiovascular disease (CVD) mortality. Coronary artery calcium (CAC) scanning may inform CVD risk stratification. However, the prevalence of CAC in rural areas is unknown. Research Question: What is the prevalence of CAC according to age, sex, and self-reported...

Background Despite an increasingly diverse population, knowledge regarding racial and ethnic disparities is limited among women and men undergoing atherosclerotic cardiovascular (ASCVD) screening. Our aim was to compare CV mortality by ASCVD risk and coronary artery calcium (CAC) scores among Black and Hispanic women and men compared to other parti...

Two recent large trials showed the potential of single pill combinations (SPCs) with ≥3 low-dose components among people with hypertension who were untreated or receiving monotherapy. In both trials, these ‘hypertension polypills’ were superior to usual care, achieving >80% BP control without increasing withdrawal due to side effects. However, ther...

Background The initiation of coronary artery calcium (CAC) is an important physiologic milestone associated with increased cardiovascular disease risk. However, traditional risk factors (RF) do not perform well for predicting incident CAC among the 54 million older U.S. adults. Objectives The authors sought to assess the association between nontra...

Background In a post hoc analysis, we examined whether post-randomization diuretics use can explain and/or mediate the beneficial effects of intensive systolic blood pressure (BP)-lowering on cardiovascular disease and all-cause mortality in Systolic Blood Pressure Intervention Trial (SPRINT) Methods SPRINT was a randomized, controlled trial of 93...

Comment www.thelancet.com/lancetgh Vol 12 February 2024 e192 Priorities to reduce the burden of hypertension in Africa through ACHIEVE Hypertension is a leading cause of premature deaths in Africa. 1 Its prevalence of up to 54% in adults in Africa 2,3 is among the highest rates in the world. 4 More disturbingly, only 7% of individuals with hyperten...

BACKGROUND The development of thoracic aortic calcium (TAC) temporally precedes coronary artery calcium more often in women versus men. Whether TAC density and area confer sex-specific differences in atherosclerotic cardiovascular disease (ASCVD) risk is unknown. METHODS We studied 5317 primary prevention patients who underwent coronary artery cal...

Introduction: Racial/ethnic differences exist in the prevalence and burden of aortic valve calcium (AVC) and in the incidence of aortic stenosis (AS). While AVC is strongly associated with the long-term risk for AS, whether this association differs by race/ethnicity remains uncertain. Hypothesis: There will be a similar absolute event rate for inci...

Introduction: Persons with very-high high-density lipoprotein-cholesterol (HDL-C) may experience an increased mortality risk. However, the predictors of mortality among those with very-high HDL-C remain unknown. Hypothesis: Compared to traditional risk factors, coronary artery calcium (CAC) will more strongly stratify risk among individuals with ve...

Introduction: Cancer patients may face an elevated risk of developing atherosclerotic cardiovascular disease (ASCVD). Consequently, a conventional pooled cohort equation may not accurately predict cardiovascular (CV) outcomes in this population. Hypothesis: A cancer-specific algorithm is superior to conventional ASCVD risk scores in women with brea...

Corresponding Author

Background Intensive blood pressure (BP) lowering in SPRINT produced acute decreases in kidney function and higher risk for acute kidney injury. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values. Methods SPRINT data were linked with E...

Corresponding Author

Coronary artery calcium (CAC) is the measure of subclinical coronary artery atherosclerosis most strongly associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, CAC is rarely reported in the inpatient setting to guide chest pain management. We present a case of very high CAC in a 64-year-old woman with hypertension, type 2 di...

Purpose of review: To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD). Recent findings: Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk predict...

Objective: The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied. Methods: Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectivel...

Background: Alcohol consumption may increase blood pressure but the details of the relationship are incomplete, particularly for the association at low levels of alcohol consumption, and no meta-analyses are available for nonexperimental cohort studies. Methods: We performed a systematic search of longitudinal studies in healthy adults that repo...

Objective: To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019. Methods: This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortalit...

Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths...

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated an intensive (<120 mmHg) versus standard (<140 mmHg) systolic blood pressure (SBP) goal lowered cardiovascular disease (CVD) risk. Estimating the effect of intensive SBP lowering among SPRINT-eligible adults most likely to benefit can guide implementation efforts. Me...

Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice gui...

This study examines the availability, cost, and consumer ratings of blood pressure–measuring devices relative to validation status across 10 countries.

Coronary artery calcium (CAC) is a direct measure of an individual’s coronary atherosclerotic burden. Higher levels of CAC are strongly associated with an increased risk of cardiovascular disease (CVD) events and individuals with very high CAC levels have a CVD risk similar to stable persons with a prior CVD event. Conversely, the absence of CAC (C...

Background: Aortic valve calcification (AVC) is a principal mechanism underlying aortic stenosis (AS). Objectives: This study sought to determine the prevalence of AVC and its association with the long-term risk for severe AS. Methods: Noncontrast cardiac computed tomography was performed among 6,814 participants free of known cardiovascular d...

Treatment with a single-pill combination (SPC) as compared to two or more single-agent pill (SAP) antihypertensive agents

Hypertension is a leading preventable and controllable risk factor for cardiovascular and cerebrovascular diseases and the leading preventable risk for death globally. With a prevalence of nearly 50% and 93% of uncontrolled cases, very little progress has been made in detecting, treating, and controlling hypertension in Africa over the past thirty...

This review aims to summarize key articles published in the Journal of Cardiovascular Computed Tomography (JCCT) in 2022, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor c...

Introduction: Current guidelines recommend ≥2 servings of fish/week for the prevention of atherosclerotic cardiovascular disease (ASCVD). However, a recent large meta-analysis suggested that the benefit may exist only for persons with a prior ASCVD event. Whether coronary artery calcium (CAC) can help to identify individuals who are likely to benef...

Introduction: Albuminuria, an early marker of kidney damage, is a risk factor for chronic kidney disease (CKD) progression, cardiovascular disease (CVD), and death. Dietary sodium is a risk factor for elevated blood pressure, CVD, and all cause-mortality. It is particularly important in patients with CKD due to increased salt-sensitivity. It is unc...

Background: Inflammation plays an important role in the pathophysiology of atherosclerosis. However, inflammatory biomarkers have been found to have a weak association with coronary artery calcium (CAC), a representative measure of subclinical atherosclerosis. Moreover, the existing evidence does not sufficiently explore extra coronary calcium (ECC...

Introduction: Poor medication adherence is a major contributor to uncontrolled hypertension, the leading preventable risk factor for CVD and mortality worldwide. Simple and accessible tools are needed to quantify medication adherence. We developed a novel two-question adherence scale in the Implementation of Multifaceted Patient-Centered Treatment...

Purpose of Review To characterize the barriers and opportunities associated with racial and ethnic disparities in blood pressure (BP) control. Recent Findings Blood pressure (BP) control rates in the USA have worsened over the last decade, with significantly lower rates of control among people from racial and ethnic minority groups, with non-Hispa...

Importance: Hypertension, defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg, affects approximately 116 million adults in the US and more than 1 billion adults worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, heart f...

Background Machine learning (ML) models of risk prediction with coronary artery calcium (CAC) and CAC characteristics exhibit high performance, but are not inherently interpretable. Objectives To determine the direction and magnitude of impact of CAC characteristics on 10-year all-cause mortality (ACM) with explainable ML. Methods We analyzed asy...

The online purchase of automated blood pressure (BP) devices is a multibillion-dollar industry, but most BP devices available for online purchase have not passed adequate clinical validation testing. This study aimed to determine the extent to which BP devices available in best-selling lists of the e-commerce business Amazon were properly validated...