Roger S Blumenthal

• M.D.
• Managing Director at Johns Hopkins Medicine

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 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...

Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease (CVD) outcomes. Yet, there is no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association...

Background/Introduction Metabolic Syndrome (MetS) is linked to increased risk of developing heart failure (HF), underscoring a need to implement more aggressive lifestyle and pharmacotherapeutic HF prevention strategies. Chronic kidney disease (CKD) is associated with MetS and is a risk factor for HF; however, therapies protective against both kidn...

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...

Background: NT-proBNP is a powerful marker of heart failure (HF) risk. NT-proBNP levels increase with age; however, the impact of distinct longitudinal trajectories of NT-proBNP on future HF risk with aging is largely unexplored. Hypothesis: Middle-aged adults with higher baseline concentrations and steeper increases of NT-proBNP through older ages...

Background: Bariatric surgery results in marked weight loss and has many cardiometabolic benefits. Adipokines, proteins secreted by adipose tissue with diverse metabolic effects, are affected by bariatric surgery. Whether favorable changes in adipokines after bariatric surgery are associated with improvements in cardiac biomarkers is unknown. Metho...

Introduction: Although chronic kidney disease (CKD) is closely linked to hypertension and diabetes, and is an independent risk factor for heart failure (HF), most HF risk prediction algorithms do not include CKD measures as covariates. Hypothesis: We hypothesized that the addition of estimated glomerular function (eGFR), using creatinine (Cr) and c...

Introduction: Racial differences in Lp(a) distributions are well known, with higher levels in Black adults compared to White adults. It is unclear whether the risk implications of higher Lp(a) levels are the same in Black and White adults. Furthermore, the contribution of racial differences in Lp(a) to disparities in ASCVD in the US has not been we...

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...

Background: Obesity is linked with subclinical myocardial injury, even in those with metabolically healthy obesity (MHO). There is limited data on the impact of weight loss via bariatric surgery on myocardial injury, particularly at different levels of metabolic health. Methods: We prospectively evaluated 294 Geisinger Obesity Institute Registry pa...

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...

Background: The population of adults with prediabetes is growing worldwide. The value of coronary artery calcium (CAC) testing to assess ASCVD risk in this group is poorly defined. Methods: We pooled participants free of clinical ASCVD from 4 prospective cohort studies including the Multi-Ethnic Study of Atherosclerosis (MESA), Heinz Nixdorf Recall...

Background: Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease(CVD)outcomes. Yet, there's no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the as...

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: The pathophysiology of peripartum cardiomyopathy (PPCM) and its distinctive biological features remain incompletely understood. High-throughput serum proteomic profiling, a powerful tool to gain insights into the pathophysiology of diseases at a systems biology level, has never been used to investigate PPCM relative to nonischemic card...

Multiple lines of evidence confirm that the cumulative burden of low-density lipoprotein cholesterol (LDL-C) is causally related to the development of atherosclerotic cardiovascular disease (ASCVD). As such, lowering LDL-C is a central tenet in all ASCVD prevention guidelines, which recommend matching the intensity of LDL-C lowering with the absolu...

The prevalence of heart failure (HF) in the United States (U.S.) is estimated at over 6 million adults, with the incidence continuing to increase. A large proportion of the U.S. population is also at risk of HF due to the high prevalence of established HF risk factors, such as hypertension, diabetes, and obesity. Many individuals have multiple risk...

Background: Alternatives to the Friedewald low-density lipoprotein cholesterol (LDL-C) equation have been proposed. Objective: To compare the accuracy of available LDL-C equations with ultracentrifugation measurement. Methods: We used the second harvest of the Very Large Database of Lipids (VLDbL), which is a population-representative convenience s...

Objective: To evaluate preconception health and adverse pregnancy outcome (APO) awareness in a large population-based registry. Methods: We examined data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry to questions regarding prenatal health care experiences, postpartum health, and awareness of...

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...

Background The pathophysiology of peripartum cardiomyopathy (PPCM) and its defining features when compared to other forms of cardiomyopathy remain unclear, thus limiting the development of targeted therapies. Methods To address this knowledge gap, we utilized a systems biology approach and performed high-throughput aptamer-based proteomic analysis...

The American Heart Association recently published updates to its definition of cardiovascular health (CVH) in its Presidential Advisory called Life's Essential 8. In particular, the update from Life's Simple 7 added a new component of sleep duration and refined definitions of prior components, including measurement of diet, nicotine exposure, blood...

Cardiovascular disease is the leading cause of death in women, yet differences exist among certain racial and ethnic groups. Aside from traditional risk factors, behavioral and environmental factors and social determinants of health affect cardiovascular health and risk in women. Language barriers, discrimination, acculturation, and health care acc...

Purpose of Review Obesity is a chronic disease that is becoming increasingly prevalent, and more individuals of reproductive age have obesity prior to becoming pregnant. Obesity in pregnancy is associated with short- and long-term adverse consequences for both the birthing person and their offspring which have been associated with increased long-te...

Background: Information on reproductive experiences and awareness of adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD) risk among pregnancy-capable and post-menopausal individuals has not been well described. We sought to evaluate preconception health and APO awareness in a large population-based registry. Methods: Data from the Fe...

South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often unde...

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: Adipokine levels are strongly linked to diabetes and metabolic syndrome, with higher adiponectin having protective associations and higher leptin having harmful associations. Little is known about how past changes in adipokine levels relate to current metabolic risk. Methods: Among ARIC Visit 3 (1993-1995) participants, we examined th...

Background Depression is a nontraditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods and Results We used data from 593 616 young adults (aged 18–49 years) from the 2017 to 2020 Behavioral Risk...

Pollution is a leading cause of premature morbidity and mortality and an important risk factor for cardiovascular disease. Convincing data predict increased rates of cardiovascular morbidity and mortality with current and projected pollution burden trends. Multiple classes of pollutants – including criteria air pollutants, secondhand smoke, toxic s...

Background: Mental illness among physicians is an increasingly recognized concern. Global data on mental health conditions (MHCs) among cardiologists are limited. Objectives: The purpose of this study was to investigate the global prevalence of MHCs among cardiologists and its relationships to professional life. Methods: The American College o...

Coronary artery disease (CAD) remains the leading cause of adult mortality globally. Targeting known modifiable risk factors has had substantial benefit, but there remains a need for new approaches. Improvements in invasive and noninvasive imaging techniques have enabled an increasing recognition of distinct quantitative phenotypes of coronary athe...

Cardiovascular disease is the most common cause of death worldwide, especially beyond the age of 65 years, with the vast majority of morbidity and mortality due to myocardial infarction and stroke. Vascular pathology stems from a combination of genetic risk, environmental factors, and the biologic changes associated with aging. The pathogenesis und...

Introduction: Suboptimal cardiovascular health (CVH) is associated with adverse pregnancy outcomes and long-term CV risk. Studies examining contemporary trends in CV risk factors (RF) and suboptimal CVH among US women of reproductive age are limited. Methods: We used the 2015 - 2020 Behavioral Risk Factor Surveillance System, a nationally represent...

Introduction: Adipokines have metabolic effects and laboratory studies also suggest direct effects of adipokines on the myocardium. However, there are no population-based studies examining heart failure (HF) risk with multiple adipokines in concert. Methods: We conducted a prospective analysis of ARIC Visit 2 (1990-92) participants without HF. Adip...

Introduction: Initiation of coronary artery calcium (CAC) is an important milestone associated with a marked increase in cardiovascular disease (CVD) risk. However, traditional risk factors do not perform well for CVD risk stratification among older persons. Hypothesis: Contrasting to measures of subclinical CVD, blood-based non-traditional risk fa...

Introduction: Depression is a non-traditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods: We utilized data from 593,616 young adults (18-44 years) from the 2017-2020 Behavioral Risk Factor Surve...

Background : Chronic obesity is a major risk factor for hypertension, and obesity-associated hypertension is often difficult to control. Adipokines have vascular effects, but the degree to which they mediate the association between chronic obesity and hypertension is unknown. Methods: We conducted a cross-sectional analysis of 10,842 ARIC participa...

Introduction: Adverse pregnancy outcomes (APOs) are associated with long-term cardiovascular (CV) risk. This study aimed to identify awareness of the association of APOs with CV risk among patients and to determine whether care providers assessed pregnancy history and counseled on the association of APOs with CV risk during patient visits. Methods:...

Background: Cardiac arrhythmias are associated with increased maternal morbidity. Few data exist on trends of delivery-related hospitalizations complicated by arrhythmias. Methods: We used the National Inpatient Sample database to identify delivery hospitalizations for women ages 18-49 years between 2009 to 2019 and coding data from the 9 th and 10...

Introduction: Maternal shock is an important contributor to severe maternal morbidity and mortality. Although there is some data on hypovolemic shock in pregnancy, the literature on maternal shock is remarkably limited. Methods: Data from the National Inpatient Sample with delivery hospitalizations from 2009 to 2019 were used for the data extractio...

Introduction: Postpartum depression (PPD) affects 1 in 5 women in the United States and is associated with cardiovascular disease. Disparities in PPD screening have not been well studied. We investigated the level of self-reported screening, diagnosis of PPD, and disparities in screening. Methods: We utilized data from participants enrolled in the...

Introduction: Individuals with similar weights have substantial heterogeneity in metabolic risk, a key indicator of cardiovascular disease risk. Additionally, many persons progress from metabolically healthy to metabolically unhealthy status, or regress in metabolic risk, over time. The association of adipokines with transitions in metabolic risk s...

Background Cardiac arrhythmias are associated with increased maternal morbidity. There are limited data on trends of arrhythmias among women hospitalized for delivery. Materials and methods We used the National Inpatient Sample (NIS) database to identify delivery hospitalizations for individuals aged 18–49 years between 2009 to 2019 and utilized c...

Background: Work-related stress is a psychosocial risk factor linked to a higher risk of adverse health outcomes, especially cardiovascular disease (CVD). However, the association between work-related stress and ideal cardiovascular health (CVH) is not well established. We examined whether work-related stress was negatively associated with favorabl...

Aim: Some observational studies have observed a lower, rather than higher, mortality rate in association with hypercholesterolemia during follow-up of patients after cardiac stress testing. We aim to assess the relationship of hypercholesterolemia and other CAD risk factors to mortality across a wide spectrum of patients referred for various cardi...

Gender and regional differences in paid parental leave among cardiologists worldwide has not been documented. We investigated differences in paid parental leave policies globally. There are significant regional differences in parental leave among cardiologists, with North America having the shortest duration for both men and women, and highest diss...

Determining optimal candidates for the numerous potential pharmacotherapies for primary prevention of atherosclerotic cardiovascular disease remains challenging. Selective use of coronary artery calcium (CAC) scoring is recommended by the 2018 and 2019 American Heart Association/American College of Cardiology Cholesterol and Primary Prevention Guid...

Climate change is a worsening global crisis that will continue negatively impacting population health and well-being unless adaptation and mitigation interventions are rapidly implemented. Climate change-related cardiovascular disease is mediated by air pollution, increased ambient temperatures, vector-borne disease and mental health disorders. Cli...

Commercial motor vehicle (CMV) drivers have an increased risk for cardiometabolic risk factors and higher rates of cardiovascular disease relative to the general population. Lifestyle factors, including the sedentary nature of driving and lack of access to healthy foods, contribute to the disproportionately high cardiovascular disease (CVD) risk am...

The prognostic value of traditional atherosclerotic cardiovascular disease (ASCVD) risk factors may decrease with age. We sought to determine whether the association between traditional ASCVD risk factors and incident coronary artery calcium (CAC) differs for younger versus older persons. We included 5,108 participants with baseline CAC = 0. Repeat...

Background Polygenic risk scores (PRS) are associated with atherosclerotic cardiovascular disease (ASCVD) events. We studied incident ASCVD among individuals with absent coronary artery calcium (CAC = 0), to investigate the association of PRS with incident ASCVD among such individuals. Methods Data was used from Multi-Ethnic Study of Atheroscleros...

Introduction The United States Preventive Services Taskforce (USPSTF) recently released recommendations for statin therapy eligibility for the primary prevention of cardiovascular disease (CVD). We report the proportion and the absolute number of US adults who would be eligible for statin therapy under these recommendations and compare them with th...

Machine learning (ML) refers to computational algorithms that iteratively improve their ability to recognize patterns in data. The digitization of our healthcare infrastructure is generating an abundance of data from electronic health records, imaging, wearables, and sensors that can be analyzed by ML algorithms to generate personalized risk assess...

Background Diabetes exerts adverse effects on the heart, and a longer diabetes duration is associated with greater heart failure risk. We studied diabetes duration and subclinical myocardial injury, as reflected by high-sensitivity cardiac troponin (hs-cTnT). Methods We analyzed 9052 participants without heart failure or coronary heart disease (me...

Background: More than 80% of adult patients diagnosed with cancer survive long term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies using adjudicated cancer and CVD events are lacking. Objectives: The aim of this study was to assess the risk of CVD in cancer surv...

Pregnant women with gestational hypertension and/or preeclampsia, have derangements of atherogenic lipids in early pregnancy. Changes in maternal lipids can promote atherogenesis through endothelial injury. These alterations in serum lipid levels have been linked to adverse pregnancy outcomes and maternal morbidity and mortality. Several recent stu...

Purpose of Review Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk...

Absolute coronary artery calcium (CAC) scores and CAC percentiles can identify different patient groups, which could be confusing in clinical practice. We aimed to create a simple “rule of thumb” for identifying the American College of Cardiology/American Heart Association endorsed 75th CAC percentile based on age, gender, and the absolute CAC scor...

Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307—PDM; 582—GDM; 3230—non-PDM/GDM) in the Boston Birth Cohort (1998–2016). Women in...

Background Lipoprotein(a) (Lp(a)) is a potent causal risk factor for cardiovascular events and mortality. However, its relationship with subclinical atherosclerosis, as defined by arterial calcification, remains unclear. This study uses the ARIC (Atherosclerosis Risk in Communities Study) to evaluate the relationship between Lp(a) in middle age and...

Background and Aims: We aimed to determine the utility of coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk stratification in women with and without early menopause (EM). Methods: To examine the association between CAC and incident ASCVD, we performed Kaplan-Meier survival analysis and multivariable Cox proportio...

Background and aims: High-dose eicosapentaenoic acid (EPA) therapy was beneficial in high-risk patients without clinical cardiovascular disease (CVD). Whether higher plasma levels of EPA and docosahexaenoic acid (DHA) have similar benefits in those without subclinical CVD is unclear. We aim to evaluate the interplay between plasma omega-3 fatty ac...

A core principle of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline is the importance of preventive therapies among patients with nonobstructive or obstructive coronary artery disease (CAD). Accordingly, this editorial provides unique insights that emphasize the role of preventive cardiology throughout the new guideline. For the firs...

Purpose of review Cardiac rehabilitation (CR) is a comprehensive outpatient program that reduces the risk of mortality and recurrent events and improves functional status and quality of life for patients recovering from acute cardiovascular disease (CVD) events. Among individuals with established CVD, African Americans have a higher risk of major c...

Background Laboratory data suggest obesity is linked to myocardial inflammation and fibrosis, but clinical data are limited. We aimed to examine the association of obesity with galectin‐3, a biomarker of cardiac inflammation and fibrosis, and the related implications for heart failure (HF) risk. Methods and Results We evaluated 8687 participants (...

Coronary artery calcium (CAC) is a specific marker of coronary atherosclerosis that can be used to measure calcified subclinical atherosclerotic burden. The Agatston method is the most widely used scoring algorithm for quantifying CAC and is expressed as the product of total calcium area and a quantized peak calcium density weighting factor defined...

Background Hepatocyte growth factor (HGF) is a biomarker with potential for use in the diagnosis, treatment and prognostication of cardiovascular disease (CVD). Elevated HGF is associated with calcification in the coronary arteries. However, knowledge is limited on the role HGF may play in extracoronary calcification (ECC). This study examined whet...

Purpose of Review We discuss current controversies in the clinical use of omega-3 fatty acids (FA), primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and examine discrepancies between recent trials. Furthermore, we discuss potential side effects reported in these studies and the role of mixed omega-3 FA dietary supplements and c...

Background Aspirin is widely administered to prevent cardiovascular disease (CVD). However, appropriate use of aspirin depends on patient understanding of its risks, benefits, and indications, especially where aspirin is available over the counter (OTC). Methods and Results We did a survey of patient‐reported 10‐year cardiovascular risk; aspirin t...

Introduction Having a preterm birth is associated with future cardiovascular risk. Non-Hispanic Black women have higher rates of preterm birth than non-Hispanic White and Hispanic women, but nativity-related disparities in preterm birth are not well understood. Methods Data from 6,096 women in the Boston Birth Cohort: non-Hispanic Black (2,699), n...

Background Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. Objectives This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. Methods Plas...

Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary...

Background Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease. Extracoronary calcification (ECC)—measured at the aortic valve, mitral annulus, ascending thoracic aorta, and descending thoracic aorta—is an indicator of systemic atherosclerosis. This study examined whether favorable CVH was associated wit...