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Find video protocols related to scientific articles indexed in Pubmed.
Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.
J Am Heart Assoc
PUBLISHED: 10-04-2014
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Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry.
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Long-Term Blood Pressure Variability Throughout Young Adulthood and Cognitive Function in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.
Hypertension
PUBLISHED: 08-25-2014
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Whether long-term blood pressure (BP) variability throughout young adulthood is associated with cognitive function in midlife remains uncertain. Using data from the Coronary Artery Risk Development in Young Adults (CARDIA), which recruited healthy young adults aged 18 to 30 years (mean age, 25 years) at baseline (Y0), we assessed BP variability by SD and average real variability (ARV) for 25 years (8 visits). Cognitive function was assessed with the Digit Symbol Substitution Test (psychomotor speed test), the Rey Auditory Verbal Learning Test (verbal memory test), and the modified Stroop test (executive function test) at follow-up (Y25). At the Y25 examination, participants (n=2326) had a mean age of 50.4 years, 43% were men, and 40% were black. In multivariable-adjusted linear regression models, higher ARVSBP, ARVDBP, and SDDBP were significantly associated with lower scores of Digit Symbol Substitution Test (? [SE]: -0.025 [0.006], -0.029 [0.007], and -0.029 [0.007], respectively; all P<0.001) and Rey Auditory Verbal Learning Test (? [SE]: -0.016 [0.006], -0.021 [0.007], and -0.019 [0.007], respectively; all P<0.05) after adjustment for demographic and clinical characteristics and with cumulative exposure to BP through Y0 to Y25. Neither SDBP nor ARVBP was associated with the Stroop score. The associations between ARVBP or SDBP and each cognitive function test were similar between blacks and whites except for 1 significant interaction between race and SDSBP on the Digit Symbol Substitution Test (P<0.05). Long-term BP variability for 25 years beginning in young adulthood was associated with worse psychomotor speed and verbal memory tests in midlife, independent of cumulative exposure to BP during follow-up.
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Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data.
Lancet
PUBLISHED: 08-19-2014
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We aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering therapy.
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Association of the degree of adiposity and duration of obesity with measures of cardiac structure and function: The CARDIA study.
Obesity (Silver Spring)
PUBLISHED: 08-13-2014
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Examine whether there are independent influences of a greater degree of adiposity and longer duration of obesity on cardiac structure and function.
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Association of neighborhood characteristics with cardiovascular health in the multi-ethnic study of atherosclerosis.
Circ Cardiovasc Qual Outcomes
PUBLISHED: 07-10-2014
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The concept of cardiovascular health (CVH) was introduced as a global measure of one's burden of cardiovsacular risk factors. Previous studies established the relationship between neighborhood characteristics and individual cardiovascular risk factors. However, the relationship between neighborhood environment and overall CVH remains unknown.
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Electrocardiographic abnormalities and coronary artery calcium for coronary heart disease prediction and reclassification: the Multi-Ethnic Study of Atherosclerosis (MESA).
Am. Heart J.
PUBLISHED: 06-09-2014
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Electrocardiographic (ECG) abnormalities and coronary artery calcium (CAC) identify different aspects of subclinical coronary heart disease (CHD). We sought to determine whether ECG abnormalities improve risk prediction for all CHD and fatal CHD events jointly with CAC measures.
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Home-based walking exercise in peripheral artery disease: 12-month follow-up of the goals randomized trial.
J Am Heart Assoc
PUBLISHED: 05-23-2014
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We studied whether a 6-month group-mediated cognitive behavioral (GMCB) intervention for peripheral artery disease (PAD) participants, which promoted home-based walking exercise, improved 6-minute walk and other outcomes at 12-month follow-up, 6 months after completing the intervention, compared to a control group.
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The detection of coronary stiffness in cardiac allografts using MR imaging.
Eur J Radiol
PUBLISHED: 05-20-2014
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To test the hypothesis that biomechanical changes are quantitatively related to morphological features of coronary arteries in heart transplant (HTx) recipients.
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Associations between nonalcoholic fatty liver disease and subclinical atherosclerosis in middle-aged adults: the Coronary Artery Risk Development in Young Adults Study.
Atherosclerosis
PUBLISHED: 05-16-2014
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Non-alcoholic fatty liver disease (NAFLD) is an obesity-related condition associated with cardiovascular mortality. Yet, whether or not NAFLD is independently related to atherosclerosis is unclear. In a population-based cross-sectional sample of middle-aged adults free from liver or heart disease, we tested the hypothesis that NAFLD is associated with subclinical atherosclerosis (coronary artery (CAC) and abdominal aortic calcification (AAC)) independent of obesity.
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A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease.
J. Am. Coll. Cardiol.
PUBLISHED: 04-29-2014
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The 2013 American College of Cardiology/American Heart Association updated cholesterol guidelines recommend the use of Pooled Cohort Equations to estimate 10-year absolute risk for atherosclerotic cardiovascular disease (ASCVD) in primary prevention.
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Clinical characteristics and outcomes associated with the natural history of early repolarization in a young, biracial cohort followed to middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study.
Circ Arrhythm Electrophysiol
PUBLISHED: 04-23-2014
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Early repolarization (ER), a common electrocardiographic phenotype, has been associated with increased mortality risk in middle-aged adults. Data are sparse on long-term follow-up and outcomes associated with ER in younger adults.
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Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations.
JAMA
PUBLISHED: 04-01-2014
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The American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort risk equations were developed to estimate atherosclerotic cardiovascular disease (CVD) risk and guide statin initiation.
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Vulnerable blood in high risk vascular patients: study design and methods.
Contemp Clin Trials
PUBLISHED: 03-25-2014
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Basic research suggests that rapid increases in circulating inflammatory and hemostatic blood markers may trigger or indicate impending plaque rupture and coronary thrombosis, resulting in acute ischemic heart disease (IHD) events. However, these associations are not established in humans.
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Coronary heart disease risks associated with high levels of HDL cholesterol.
J Am Heart Assoc
PUBLISHED: 03-15-2014
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The association between high-density lipoprotein cholesterol (HDL-C) and coronary heart disease (CHD) events is not well described in individuals with very high levels of HDL-C (>80 mg/dL).
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High early cardiovascular mortality after liver transplantation.
Liver Transpl.
PUBLISHED: 03-10-2014
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Cardiovascular disease (CVD) contributes to excessive long-term mortality after liver transplantation (LT); however, little is known about early postoperative CVD mortality in the current era. In addition, there is no model for predicting early postoperative CVD mortality across centers. We analyzed adult recipients of primary LT in the Organ Procurement and Transplantation Network (OPTN) database between February 2002 and December 2012 to assess the prevalence and predictors of early (30-day) CVD mortality, which was defined as death from arrhythmia, heart failure, myocardial infarction, cardiac arrest, thromboembolism, and/or stroke. We performed logistic regression with stepwise selection to develop a predictive model of early CVD mortality. Sex and center volume were forced into the final model, which was validated with bootstrapping techniques. Among 54,697 LT recipients, there were 1576 deaths (2.9%) within 30 days. CVD death was the leading cause of 30-day mortality (40.2%), and it was followed by infection (27.9%) and graft failure (12.2%). In a multivariate analysis, 9 significant covariates (6 recipient covariates, 2 donor covariates, and 1 operative covariate) were identified: age, preoperative hospitalization, intensive care unit status, ventilator status, calculated Model for End-Stage Liver Disease score, portal vein thrombosis, national organ sharing, donor body mass index, and cold ischemia time. The model showed moderate discrimination (C statistic?=?0.66, 95% confidence interval?=?0.63-0.68). In conclusion, we provide the first multicenter prognostic model for the prediction of early post-LT CVD death, the most common cause of early post-LT mortality in the current transplant era. However, evaluations of additional CVD-related variables not collected by the OPTN are needed in order to improve the model's accuracy and potential clinical utility. Liver Transpl 20:1306-1316, 2014. © 2014 AASLD.
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Race and socioeconomic differences in obesity and depression among Black and non-Hispanic White Americans.
J Health Care Poor Underserved
PUBLISHED: 02-11-2014
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Obesity and depression often co-occur; however, the association between these conditions is poorly understood, especially among racial/ethnic minority groups. Using multinomial logistic regression and data from the National Survey of American Life, the relationships between race, ethnicity, and sociodemographic factors to the joint classification of body mass index categories and depression among African Americans, Caribbean Blacks, and non-Hispanic Whites were examined. Differential risk for the combination of obesity and depression by sociodemographic status was found. Being African American, female, young, married, or having low income or education increases the risk for obesity without depression. Risk factors for obesity with depression include being female, young, married and having a low income. Race was not a significant predictor of obesity with depression relative to normal weight without depression status. However, racial differences were observed among the non-depressed. Non-depressed African Americans were more likely than non-depressed Whites or Caribbean Blacks to be obese.
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Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age.
JAMA
PUBLISHED: 02-06-2014
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Single measures of blood pressure (BP) levels are associated with the development of atherosclerosis; however, long-term patterns in BP and their effect on cardiovascular disease risk are poorly characterized.
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Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline.
Ann. Intern. Med.
PUBLISHED: 01-30-2014
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In November 2013, the American College of Cardiology and American Heart Association (ACC/AHA) released a clinical practice guideline on the treatment of blood cholesterol to reduce cardiovascular risk in adults. This synopsis summarizes the major recommendations.
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T1 contrast in the myocardium and blood pool: a quantitative assessment of gadopentetate dimeglumine and gadofosveset trisodium at 1.5 and 3 T.
Invest Radiol
PUBLISHED: 01-30-2014
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The objective of this study was to assess the evolution of T1 contrast (T1c) between cardiovascular tissues, contrast agents, and magnetic field strengths.
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Strategies for treating lipids for prevention: risk stratification models with and without imaging.
Best Pract. Res. Clin. Endocrinol. Metab.
PUBLISHED: 01-18-2014
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Cardiovascular disease (CVD) remains the leading cause of mortality both in the United States and worldwide. Traditional risk factors are essential to CVD risk prediction and explain a significant portion of the between-population and between-individual variance in CVD. Nonetheless, due to the large size of the group, a substantial portion of cardiovascular events occur in individuals predicted to be at low risk based on traditional risk factor models such as the Framingham risk score. The problem is that by disregarding this low risk group, a significant proportion of events are ignored and deemed 'unpreventable'. As such, it is imperative to find new ways to improve CVD risk prediction and thereby apply preventive measures to persons more likely to develop 'preventable' disease. Focus has consequently shifted towards identification of novel markers to improve cardiovascular risk prediction. We review the role of various risk stratification models, and assess the incorporation of imaging markers to guide treatment for lipids in prevention of CVD.
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Perceived lifetime risk for cardiovascular disease (from the Dallas Heart Study).
Am. J. Cardiol.
PUBLISHED: 01-16-2014
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Lifetime risk estimation for cardiovascular disease (CVD) has been proposed as a useful strategy to improve risk communication in the primary prevention setting. However, the perception of lifetime risk for CVD is unknown. We included 2,998 subjects from the Dallas Heart Study. Lifetime risk for developing CVD was classified as high (?39%) versus low (<39%) according to risk factor burden as described in our previously published algorithm. Perception of lifetime risk for myocardial infarction was assessed by way of a 5-point scale. Baseline characteristics were compared across levels of perceived lifetime risk. Multivariable logistic regression analyses were performed to determine the association of participant characteristics with level of perceived lifetime risk for CVD and with correctness of perceptions. Of the 2,998 participants, 64.8% (n = 1,942) were classified as having high predicted lifetime risk for CVD. There was significant discordance between perceived and predicted lifetime risk. After multivariable adjustment, family history of premature myocardial infarction, high self-reported stress, and low perceived health were all strongly associated with high perceived lifetime risk (odds ratio [OR] 2.37, 95% confidence interval [CI] 1.72 to 3.27; OR 2.17, 95% CI 1.66 to 2.83; and OR 2.71, 95% CI 2.09 to 3.53; respectively). However, the association between traditional CVD risk factors and high perceived lifetime risk was more modest. In conclusion, misperception of lifetime risk for CVD is common and frequently reflects the influence of factors other than traditional risk factor levels. These findings highlight the importance of effectively communicating the significance of traditional risk factors in determining the lifetime risk for CVD.
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The compensation for asynchronous cardiac quiescence in coronary wall MR imaging.
Int J Cardiovasc Imaging
PUBLISHED: 08-27-2013
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The aim of the present study was to assess the incremental benefit of compensating asynchronous cardiac quiescence in coronary wall MR imaging. With the approval of IRB, black-blood coronary wall MR imaging was performed on 30 older subjects (90 coronary wall segments). For round 1 coronary wall MR imaging, acquisition windows were traditionally set within rest period4-chamber. Totally 51 of 90 images were ranked as "good" images and resulted in an interpretability rate of 57 %. Then, an additional cine-MR was centered at coronary segments to obtain rest periodcross-sectional. The rest periodoverlap (the intersection between rest period4-chamber and rest periodcross-sectional) was measured for each coronary segment. The "good" images had a longer rest periodoverlap and higher acquisition coincidence rate (the percentage of acquisition window covered by the rest periodoverlap) than "poor" images. Coronary wall rescans (round 2) were completed at 39 coronary segments that were judged as having "poor" images in round 1 scans. The acquisition window was set within the rest periodoverlap. For the round 2 images, 17 of 39 (44 %) coronary segments were ranked as "good" images. The overall interpretability rate (68 of 90, 76 %) was significantly higher than that of the round 1 images alone. Our data demonstrated that asynchronous cardiac quiescence adversely affects the performance of coronary wall MR imaging. Individualizing acquisition windows based on multi-plane cine-MR helps to compensate for this motion discrepancy and to improve image quality.
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Associations of Dietary Fiber Intake With Long-Term Predicted Cardiovascular Disease Risk and C-Reactive Protein Levels (from the National Health and Nutrition Examination Survey Data [2005-2010]).
Am. J. Cardiol.
PUBLISHED: 07-11-2013
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Dietary fiber intake might reduce cardiovascular risk factor levels and, in turn, might lower the long-term risk of cardiovascular disease (CVD). A total of 11,113 subjects, aged 20 to 79 years with no history of CVD, from the 2005 to 2010 National Health and Nutrition Examination Survey were included in the present study to examine associations of dietary fiber intake with predicted lifetime CVD risk and C-reactive protein levels. Dietary fiber intake showed a significant gradient association with the likelihood of having a low or an intermediate predicted lifetime CVD risk among young and middle-age adults. In fully adjusted multinomial logistic models, dietary fiber intake was related to a low lifetime CVD risk with an odds ratio of 2.71 (95% confidence interval 2.05 to 3.59) in the young adults and 2.13 (95% confidence interval 1.42 to 3.20) in the middle-age adults and was related to an intermediate lifetime risk of 2.65 (95% confidence interval 1.79 to 3.92) in the young and 1.98 (95% confidence interval 1.32 to 2.98) in the middle-age adults compared with a high lifetime risk. A significant inverse linear association was seen between dietary fiber intake and log-transformed C-reactive protein levels with a regression coefficient ± standard error of -0.18 ± 0.04 in the highest quartile of fiber intake compared with the lowest fiber intake. In conclusion, these data suggest that dietary fiber intake is independently associated with the predicted lifetime CVD risk, especially in young and middle-age adults. A greater amount of dietary fiber intake might be associated with lower C-reactive protein levels.
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Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial.
JAMA
PUBLISHED: 07-04-2013
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Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program.
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Progenitor cell release plus exercise to improve functional performance in peripheral artery disease: The PROPEL Study.
Contemp Clin Trials
PUBLISHED: 06-28-2013
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Functional impairment, functional decline, and mobility loss are major public health problems in people with lower extremity peripheral artery disease (PAD). Few medical therapies significantly improve walking performance in PAD. We describe methods for the PROgenitor cell release Plus Exercise to improve functionaL performance in PAD (PROPEL) Study, a randomized controlled clinical trial designed to determine whether granulocyte-macrophage colony stimulating factor (GM-CSF) combined with supervised treadmill walking exercise improves six-minute walk distance more than GM-CSF alone, more than supervised treadmill exercise alone, and more than placebo plus attention control in participants with PAD, respectively. PROPEL Study participants are randomized to one of four arms in a 2 by 2 factorial design. The four study arms are GM-CSF plus supervised treadmill exercise, GM-CSF plus attention control, placebo plus supervised exercise therapy, or placebo plus attention control. The primary outcome is change in six-minute walk distance at 12-week follow-up. Secondary outcomes include change in brachial artery flow-mediated dilation (FMD), change in maximal treadmill walking time, and change in circulating CD34+ cells at 12-week follow-up. Outcomes are also measured at six-week and six-month follow-up. Results of the PROPEL Study will have important implications for understanding mechanisms of improving walking performance and preventing mobility loss in the large and growing number of men and women with PAD.
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Major and minor electrocardiographic abnormalities and their association with underlying cardiovascular disease and risk factors in Hispanics/Latinos (from the Hispanic Community Health Study/Study of Latinos).
Am. J. Cardiol.
PUBLISHED: 06-10-2013
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The association of electrocardiographic (ECG) abnormalities with cardiovascular disease and risk factors has been extensively studied in whites and African-Americans. Comparable data have not been reported in Hispanics/Latinos. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multicenter, community-based, prospective cohort study of men and women of diverse backgrounds aged 18 to 74 years who self-identified as Hispanic/Latinos. Participants (n = 16,415) enrolled from March 2008 to June 2011. We describe the prevalence of minor and major ECG abnormalities and examined their cross-sectional associations with cardiovascular disease and risk factors. The Minnesota code criteria were used to define minor and major ECG abnormalities. Previous cardiovascular disease and risk factors were based on data obtained at baseline examination. Significant differences in prevalent ECG findings were found between men and women. Major ECG abnormalities were present in 9.2% (95% confidence interval 8.3 to 10.1) of men and 6.6% (95% confidence interval 5.8 to 7.3) of women (p <0.0001). The odds of having major ECG abnormalities significantly increased with age, presence of ?3 cardiovascular risk factors, and prevalent cardiovascular disease, in both men and women. Significant differences in major ECG abnormalities were found among the varying groups; Puerto Ricans and Dominicans had more major abnormalities compared with Mexican men and women. In conclusion, in a large cohort of Hispanic/Latino men and women, prevalence of major abnormalities was low, yet strong associations of major ECG abnormalities with cardiovascular disease and risk factors were observed in both men and women.
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Impact of inflammatory biomarkers on relation of high density lipoprotein-cholesterol with incident coronary heart disease: Cardiovascular Health Study.
Atherosclerosis
PUBLISHED: 05-28-2013
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Inflammatory factors and low HDL-C relate to CHD risk, but whether inflammation attenuates any protective association of high HDL-C is unknown.
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Prognostic Value of Frontal QRS-T Angle in Patients Without Clinical Evidence of Cardiovascular Disease (from the Multi-Ethnic Study of Atherosclerosis).
Am. J. Cardiol.
PUBLISHED: 05-14-2013
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Abnormal frontal QRS-T angle on a 12-lead electrocardiogram is associated with incident coronary heart disease and total mortality in a biracial cohort, but there have been no studies to date examining QRS-T angles prognostic value across multiple ethnicities. We studied 6,814 participants (52.7% women, mean age 62 years) from Multi-Ethnic Study of Atherosclerosis, a multiethnic cohort aged 45 to 84 years free of clinical cardiovascular disease (CVD) at enrollment. Baseline examination included measurement of traditional risk factors and 12-lead electrocardiograms. Frontal QRS-T axis was defined as normal (less than seventy-fifth percentile), borderline (seventy-fifth to ninety-fifth percentile), or abnormal (ninety-fifth percentile or more), and participants were followed for the composite end point of incident CVD events: cardiovascular death, myocardial infarction, angina pectoris, or heart failure. After 7.6 years of follow-up, there were 444 total events. Borderline (HR [hazard ratio] 1.37, 95% confidence interval [CI] 1.10 to 1.70) and abnormal QRS-T angles (HR 2.2, 95% CI 1.63 to 2.97) were associated with incident CVD events in multivariate-adjusted models. However, after adjusting for T-wave abnormalities, there was no statistically significant association of either borderline (HR 1.12, 95% CI 0.90 to 1.41) or abnormal (HR 1.31, 95% CI 0.93 to 1.84) QRS-T angle with incident CVD events. Abnormal frontal QRS-T angle predicts incident CVD events in a multiethnic population, and this increased risk is primarily mediated through T-wave abnormalities. QRS-T angle provides an easily interpretable continuous marker of abnormal ventricular repolarization that can aid the everyday clinician in risk prediction.
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Chicago Healthy Aging Study: objectives and design.
Am. J. Epidemiol.
PUBLISHED: 05-12-2013
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Investigators in the Chicago Healthy Aging Study (CHAS) reexamined 1,395 surviving participants aged 65-84 years (28% women) from the Chicago Heart Association Detection Project in Industry (CHA) 1967-1973 cohort whose cardiovascular disease (CVD) risk profiles were originally ascertained at ages 25-44 years. CHAS investigators reexamined 421 participants who were low-risk (LR) at baseline and 974 participants who were non-LR at baseline. LR was defined as having favorable levels of 4 major CVD risk factors: serum total cholesterol level <200 mg/dL and no use of cholesterol-lowering medication; blood pressure 120/?80 mm Hg and no use of antihypertensive medication; no current smoking; and no history of diabetes or heart attack. While the potential of LR status in overcoming the CVD epidemic is being recognized, the long-term association of LR with objectively measured health in older age has not been examined. It is hypothesized that persons who were LR in 1967-1973 and have survived to older age will have less clinical and subclinical CVD, lower levels of inflammatory markers, and better physical performance/functioning and sleep quality. Here we describe the rationale, objectives, design, and implementation of this longitudinal epidemiologic study, compare baseline and follow-up characteristics of participants and nonparticipants, and highlight the feasibility of reexamining study participants after an extended period postbaseline with minimal interim contact.
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Quantitative imaging biomarkers for the evaluation of cardiovascular complications in type 2 diabetes mellitus.
J. Diabetes Complicat.
PUBLISHED: 05-09-2013
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Type 2 diabetes mellitus (T2DM) is a prevalent condition in aged populations. Cardiovascular diseases are leading causes of death and disability in patients with T2DM. Traditional strategies for controlling the cardiovascular complications of diabetes primarily target a cluster of well-defined risk factors, such as hyperglycemia, lipid disorders and hypertension. However, there is controversy over some recent clinical trials aimed at evaluating efficacy of intensive treatments for T2DM. As a powerful tool for quantitative cardiovascular risk estimation, multi-disciplinary cardiovascular imaging have been applied to detect and quantify morphological and functional abnormalities in the cardiovascular system. Quantitative imaging biomarkers acquired with advanced imaging procedures are expected to provide new insights to stratify absolute cardiovascular risks and reduce the overall costs of health care for people with T2DM by facilitating the selection of optimal therapies. This review discusses principles of state-of-the-art cardiovascular imaging techniques and compares applications of those techniques in various clinical circumstances. Individuals measurements of cardiovascular disease burdens from multiple aspects, which are closely related to existing biomarkers and clinical outcomes, are recommended as promising candidates for quantitative imaging biomarkers to assess the responses of the cardiovascular system during diabetic regimens.
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Quantifying options for reducing coronary heart disease mortality by 2020.
Circulation
PUBLISHED: 05-09-2013
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The American Heart Association (AHA) 2020 Strategic Impact Goal proposes a 20% improvement in cardiovascular health of all Americans. We aimed to estimate the potential reduction in coronary heart disease (CHD) deaths.
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Trends in vascular risk factor treatment and control in US stroke survivors: the National Health and Nutrition Examination Surveys (1999-2010).
Circ Cardiovasc Qual Outcomes
PUBLISHED: 05-07-2013
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Treatment and control of vascular risk factors reduce the likelihood of recurrent stroke. Present nationally representative data are sparse regarding secondary prevention treatment and control rates.
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Cardiomyocyte injury assessed by a highly sensitive troponin assay and sudden cardiac death in the community: the cardiovascular health study.
J. Am. Coll. Cardiol.
PUBLISHED: 04-24-2013
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This study sought to determine the association between markers of cardiomyocyte injury in ambulatory subjects and sudden cardiac death (SCD).
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Minor isolated Q waves and cardiovascular events in the MESA study.
Am. J. Med.
PUBLISHED: 04-16-2013
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The significance of minor isolated Q waves in the resting electrocardiograms (ECGs) of apparently healthy individuals is unknown.
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Insulin resistance and risk of incident heart failure: Cardiovascular Health Study.
Circ Heart Fail
PUBLISHED: 04-10-2013
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Patients with heart failure (HF) have higher fasting insulin levels and a higher prevalence of insulin resistance as compared with matched controls. Insulin resistance leads to structural abnormalities in the heart, such as increased left atrial size, left ventricular mass, and alterations in transmitral velocity that can precede the diagnosis of HF. It is not known whether insulin resistance precedes the development of HF or whether the relationship between insulin resistance and HF is present among adults with HF caused by nonischemic heart disease.
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Inflammation and sudden cardiac death in a community-based population of older adults: the Cardiovascular Health Study.
Heart Rhythm
PUBLISHED: 04-04-2013
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Inflammation is linked to adverse cardiovascular events, but its association with sudden cardiac death (SCD) has been controversial. Older subjects, who are at particular risk for SCD, were underrepresented in previous studies addressing this issue.
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Status of cardiovascular health in US adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005-2010.
Circulation
PUBLISHED: 04-01-2013
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The American Heart Association recently developed definitions and metrics for monitoring the spectrum of cardiovascular health in adolescents and children. Current nationally representative prevalence estimates according to sex and race/ethnicity are unavailable.
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Reference ranges of PR duration and P-wave indices in individuals free of cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA).
J Electrocardiol
PUBLISHED: 02-27-2013
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In this brief report, we provide normal reference ranges for PR duration [unadjusted and heart rate adjusted] and P-wave indices [duration, amplitude and terminal force in V1] in individuals free of cardiovascular disease and its risk factors. We used automatically processed digital ECG data from 1252 US participants [mean age 59 (± 10) years, 738 women, 588 whites, 207 African-Americans, 217 Hispanics, 240 Chinese] from the Multi-Ethnic Study of Atherosclerosis [MESA]. In multivariable adjusted linear regression models with PR and each P-wave variable as a separate outcome, significant age, sex and race differences in these markers were observed. Subsequently, we report reference ranges for abnormal [2nd and 98th percentiles], borderline abnormal [5th and 95th percentiles] and mean [SD] values of PR and P-wave indices stratified by age [middle age (45-64 years) and seniors (65-84 years)], sex [men and women] and race [whites, African Americans, Hispanics and Chinese].
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Cardiovascular health through young adulthood and cognitive functioning in midlife.
Ann. Neurol.
PUBLISHED: 02-26-2013
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A study was undertaken to examine the association between overall cardiovascular health as recently defined by the American Heart Association in young adulthood to middle age and cognitive function in midlife. Overall ideal cardiovascular health incorporates 7 metrics, including the avoidance of overweight or obesity, a healthful diet, nonsmoking, and physical activity, total cholesterol, blood pressure, and fasting glucose at goal levels.
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Natural history of the early repolarization pattern in a biracial cohort: CARDIA (Coronary Artery Risk Development in Young Adults) Study.
J. Am. Coll. Cardiol.
PUBLISHED: 02-23-2013
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The objective of this analysis was to determine the natural history and prospective association of cardiovascular risk factors with early repolarization (ER).
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Competing cardiovascular outcomes associated with subclinical atherosclerosis (from the Multi-Ethnic Study of Atherosclerosis).
Am. J. Cardiol.
PUBLISHED: 02-03-2013
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Subclinical atherosclerosis measured by coronary artery calcium (CAC) is associated with increased risk for multiple cardiovascular disease (CVD) outcomes and non-CVD death simultaneously. The aim of this study was to determine the competing risks of specific CVD events and non-CVD death associated with varying burdens of subclinical atherosclerosis. A total of 3,095 men and 3,486 women from the Multi-Ethnic Study of Atherosclerosis (MESA), aged 45 to 84 years, from 4 ethnic groups were included. Participants were stratified by CAC score (0, 1 to 99, and ?100). Competing Cox models were used to determine competing cumulative incidences and hazard ratios within a group (e.g., those with CAC scores ?100) and hazard ratios for specific events between groups (e.g., CAC score ?100 vs 0). Risks were compared for specific CVD events and also against non-CVD death. In women, during a mean follow-up period of 7.1 years, the hazard ratios for any CVD event compared with a non-CVD death occurring first for CAC score 0 and CAC score ?100 were 1.40 (95% confidence interval 0.97 to 2.04) and 3.07 (95% confidence interval 2.02 to 4.67), respectively. Coronary heart disease was the most common first CVD event type at all levels of CAC, and coronary heart disease rates were 9.5% versus 1.6% (hazard ratio 6.24, 95% confidence interval 3.99 to 9.75) for women with CAC scores ?100 compared with CAC scores of 0. Similar results were observed in men. In conclusion, at all levels of CAC, coronary heart disease was the most common first CVD event, and this analysis represents a novel approach to understanding the temporal sequence of cardiovascular events associated with atherosclerosis.
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White blood cell count in young adulthood and coronary artery calcification in early middle age: coronary artery risk development in young adults (CARDIA) study.
Eur. J. Epidemiol.
PUBLISHED: 01-28-2013
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White blood cell (WBC) count is associated with incident coronary heart disease (CHD). Data are sparse regarding its association in young adults with future coronary artery calcification (CAC). Our study was conducted among coronary artery risk development in young adults (CARDIA) participants (n=3,094). We examined the association between baseline (Y0) WBC counts and CHD risk factors using linear regression models. We further assessed prospective associations between Y0 WBC and inflammatory biomarkers during the follow-up, and the presence of CAC 15 and 20 years later. In total, 272 and 566 subjects had CAC scores>0 at year (Y) 15 and Y20, respectively. Baseline total WBC counts were cross-sectionally associated with SBP, BMI, and smoking, or HDL-cholesterol (p?0.01) at Y0, and prospectively associated with C-reactive protein at Y7, Y15, and Y20, and fibrinogen at Y5 and Y20 (p<0.01). After adjustment for potential confounding factors, baseline neutrophil count was borderline associated with CAC presence 15 years later (OR=1.18 per unit, 95% CI 1.00-1.44) and total WBC (OR=1.07, 95% CI 0.96-1.19) or eosinophil (OR=1.12, 95%CI 1.00-1.25) was borderline associated with CAC presence at Y20. Baseline total WBC counts in young adults was associated prospectively with CAC presence 20 years later after adjusting for age, sex, and race. Results are attenuated when other risk factors are accounted for. Our results suggest the possible early involvement of WBC, particularly eosinophils, in the early stages of atherosclerosis.
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Effects of respiratory motion on coronary wall MR imaging: a quantitative study of older adults.
Int J Cardiovasc Imaging
PUBLISHED: 01-25-2013
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The aim of the present study is to assess the effects of respiratory motion on the image quality of two-dimensional (2D), free-breathing, black-blood coronary wall magnetic resonance (MR) imaging. This study was compliance with the HIPPA. With the approval of the institution review board, 230 asymptomatic participants, including 164 male patients (72.9 ± 4.4 years) and 66 female patients (72.4 ± 5.1 years), were recruited. Written informed consent was obtained. A 2D navigator (NAV)-gated, black-blood coronary wall MR imaging sequence was run on the left main artery, the left anterior descending artery and the right coronary artery. The drift of the location of the NAV and scan efficiency were compared between good (scored 2 or 3) and poor images (scored 1). Age, body weight, body weight index, heart rate, length of the rest period of cardiac motion, diaphragm excursion and breathing frequency were compared using a t test between the "successful" (having 2 or 3 good images) and "unsuccessful" cases (having 1 or 0 good images). A logistic regression model was applied to identify the contributors to good image quality. The drift of the NAV location and the scan efficiency were higher in the 411 good images compared with the 279 poor images. Minimal drift of the NAV location and low body weight were identified as independent predictors of good images after using a logistic regression model to adjust for multiple physiological and technical factors. The stability of respiratory motion significantly influences the image quality of 2D, free-breathing, black-blood coronary wall MR imaging.
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Lifetime risk for heart failure among white and black Americans: cardiovascular lifetime risk pooling project.
J. Am. Coll. Cardiol.
PUBLISHED: 01-08-2013
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This study sought to estimate lifetime risk for heart failure (HF) by sex and race.
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Adding a life-course perspective to cardiovascular-risk communication.
Nat Rev Cardiol
PUBLISHED: 01-08-2013
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Current practice in the primary prevention of cardiovascular disease (CVD) involves estimation of the short-term (typically 5-10-year) risk of developing CVD. This risk estimation can serve as the prelude to a conversation between physicians and patients about CVD risk and risk-reducing therapies. However, focusing solely on short-term risk directs these conversations towards individuals who, in all likelihood, have already accrued substantial atherosclerosis during their lifetime. We suggest that estimation of lifetime risk and other novel methods of risk communication, such as risk-adjusted age, should be used as an adjunct to 10-year risk estimation. We believe that these strategies will improve patient understanding of CVD risk, identify new sections of the population who might benefit from preventive therapy, and motivate lifestyle changes and adherence to therapy early in the course of disease progression.
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Impact of blood pressure and blood pressure change during middle age on the remaining lifetime risk for cardiovascular disease: the cardiovascular lifetime risk pooling project.
Circulation
PUBLISHED: 12-19-2011
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Prior estimates of lifetime risk (LTR) for cardiovascular disease (CVD) examined the impact of blood pressure (BP) at the index age and did not account for changes in BP over time. We examined how changes in BP during middle age affect LTR for CVD, coronary heart disease, and stroke.
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Coronary artery calcium testing: dos and donts.
Cardiol Clin
PUBLISHED: 12-09-2011
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Measurement of traditional risk factors remains the foundation of current clinical practice guidelines when screening for coronary heart disease (CHD) risk. However, many adults who experience CHD events are not identified as higher risk based on their traditional risk factors. Observational data show that the coronary artery calcium (CAC) score improves risk prediction, even after taking into account traditional risk factors. The authors have outlined several principles of CAC testing into a list of dos and donts to help maximize its potential benefit while minimizing potential harm.
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Competing cardiovascular outcomes associated with electrocardiographic left ventricular hypertrophy: the Atherosclerosis Risk in Communities Study.
Heart
PUBLISHED: 12-03-2011
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Individuals with electrocardiographically determined left ventricular hypertrophy (ECG LVH) are at risk of multiple cardiovascular disease (CVD) outcomes simultaneously. The study sought to characterise the competing incidences for subtypes of first CVD events or non-CVD death in those with and without ECG LVH.
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Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003-2008.
Circulation
PUBLISHED: 11-17-2011
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The American Heart Associations 2020 Strategic Impact Goals define a new concept, cardiovascular (CV) health; however, current prevalence estimates of the status of CV health in US adults according to age, sex, and race/ethnicity have not been published.
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Can we dramatically reduce the incidence of coronary heart disease?
Nat Rev Cardiol
PUBLISHED: 11-01-2011
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Thrombotic events caused by atherosclerosis are by far the most common cause of death in the world. Advances in treatment have prolonged the life of patients with atherosclerotic disease, but treating individuals with clinically manifest disease will not result in a cure, and will not prevent the majority of such events. This paper explores the possibility that early implementation of a drug-based approach to the prevention of atherosclerosis and atherothrombotic events could dramatically reduce the footprint of this disease. Specifically, we consider the potential impact on atherothrombotic events of a population-based, pharmacological approach to lowering serum LDL-cholesterol levels in asymptomatic adults aged 35-50 years. We also consider the feasibility and basic design considerations for a clinical trial to assess the validity of this public health and primary prevention approach.
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Incident obesity and cardiovascular risk factors between young adulthood and middle age by religious involvement: the Coronary Artery Risk Development in Young Adults (CARDIA) study.
Prev Med
PUBLISHED: 09-24-2011
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Religious involvement has been associated with improved health outcomes but greater obesity in older adults. No longitudinal study of young adults has examined the prospective association of religious involvement with incident cardiovascular risk factors (RFs) and subclinical disease (subCVD).
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Noninvasive evaluation of coronary distensibility in older adults: a feasibility study with MR angiography.
Radiology
PUBLISHED: 08-26-2011
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To assess the feasibility of using magnetic resonance (MR) angiography to noninvasively measure the coronary distensibility index (CDI) in older adults.
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The History and Timing of Depression Onset as Predictors of Young-Adult Self-Esteem.
J Res Adolesc
PUBLISHED: 08-24-2011
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Depression often emerges early in the lifecourse and is consistently shown to be associated with poor self-esteem. The three main objectives of the current study are to (1) evaluate the association between a history major depression and self-esteem in young adulthood; (2) assess the relationship between timing of depression onset and young adult self-esteem; and (3) help rule out the alternative interpretation that the relationship between major depression and self-esteem is due to state dependence bias stemming from recent depressive symptoms and stressful life events. To address these objectives we use data from a two-wave panel study based on a community sample of young adults in Miami-Dade County, Florida (n = 1,197). Results indicated a history of major depression during sensitive periods of social development is associated with negative changes in self-esteem over a two-year period during the transition to young adulthood. Among those with a history of depression, earlier onset was more problematic than later onset for young adult self-esteem, although the difference disappeared once the level of self-esteem two years prior was controlled. The linkages between the history and timing of depression onset with self-esteem were observed net of recent depressive symptoms and stressful life events, and thus robust to an alternative interpretation of state dependence. The findings support the argument that major depression, especially if it develops earlier during child-adolescent development, has negative consequences for ones self-esteem.
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Factors associated with development of prolonged QRS duration over 20 years in healthy young adults: the Coronary Artery Risk Development in Young Adults study.
J Electrocardiol
PUBLISHED: 08-10-2011
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Data describing factors associated with the development of a prolonged QRS duration (QRSd) from young adulthood to middle age are sparse.
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Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association.
Circulation
PUBLISHED: 07-25-2011
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The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.
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Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study.
Heart
PUBLISHED: 06-02-2011
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The exact form of the association between systolic blood pressure (SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive drugs.
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Diet quality and the risk of cardiovascular disease: the Womens Health Initiative (WHI).
Am. J. Clin. Nutr.
PUBLISHED: 05-25-2011
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The association between diet quality and risk of incident cardiovascular disease (CVD) or heart failure (HF) in postmenopausal women is uncertain.
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Fish intake and the risk of incident heart failure: the Womens Health Initiative.
Circ Heart Fail
PUBLISHED: 05-24-2011
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Whether fish or the fatty acids they contain are independently associated with risk for incident heart failure (HF) among postmenopausal women is unclear.
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The association of Framingham and Reynolds risk scores with incidence and progression of coronary artery calcification in MESA (Multi-Ethnic Study of Atherosclerosis).
J. Am. Coll. Cardiol.
PUBLISHED: 05-18-2011
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The purpose of this study was to compare the association of the Framingham risk score (FRS) and Reynolds risk score (RRS) with subclinical atherosclerosis, assessed by incidence and progression of coronary artery calcium (CAC).
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Distribution of coronary artery calcium scores by Framingham 10-year risk strata in the MESA (Multi-Ethnic Study of Atherosclerosis) potential implications for coronary risk assessment.
J. Am. Coll. Cardiol.
PUBLISHED: 04-30-2011
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By examining the distribution of coronary artery calcium (CAC) levels across Framingham risk score (FRS) strata in a large, multiethnic, community-based sample of men and women, we sought to determine if lower-risk persons could benefit from CAC screening.
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Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results).
BMJ Open
PUBLISHED: 04-29-2011
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Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date.
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Gene expression variation between African Americans and whites is associated with coronary artery calcification: the multiethnic study of atherosclerosis.
Physiol. Genomics
PUBLISHED: 04-26-2011
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Coronary artery calcium (CAC) is a strong indicator of total atherosclerosis burden. Epidemiological data have shown substantial differences in CAC prevalence and severity between African Americans and whites. However, little is known about the molecular mechanisms underlying initiation and progression of CAC. Microarray gene expression profiling of peripheral blood leucocytes was performed from 119 healthy women aged 50 yr or above in the Multi-Ethnic Study of Atherosclerosis cohort; 48 women had CAC score >100 and carotid intima-media thickness (IMT) >1 mm, while 71 had CAC <10 and IMT <0.65 mm. When 17 African Americans were compared with 41 whites in the low-CAC group, 409 differentially expressed genes (false discovery rate <5%) were identified. In addition, 316 differentially expressed genes were identified between the high- and low-CAC groups. A substantial overlap between these two gene lists was observed (148 genes, P < 10(-6)). Furthermore, genes expressed lower in African Americans also tend to express lower in individuals with low CAC (correlation 0.69, P = 0.002). Ontology analysis of the 409 race-associated genes revealed significant enrichment in mobilization of calcium and immune/inflammatory response (P < 10(-9)). Of note, 25 of 30 calcium mobilization genes were involved in immune/inflammatory response (P < 10(-10)). Our data suggest a connection between immune response and vascular calcification and the result provides a potential mechanistic explanation for the lower prevalence and severity of CAC in African Americans compared with whites.
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The relationship between resting heart rate and incidence and progression of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis (MESA).
Atherosclerosis
PUBLISHED: 04-21-2011
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Elevated resting heart rate has been independently associated with cardiovascular and all-cause mortality. The pathophysiological mechanisms by which this increased risk occurs are unclear. We hypothesized that elevated resting heart rate will be associated with increased development of atherosclerosis, as assessed by the incidence and progression of coronary artery calcium (CAC).
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The use of group sequential, information-based sample size re-estimation in the design of the PRIMO study of chronic kidney disease.
Clin Trials
PUBLISHED: 04-12-2011
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Chronic kidney disease is associated with a marked increase in risk for left ventricular hypertrophy and cardiovascular mortality compared with the general population. Therapy with vitamin D receptor activators has been linked with reduced mortality in chronic kidney disease and an improvement in left ventricular hypertrophy in animal studies.
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Comparing costs associated with risk stratification rules for t-year survival.
Biostatistics
PUBLISHED: 03-16-2011
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Accurate risk prediction is an important step in developing optimal strategies for disease prevention and treatment. Based on the predicted risks, patients can be stratified to different risk categories where each category corresponds to a particular clinical intervention. Incorrect or suboptimal interventions are likely to result in unnecessary financial and medical consequences. It is thus essential to account for the costs associated with the clinical interventions when developing and evaluating risk stratification (RS) rules for clinical use. In this article, we propose to quantify the value of an RS rule based on the total expected cost attributed to incorrect assignment of risk groups due to the rule. We have established the relationship between cost parameters and optimal threshold values used in the stratification rule that minimizes the total expected cost over the entire population of interest. Statistical inference procedures are developed for evaluating and comparing given RS rules and examined through simulation studies. The proposed procedures are illustrated with an example from the Cardiovascular Health Study.
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Factors associated with presence and extent of coronary calcium in those predicted to be at low risk according to Framingham risk score (from the Multi-Ethnic Study of Atherosclerosis).
Am. J. Cardiol.
PUBLISHED: 03-08-2011
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Even among asymptomatic persons at low risk (<10%) according to the Framingham risk score, high coronary artery calcium (CAC) scores signify a greater predicted risk of coronary heart disease events. We sought to determine the noninvasive factors (without radiation exposure) significantly associated with CAC in low-risk, asymptomatic persons. In a cross-sectional analysis, we studied 3,046 participants from the Multi-Ethnic Study of Atherosclerosis at a low 10-year predicted risk (Framingham risk score <10%) of coronary heart disease events. Multivariate logistic regression analysis was used to assess the association of novel markers with the presence of any CAC (CAC >0) and advanced CAC (CAC ? 300). A CAC level of >0 and of ? 300 was present in 30% and 3.5% of participants, respectively. Factor VIIIc, fibrinogen, and soluble intercellular adhesion molecule were each associated with the presence of CAC (p ? 0.02), and C-reactive protein, D-dimer, and the carotid intima-media thickness with advanced CAC (p ? 0.03). The base model combining the traditional risk factors had excellent discrimination for advanced CAC (C-statistic 0.808). The addition of the 2 best-fit models combining the biomarkers with or without carotid intima-media thickness improved the c-statistic to 0.822 and 0.820, respectively. All 3 models calibrated well but were similar in estimating the individual risk probabilities for advanced CAC (prevalence 9.97%, 10.63%, and 10.10% in the greatest quartiles of predicted probabilities vs 0.26%, 0.26%, and 0.26% in the lowest quartiles, respectively). In conclusion, in low-risk persons, the traditional risk factors alone predicted advanced CAC with high discrimination and calibration. The biomarker combinations with and without carotid intima-media thickness were also significantly associated with advanced CAC; however, the improvement in the prediction and estimation of the clinical risk were modest compared to the traditional risk factors alone.
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Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.
Circulation
PUBLISHED: 01-24-2011
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Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to increase substantially.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.