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Search Results for all work with filters:

  • Health Sciences, Epidemiology
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Work 1-10 of 10

Sorted by relevance

Article

Comparisons of the Framingham and Pooled Cohort Equation Risk Scores for Detecting Subclinical Vascular Disease in Blacks Versus Whites

by Matthew L Topel; Jia Shen; Alanna A. Morris; Ibhar Al Mheid; Salman Sher; Sandra B Dunbar; Viola Vaccarino; Laurence S Sperling; Gary H. Gibbons; Greg Martin; Arshed Ali Quyyumi

2018

Subjects
  • Health Sciences, Epidemiology
  • Health Sciences, General
  • File Download
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Abstract:Close

The pooled cohort Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator is designed to improve cardiovascular risk estimation compared with the Framingham Risk Score, particularly in blacks. Although the ASCVD risk score better predicts mortality and incident cardiovascular disease in blacks, less is known about its performance for subclinical vascular disease measures, including arterial stiffness and carotid intima-media thickness. We sought to determine if the ASCVD risk score better identifies subclinical vascular disease in blacks compared with the Framingham risk score. We calculated both the Framingham and ASCVD cohort risk scores in 1,231 subjects (mean age 53 years, 59% female, 37% black) without known cardiovascular disease and measured the extent of arterial stiffness, as determined by pulse wave velocity (PWV), central pulse pressure (CPP), and central augmentation index (CAIx), and subclinical atherosclerosis, as determined by carotid-IMT (C-IMT). Compared with whites, blacks had higher CAIx (23.9 ± 10.2 vs 22.1 ± 9.6%, p = 0.004), CPP (36.4 ± 10.5 vs 34.9 ± 9.8 mmHg, p = 0.014), PWV (7.6 ± 1.5 vs 7.3 ± 1.3 m/s, p = 0.004), and C-IMT (0.67 ± 0.10 vs 0.65 ± 0.10 mm, p = 0.005). In a multivariable analysis including race and Framingham risk score, race remained an independent predictor of all measures of subclinical vascular disease; however, models with race and the ASCVD risk score showed that race was not an independent predictor of subclinical vascular disease. In conclusion, greater subclinical vascular disease in blacks was not estimated by the Framingham risk score. The new ASCVD risk score provided a better estimate of racial differences in vascular function and structure.

Article

Measuring Social Networks for Medical Research in Lower-Income Settings

by Laura Kelly; Shivani Patel; Kabayam Venkat Narayan; Dorairaj Prabhakaran; Solveig A. Cunningham

2014

Subjects
  • Health Sciences, Public Health
  • Health Sciences, General
  • Health Sciences, Epidemiology
  • File Download
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Social networks are believed to affect health-related behaviors and health. Data to examine the links between social relationships and health in low- and middle-income country settings are limited. We provide guidance for introducing an instrument to collect social network data as part of epidemiological surveys, drawing on experience in urban India. We describe development and fielding of an instrument to collect social network information relevant to health behaviors among adults participating in a large, population-based study of non-communicable diseases in Delhi, India. We discuss basic characteristics of social networks relevant to health including network size, health behaviors of network partners (i.e., network exposures), network homogeneity, network diversity, strength of ties, and multiplexity. Data on these characteristics can be collected using a short instrument of 11 items asked about up to 5 network members and 3 items about the network generally, administered in approximately 20 minutes. We found high willingness to respond to questions about social networks (97% response). Respondents identified an average of 3.8 network members, most often relatives (80% of network ties), particularly blood relationships. Ninety-one percent of respondents reported that their primary contacts for discussing health concerns were relatives. Among all listed ties, 91% of most frequent snack partners and 64% of exercise partners in the last two weeks were relatives. These results demonstrate that family relationships are the crux of social networks in some settings, including among adults in urban India. Collecting basic information about social networks can be feasibly and effectively done within ongoing epidemiological studies.

Article

Negative Affect and Risk of Atrial Fibrillation: MESA

by Parveen K. Garg; Wesley T. O'Neal; Ana V. Diez-Roux; Alvaro Alonso; Elsayed Z. Soliman; Susan Heckbert

2019

Subjects
  • Psychology, Psychobiology
  • Health Sciences, Epidemiology
  • Health Sciences, General
  • File Download
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Background-—Current literature examining the prospective relationship between depression and other measures of negative affect with atrial fibrillation (AF) are limited. We determined the relationships of depression, anger, anxiety, and chronic stress with incident AF in a multiethnic cohort of middle-and older-aged adults. Methods and Results-—This analysis included 6644 MESA (Multi-Ethnic Study of Atherosclerosis) study participants who were free of AF at baseline. Depressive symptoms were assessed at baseline and defined as either a 20-item Center for Epidemiologic Studies Depression Scale score ≥16 or use of antidepressant medications. The Spielberger Trait Anger Scale, Spielberger Trait Anxiety Scale, and Chronic Burden Scale were also administered at baseline to assess anger, anxiety, and chronic stress, respectively. The primary outcome was incident AF, identified by follow-up study visit ECGs, hospital discharge diagnoses, or Medicare claims data. A total of 875 (13%) incident AF cases were detected over a median follow-up of nearly 13 years. A Center for Epidemiologic Studies Depression Scale score ≥16 (referent, Center for Epidemiologic Studies Depression Scale score <2) and antidepressant use were associated with a 34% and 36% higher risk of AF, respectively, in separate adjusted Cox proportional hazards analyses (hazard ratio, 1.34; 95% CI 1.04–1.74 for Center for Epidemiologic Studies Depression Scale ≥16; hazard ratio, 1.36; 95% CI, 1.04–1.77 for antidepressant use). No significant associations were observed for anger, anxiety, or chronic stress with development of AF. Conclusions-—Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.

Article

Discussing Out-of-Pocket Costs With Patients: Shared Decision Making for Sacubitril-Valsartan in Heart Failure

by Graham H. Smith; Supriya Shore; Larry A. Allen; David Markham; Andrea R. Mitchell; Miranda Moore; Alanna Morris; Candace D. Speight; Neal Dickert Jr

2019

Subjects
  • Health Sciences, Epidemiology
  • Health Sciences, General
  • Health Sciences, Health Care Management
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Background-—“Financial toxicity” is a concern for patients, but little is known about how patients consider out-of-pocket cost in decisions. Sacubitril-valsartan provides a contemporary scenario to understand financial toxicity. It is guideline recommended for heart failure with reduced ejection fraction, yet out-of-pocket costs can be considerable. Methods and Results-—Structured interviews were conducted with 49 patients with heart failure with reduced ejection fraction at heart failure clinics and inpatient services. Patient opinions of the drug and its value were solicited after description of benefits using graphical displays. Descriptive quantitative analysis of closed-ended responses was conducted, and qualitative descriptive analysis of text data was performed. Of participants, 92% (45/49) said that they would definitely or probably switch to sacubitril-valsartan if their physician recommended it and out-of-pocket cost was $5 more per month than their current medication. Only 43% (21/49) would do so if out-of-pocket cost was $100 more per month (P<0.001). At least 40% across all income categories would be unlikely to take sacubitril-valsartan at $100 more per month. Participants exhibited heterogeneous approaches to cost in decision making and varied on their use and interpretation of probabilistic information. Few (20%) participants stated physicians had initiated a conversation about cost in the past year. Conclusions-—Out-of-pocket cost variation reflective of contemporary cost sharing substantially influenced stated willingness to take sacubitril-valsartan, a guideline-recommended therapy with mortality benefit. These findings suggest a need for cost transparency to promote shared decision making. They also demonstrate the complexity of cost discussion and need to study how to incorporate out-of-pocket cost into clinical decisions.

Article

Disparities in Temporal and Geographic Patterns of Declining Heart Disease Mortality by Race and Sex in the United States, 1973-2010.

by Adam S. Vaughan; Harrison Quick; Elizabeth B. Pathak; Michael Kramer; Michele Casper

2015

Subjects
  • Health Sciences, Epidemiology
  • Health Sciences, General
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BACKGROUND: Examining small-area differences in the strength of declining heart disease mortality by race and sex provides important context for current racial and geographic disparities and identifies localities that could benefit from targeted interventions. We identified and described temporal trends in declining county-level heart disease mortality by race, sex, and geography between 1973 and 2010. METHODS AND RESULTS: Using a Bayesian hierarchical model, we estimated age-adjusted mortality with diseases of the heart listed as the underlying cause for 3099 counties. County-level percentage declines were calculated by race and sex for 3 time periods (1973-1985, 1986-1997, 1998-2010). Strong declines were statistically faster or no different than the total national decline in that time period. We observed county-level race-sex disparities in heart disease mortality trends. Continual (from 1973 to 2010) strong declines occurred in 73.2%, 44.6%, 15.5%, and 17.3% of counties for white men, white women, black men, and black women, respectively. Delayed (1998-2010) strong declines occurred in 15.4%, 42.0%, 75.5%, and 76.6% of counties for white men, white women, black men, and black women, respectively. Counties with the weakest patterns of decline were concentrated in the South. CONCLUSIONS: Since 1973, heart disease mortality has declined substantially for these race-sex groups. Patterns of decline differed by race and geography, reflecting potential disparities in national and local drivers of these declines. Better understanding of racial and geographic disparities in the diffusion of heart disease prevention and treatment may allow us to find clues to progress toward racial and geographic equity in heart disease mortality.

Article

Plasma stromal cell-derived factor 1 alpha/CXCL12 level predicts long-term adverse cardiovascular outcomes in patients with coronary artery disease

by Nima Ghasemzadeh; Abdul Wahab Hritani; Christine De Staercke; Danny Eapen; Emir Veledar; Hatem Al Kassem; Mohamed Khayata; Abarmard Zafari; Laurence Sperling; Craig Hooper; Laura Vaccarino; Kreton Mavromatis; Arshed Quyyumi

2015

Subjects
  • Health Sciences, Epidemiology
  • Health Sciences, Medicine and Surgery
  • Health Sciences, General
  • File Download
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Objective: Stromal derived factor-1α/CXCL12 is a chemoattractant responsible for homing of progenitor cells to ischemic tissues. We aimed to investigate the association of plasma CXCL12 with long-term cardiovascular outcomes in patients with coronary artery disease (CAD). Methods: 785 patients aged: 63±12 undergoing coronary angiography were independently enrolled into discovery (N=186) and replication (N=599) cohorts. Baseline levels of plasma CXCL12 were measured using Quantikine CXCL12 ELISA assay (R&D systems). Patients were followed for cardiovascular death and/or myocardial infarction (MI) for a mean of 2.6yrs. Cox proportional hazard was used to determine independent predictors of cardiovascular death/MI. Results: The incidence of cardiovascular death/MI was 13% (N=99). High CXCL12 level based on best discriminatory threshold derived from the ROC analysis predicted risk of cardiovascular death/MI (HR=4.81, p=1×10-6) independent of traditional risk factors in the pooled cohort. Addition of CXCL12 to a baseline model was associated with a significant improvement in c-statistic (AUC: 0.67-0.73, p=0.03). Addition of CXCL12 was associated with correct risk reclassification of 40% of events and 10.5% of non-events. Similarly for the outcome of cardiovascular death, the addition of the CXCL12 to the baseline model was associated with correct reclassification of 20.7% of events and 9% of non-events. These results were replicated in two independent cohorts. Conclusion: Plasma CXCL12 level is a strong independent predictor of adverse cardiovascular outcomes in patients with CAD and improves risk reclassification.

Article

Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function

by Ryan G. Aleong; Matthew J. Mulvahill; Indrani Halder; Nichole E. Carlson; Madhurmeet Singh; Heather Bloom; Samuel C. Dudley; Patrick T. Ellinor; Alaa Shalaby; Raul Weiss; Rebecca Gutmann; William H. Sauer; Kumar Narayanan; Sumeet S. Chugh; Samir Saba; Barry London

2015

Subjects
  • Health Sciences, Epidemiology
  • Health Sciences, Public Health
  • Health Sciences, General
  • File Download
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BACKGROUND: Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. METHODS AND RESULTS: Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P < 0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009). CONCLUSIONS: LV dilatation may complement ejection fraction to predict ventricular arrhythmias.

Article

Attitudes of inner city patients with cardiovascular disease towards meditation

by Amit Shah; Robert J. Ostfeld

2016

Subjects
  • Health Sciences, Epidemiology
  • Health Sciences, General
  • Health Sciences, Public Health
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Objectives Meditation is a stress reduction intervention that is of potential benefit to patients with cardiovascular disease, but its interest in inner city cardiology patients is unknown. We surveyed patients at an inner city cardiology clinic about their interest in learning meditation and the impact of stress on their lifestyles. Methods A survey was distributed to 215 consecutive patients in an inner city cardiology clinic. Chi-square tests were used to compare those interested and not interested in meditation. Results Of the 215 surveys, 54 were excluded because of 2 or more missing responses, leaving 161 for analysis. The mean age was 61 (+/− 16.5) years; 59% were female, 37% were black non-Hispanic, and 34% were Hispanic, and 18% were white. Overall, 46% expressed interest in learning meditation, and 64% agreed that less stress would facilitate living a healthy lifestyle. In subgroup analysis, the highest levels of interest in meditation classes occurred in patients who were younger than 65 years old (69% interested) and those who agreed that less stress would facilitate living a healthy lifestyle (71% interested). Conclusion Many of the patients at an inner city cardiology clinic may have interest in learning meditation. Given the effects of stress in this population, clinical trials involving meditation are warranted.

Article

Discovery of Genetic Variation on Chromosome 5q22 Associated with Mortality in Heart Failure

by J. Gustav Smith; Janine F. Felix; Alanna C. Morrison; Andreas Kalogeropoulos; Stella Trompet; Jemma B. Wilk; Olof Gidlöf; Xinchen Wang; Michael Morley; Michael Mendelson; Roby Joehanes; Symen Ligthart; Xiaoyin Shan; Joshua C. Bis; Ying A. Wang; Marketa Sjögren; Julius Ngwa; Jeffrey Brandimarto; David J. Stott; David Aguilar; Kenneth M. Rice; Howard D. Sesso; Serkalem Demissie; Brendan M. Buckley; Kent D. Taylor; Ian Ford; Chen Yao; Chunyu Liu; CHARGE-SCD consortium; EchoGen consortium; QT-IGC consortium; CHARGE-QRS consortium; Nona Sotoodehnia; Pim van der Harst; Bruno H.Ch. Stricker; Stephen B. Kritchevsky; Yongmei Liu; J. Michael Gaziano; Albert Hofman; Christine S. Moravec; André G. Uitterlinden; Manolis Kellis; Joyce B. van Meurs; Kenneth B. Margulies; Abbas Dehghan; Daniel Levy; Björn Olde; Bruce M. Psaty; L. Adrienne Cupples; J. Wouter Jukema; Luc Djousse; Oscar H. Franco; Eric Boerwinkle; Laurie A. Boyer; Christopher Newton-Cheh; Javed Butler; Ramachandran S. Vasan; Thomas P. Cappola; Nicholas L. Smith

2016

Subjects
  • Biology, Genetics
  • Health Sciences, Epidemiology
  • Health Sciences, General
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Failure of the human heart to maintain sufficient output of blood for the demands of the body, heart failure, is a common condition with high mortality even with modern therapeutic alternatives. To identify molecular determinants of mortality in patients with new-onset heart failure, we performed a meta-analysis of genome-wide association studies and follow-up genotyping in independent populations. We identified and replicated an association for a genetic variant on chromosome 5q22 with 36% increased risk of death in subjects with heart failure (rs9885413, P = 2.7x10-9). We provide evidence from reporter gene assays, computational predictions and epigenomic marks that this polymorphism increases activity of an enhancer region active in multiple human tissues. The polymorphism was further reproducibly associated with a DNA methylation signature in whole blood (P = 4.5x10-40) that also associated with allergic sensitization and expression in blood of the cytokine TSLP (P = 1.1x10-4). Knockdown of the transcription factor predicted to bind the enhancer region (NHLH1) in a human cell line (HEK293) expressing NHLH1 resulted in lower TSLP expression. In addition, we observed evidence of recent positive selection acting on the risk allele in populations of African descent. Our findings provide novel genetic leads to factors that influence mortality in patients with heart failure.

Article

Epidemiology of Incident Heart Failure in a Contemporary Elderly Population: The Health, Aging, and Body Composition Study

by Andreas Kalogeropoulos; Vasiliki (Vicki) Georgiopoulou; Stephen B. Kritchevsky; Bruce M. Psaty; Nicholas L. Smith; Anne B. Newman; Nicolas Rodondi; Suzanne Satterfield; Douglas C. Bauer; Kirsten Bibbins-Domingo; Andrew L Smith; Peter W.F. Wilson; Ramachandran S. Vasan; Tamara B. Harris; Javed Butler

2009

Subjects
  • Health Sciences, Public Health
  • Health Sciences, General
  • Health Sciences, Epidemiology
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Background Race- and gender- specific epidemiology of incident heart failure (HF) in a contemporary elderly cohort is not well described. Methods We studied 2934 participants without HF enrolled in the Health ABC Study (age 73.6±2.9 years, 47.9% men, 58.6% white, 41.4% black) and assessed incidence of HF, population attributable risk (PAR) of independent risk factors for HF, and outcomes of incident HF. Results During a median follow-up of 7.1 years, 258 (8.8%) participants developed HF (13.6/1000 person-years). Men and blacks were more likely to develop HF. No significant sex-based differences were observed in risk factors. Coronary heart disease (whites: PAR 23.9%, blacks: PAR 29.5%) and uncontrolled blood pressure (whites: PAR 21.3%, blacks: PAR 30.1%) carried the highest PAR in both races. In blacks, 6 out of 8 risk factors assessed (coronary heart disease, uncontrolled blood pressure, left ventricular hypertrophy, reduced glomerular filtration rate, smoking, and increased heart rate) had >5% higher PAR compared to whites, leading to a higher overall proportion of HF attributable to modifiable risk factors in blacks vs. whites (67.8% vs. 48.9%). Participants who developed HF had a higher annual mortality (18.0% vs. 2.7%). No racial difference in survival after HF was noted; however, rehospitalization rates were higher in blacks (62.1 vs. 30.3/100 person-years, P<.001). Conclusions Incident HF is common in the elderly; a large proportion of HF risk was attributed to modifiable risk factors. Racial differences in risk factors for HF and in hospitalization rates after HF need to be accounted for prevention and treatment efforts.
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