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54. Pre-morbid body mass index and mortality after incident heart failure: the ARIC Study

Author

Khalid, Umair, Ather, Sameer, Bavishi, Chirag, Chan, Wenyaw, Loehr, Laura R., Wruck, Lisa M., Rosamond, Wayne D., Chang, Patricia P., Coresh, Joe, Virani, Salim S., Nambi, Vijay, Bozkurt, Biykem, Ballantyne, Christie M., and Deswal, Anita

Subjects
Heart Failure, Male, Anthropometry, Humans, Female, Kaplan-Meier Estimate, Obesity, Middle Aged, Prognosis, Article, Aged, Body Mass Index, Follow-Up Studies
Abstract

Although obesity is an independent risk factor for heart failure (HF), once HF is established, obesity is associated with lower mortality. It is unclear if the weight loss due to advanced HF leads to this paradoxical finding.This study sought to evaluate the prognostic impact of pre-morbid obesity in patients with HF.In the ARIC (Atherosclerosis Risk In Communities) study, we used body mass index (BMI) measured ≥6 months before incident HF (pre-morbid BMI) to evaluate the association of overweight (BMI 25 to30 kg/m(2)) and obesity (BMI ≥30 kg/m(2)) compared with normal BMI (18.5 to25 kg/m(2)) with mortality after incident HF.Among 1,487 patients with incident HF, 35% were overweight and 47% were obese by pre-morbid BMI measured 4.3 ± 3.1 years before HF diagnosis. Over 10-year follow-up after incident HF, 43% of patients died. After adjustment for demographics and comorbidities, being pre-morbidly overweight (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.58 to 0.90; p = 0.004) or obese (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.001) had a protective association with survival compared with normal BMI. The protective effect of overweight and obesity was consistent across subgroups on the basis of a history of cancer, smoking, and diabetes.Our results, for the first time, demonstrate that patients who were overweight or obese before HF development have lower mortality after HF diagnosis compared with normal BMI patients. Thus, weight loss due to advanced HF may not completely explain the protective effect of higher BMI in HF patients.

Published
2014

60. Abstract 18103: Community Trends in Incidence and Mortality of Hospitalized Acute Decompensated Heart Failure: The ARIC Study

Author

Chang, Patricia P, primary, Wruck, Lisa M, additional, Bessell, Marina, additional, Shahar, Eyal, additional, Rossi, Joseph S, additional, Loehr, Laura R, additional, Russell, Stuart D, additional, Agarwal, Sunil K, additional, Konety, Suma H, additional, Rodriguez, Carlos J, additional, and Rosamond, Wayne D, additional

Published
2015
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61. Perceived discrimination and cancer screening behaviors in US Hispanics: the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

Author

Valdovinos, Cristina, primary, Penedo, Frank J., additional, Isasi, Carmen R., additional, Jung, Molly, additional, Kaplan, Robert C., additional, Espinoza Giacinto, Rebeca, additional, Gonzalez, Patricia, additional, Malcarne, Vanessa L., additional, Perreira, Krista, additional, Salgado, Hugo, additional, Simon, Melissa A., additional, Wruck, Lisa M., additional, and Greenlee, Heather A., additional

Published
2015
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62. Trends in Myocardial Infarction Rates and Case Fatality by Anatomical Location In Four US Communities, 1987-2008 (From the Atherosclerosis Risk in Communities [ARIC] Study)

Author

Newman, Jonathan D., Shimbo, Daichi, Baggett, Chris, Liu, Xiaoxi, Crow, Richard, Abraham, JoEllyn M., Loehr, Laura R., Wruck, Lisa M., Folsom, Aaron R., and Rosamond, Wayne D.

Subjects
Adult, Male, Incidence, Myocardial Infarction, Comorbidity, Inferior Wall Myocardial Infarction, Middle Aged, Prognosis, Article, United States, surgical procedures, operative, Percutaneous Coronary Intervention, Hypertension, Diabetes Mellitus, Humans, Female, Thrombolytic Therapy, cardiovascular diseases, Coronary Artery Bypass, Anterior Wall Myocardial Infarction, Aged, Retrospective Studies
Abstract

Although the incidence of and mortality following ST-segment elevation myocardial infarction (STEMI) is decreasing, time-trends in anatomical location of STEMI and associated short-term prognosis have not been examined in a population-based community study. We determined 22-year trends in age- and race-adjusted, gender-specific incidence rates and 28-day case fatality of hospitalized STEMI by anatomic infarct location among a stratified random sample of 35-74 year old residents of four communities in the Atherosclerosis Risk in Communities (ARIC) study. STEMI infarct location was assessed by 12-lead electrocardiograms (ECG) from the hospital record, and was coded as anterior, inferior, lateral and multi-location STEMI using the Minnesota Code. Between 1987 and 2008, a total of 4,845 patients had an incident STEMI; 37.2% were inferior STEMI; 32.8% were anterior; 16.8% occurred in multiple infarct locations and 13.2% were lateral STEMI. For inferior, anterior and lateral STEMI in both men and women, significant declines were observed in the age-adjusted annual incidence rate and the associated 28-day case fatality. In contrast, for STEMI in multiple infarct locations, neither the annual incidence rate nor the 28-day case fatality changed over time. The age- and race-adjusted annual incidence rate and associated 28-day case fatality of STEMI in anterior, inferior and lateral infarct locations declined over 22 years of surveillance; however, no decline was observed for STEMI in multiple infarct locations. In conclusion, our findings suggest there is room for improvement in the care of patients with multi-location STEMI.

Published
2013

63. High Cholesterol Awareness, Treatment, and Control Among Hispanic/Latinos: Results From the Hispanic Community Health Study/Study of Latinos

Author

Rodriguez, Carlos J., primary, Cai, Jianwen, additional, Swett, Katrina, additional, González, Hector M., additional, Talavera, Gregory A., additional, Wruck, Lisa M., additional, Wassertheil‐Smoller, Sylvia, additional, Lloyd‐Jones, Donald, additional, Kaplan, Robert, additional, and Daviglus, Martha L., additional

Published
2015
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68. Comparable Ascertainment of Newly-Diagnosed Atrial Fibrillation Using Active Cohort Follow-Up versus Surveillance of Centers for Medicare and Medicaid Services in the Atherosclerosis Risk in Communities Study

Author

Bengtson, Lindsay G. S., primary, Kucharska-Newton, Anna, additional, Wruck, Lisa M., additional, Loehr, Laura R., additional, Folsom, Aaron R., additional, Chen, Lin Y., additional, Rosamond, Wayne D., additional, Duval, Sue, additional, Lutsey, Pamela L., additional, Stearns, Sally C., additional, Sueta, Carla, additional, Yeh, Hsin-Chieh, additional, Fox, Ervin, additional, and Alonso, Alvaro, additional

Published
2014
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71. Classification of Acute Decompensated Heart Failure

Author

Loehr, Laura R., primary, Agarwal, Sunil K., additional, Baggett, Chris, additional, Wruck, Lisa M., additional, Chang, Patricia P., additional, Solomon, Scott D., additional, Shahar, Eyal, additional, Ni, Hanyu, additional, Rosamond, Wayne D., additional, and Heiss, Gerardo, additional

Published
2013
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72. Abstract A88: Perceived discrimination and cancer screening behaviors in U.S. Hispanics: Preliminary results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study.

Author

Valdovinos, Cristina, primary, Isasi, Carmen, additional, Jung, Molly, additional, Greenlee, Heather, additional, Kaplan, Robert, additional, Penedo, Frank J., additional, Espinoza, Rebeca A., additional, Gonzalez, Patricia, additional, Malcarne, Vanessa L., additional, Perreira, Krista, additional, Salgado, Hugo, additional, Simon, Melissa A., additional, and Wruck, Lisa M., additional

Published
2012
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77. How to interpret figures in reports of clinical trials.

Author

Pocok, Stuart J., Travison, Thomas G., and Wruck, Lisa M.

Subjects
MEDICAL research, CLINICAL medicine, CLINICAL trials, STATISTICS, QUANTITATIVE research, MULTIVARIATE analysis
Abstract

The article presents an overview of how to interpret figures in reports of clinical trials. A discussion of the meaning and function of flow diagrams, Kaplan-Meier plots, forest plots and repeated measure plots, is presented. The importance of assessing visual evidence as a part of treatment evidence is discussed. An overview of what makes a good statistical figure, including an emphasis on clarity and the ability to be independently interpreted, is offered. An examination of several statistical figures and charts is presented.

Published
2008
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78. Rationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensin II receptor blocker therapy (losartan) in individuals with Marfan syndrome.

Author

Lacro, Ronald V., Dietz, Harry C., Wruck, Lisa M., Bradley, Timothy J., Colan, Steven D., Devereux, Richard B., Klein, Gloria L., Li, Jennifer S., Minich, L. LuAnn, Paridon, Stephen M., Pearson, Gail D., Printz, Beth F., Pyeritz, Reed E., Radojewski, Elizabeth, Roman, Mary J., Saul, J. Philip, Stylianou, Mario P., Mahony, Lynn, and Pediatric Heart Network Investigators

Subjects
CLINICAL trials, MARFAN syndrome, CARDIOVASCULAR diseases, MORTALITY
Abstract

Background: Cardiovascular disease, including aortic root dilation, dissection, and rupture, is the leading cause of mortality in patients with Marfan syndrome (MFS). The maximal aortic root diameter at the sinuses of Valsalva is considered the best predictor of adverse cardiovascular outcome. Although advances in therapy have improved life expectancy, affected individuals continue to suffer cardiovascular morbidity and mortality. Recent studies in an FBN1-targeted mouse model of MFS with aortic disease similar to that seen in humans showed that treatment with losartan normalized aortic root growth and aortic wall architecture.Methods: The Pediatric Heart Network designed a randomized clinical trial to compare aortic root growth and other short-term cardiovascular outcomes in subjects with MFS receiving atenolol or losartan. Individuals 6 months to 25 years of age with a body surface area-adjusted aortic root z score >3.0 will be eligible for inclusion. The primary aim is to compare the effect of atenolol therapy with that of losartan therapy on the rate of aortic root growth over 3 years. Secondary end points include progression of aortic regurgitation; incidence of aortic dissection, aortic root surgery, and death; progression of mitral regurgitation; left ventricular size and function; echocardiographically derived measures of central aortic stiffness; skeletal and somatic growth; and incidence of adverse drug reactions.Conclusion: This randomized trial should make a substantial contribution to the management of individuals with MFS and expand our understanding of the mechanisms responsible for the aortic manifestations of this disorder. [ABSTRACT FROM AUTHOR]

Published
2007
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80. Pre-Morbid Body Mass Index and Mortality After Incident Heart Failure The ARIC Study

Author

Khalid, Umair, Ather, Sameer, Bavishi, Chirag, Chan, Wenyaw, Loehr, Laura R., Wruck, Lisa M., Rosamond, Wayne D., Chang, Patricia P., Coresh, Joe, Virani, Salim S., Nambi, Vijay, Bozkurt, Biykem, Ballantyne, Christie M., and Deswal, Anita

Subjects
obesity paradox, pre-morbid, nutritional and metabolic diseases, overweight, outcomes
Abstract

BackgroundAlthough obesity is an independent risk factor for heart failure (HF), once HF is established, obesity is associated with lower mortality. It is unclear if the weight loss due to advanced HF leads to this paradoxical finding.ObjectivesThis study sought to evaluate the prognostic impact of pre-morbid obesity in patients with HF.MethodsIn the ARIC (Atherosclerosis Risk In Communities) study, we used body mass index (BMI) measured ≥6 months before incident HF (pre-morbid BMI) to evaluate the association of overweight (BMI 25 to

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82. Comparable Ascertainment of Newly-Diagnosed Atrial Fibrillation Using Active Cohort Follow-Up versus Surveillance of Centers for Medicare and Medicaid Services in the Atherosclerosis Risk in Communities Study

Author

Folsom, Aaron R., Wruck, Lisa M., Stearns, Sally C., Duval, Sue, Loehr, Laura R., Sueta, Carla, Kucharska-Newton, Anna, Alonso, Alvaro, Fox, Ervin, Chen, Lin Y., Lutsey, Pamela L., Bengtson, Lindsay G. S., Yeh, Hsin-Chieh, and Rosamond, Wayne D.

Subjects
3. Good health
Abstract

Increasingly, epidemiologic studies use administrative data to identify atrial fibrillation (AF). Capture of incident AF is not well documented. We examined incidence rates and concordance of AF diagnosis based on active cohort follow-up versus surveillance of Centers for Medicare and Medicaid Services data in the Atherosclerosis Risk in Communities study.

85. Impact of aspirin dose according to race in secondary prevention of atherosclerotic cardiovascular disease: a secondary analysis of the ADAPTABLE randomised controlled trial.

Author

Marquis-Gravel G, Mulder H, Wruck LM, Benziger CP, Effron MB, Farrehi PM, Girotra S, Gupta K, Kripalani S, Muñoz D, Polonsky TS, Whittle J, Harrington R, Rothman R, Hernandez AF, and Jones WS

Subjects
Aged, Female, Humans, Male, Middle Aged, Cardiovascular Diseases prevention & control, Dose-Response Relationship, Drug, Hemorrhage chemically induced, Hospitalization statistics & numerical data, Myocardial Infarction prevention & control, Myocardial Infarction ethnology, Myocardial Infarction epidemiology, Stroke prevention & control, Treatment Outcome, United States epidemiology, White, Black or African American, Aspirin administration & dosage, Aspirin therapeutic use, Atherosclerosis prevention & control, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors therapeutic use, Secondary Prevention methods
Abstract

Objectives: To evaluate whether the effectiveness and safety of low (81 mg daily) versus high-dose (325 mg daily) aspirin is consistent across races among patients with established atherosclerotic cardiovascular disease (ASCVD)., Design: A secondary analysis of the randomised controlled trial ADAPTABLE was performed., Setting: The study was conducted in 40 centres and one health plan participating in the National Patient-Centred Clinical Research Network (PCORnet) in the USA., Participants: Among 15 076 participants with established ASCVD, 14 096 had self-reported race available and were included in the analysis. Participants were divided according to self-reported race as Black (n=1311, 9.3%), White (n=11 990, 85.1%) or other race (n=795, 5.6%)., Interventions: Participants were randomised to open-label daily aspirin doses of 81 mg versus 325 mg in a 1:1 ratio for a median of 26.2 months., Primary and Secondary Outcomes Measures: The primary effectiveness endpoint was a composite of death from any cause, hospitalisation for myocardial infarction or hospitalisation for stroke. The primary safety endpoint was hospitalisation for bleeding requiring blood product transfusion., Results: Estimated cumulative incidence of the primary effectiveness endpoint at median follow-up with the 81 mg and the 325 mg daily doses were 6.70% and 7.12% in White participants (adjusted HR: 1.00 [95% CI: 0.88 to 1.15]); 12.27% and 10.69% in Black participants (adjusted HR: 1.40 [95% CI: 1.02 to 1.93]); and 6.88% and 7.69% in other participants (adjusted HR: 0.86 [95% CI: 0.54 to 1.39]) (p-interaction=0.12), respectively. There was no significant interaction between self-reported race and assigned aspirin dose regarding the secondary effectiveness and the primary safety endpoints., Conclusion: Race is not an effect modifier on the impact of aspirin dosing on effectiveness and safety in patients with established ASCVD. In clinical practice, treatment decisions regarding aspirin dose in secondary prevention of ASCVD should not be influenced by race., Trial Registration Number: NCT02697916., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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87. Prospective associations of plasma phospholipids and mild cognitive impairment/dementia among African Americans in the ARIC Neurocognitive Study.

Author

Li D, Misialek JR, Boerwinkle E, Gottesman RF, Sharrett AR, Mosley TH, Coresh J, Wruck LM, Knopman DS, and Alonso A

Abstract

Introduction: The objective of this study was to investigate whether 10 phospholipids/metabolites previously identified as prospectively predictive of mild cognitive impairment (MCI) or dementia in whites would also be predictive in a mostly African-American cohort., Methods: We repeatedly measured 188 phospholipids/metabolites in plasma samples of 221 participants of the Atherosclerosis Risk in Communities study, 97% African American, who were followed between 2004-2006 and 2011-2013., Results: After a mean follow-up of 7.3 years, 77 were classified as having MCI and 18 as having dementia. Our study failed to replicate previous findings in this mostly African American cohort, in that the 10 phospholipids/metabolites only achieved a C statistic/AUC of 0.609 in predicting development of MCI or dementia (compared to 0.96) and 0.607 in distinguishing normal from MCI or dementia at the follow-up visit., Conclusion: A panel of 10 phospholipids/metabolites previously associated with incident dementia was not predictive of MCI or dementia in an independent cohort.

Published
2016
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