179 results on '"Laura R. Loehr"'
Search Results
2. Whole genome sequence analysis of pulmonary function and COPD in 19,996 multi-ethnic participants
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Xutong Zhao, Dandi Qiao, Chaojie Yang, Silva Kasela, Wonji Kim, Yanlin Ma, Nick Shrine, Chiara Batini, Tamar Sofer, Sarah A. Gagliano Taliun, Phuwanat Sakornsakolpat, Pallavi P. Balte, Dmitry Prokopenko, Bing Yu, Leslie A. Lange, Josée Dupuis, Brian E. Cade, Jiwon Lee, Sina A. Gharib, Michelle Daya, Cecelia A. Laurie, Ingo Ruczinski, L. Adrienne Cupples, Laura R. Loehr, Traci M. Bartz, Alanna C. Morrison, Bruce M. Psaty, Ramachandran S. Vasan, James G. Wilson, Kent D. Taylor, Peter Durda, W. Craig Johnson, Elaine Cornell, Xiuqing Guo, Yongmei Liu, Russell P. Tracy, Kristin G. Ardlie, François Aguet, David J. VanDenBerg, George J. Papanicolaou, Jerome I. Rotter, Kathleen C. Barnes, Deepti Jain, Deborah A. Nickerson, Donna M. Muzny, Ginger A. Metcalf, Harshavardhan Doddapaneni, Shannon Dugan-Perez, Namrata Gupta, Stacey Gabriel, Stephen S. Rich, George T. O’Connor, Susan Redline, Robert M. Reed, Cathy C. Laurie, Martha L. Daviglus, Liana K. Preudhomme, Kristin M. Burkart, Robert C. Kaplan, Louise V. Wain, Martin D. Tobin, Stephanie J. London, Tuuli Lappalainen, Elizabeth C. Oelsner, Goncalo R. Abecasis, Edwin K. Silverman, R. Graham Barr, NHLBI Trans-Omics for Precision Medicine (TOPMed) Consortium, TOPMed Lung Working Group, Michael H. Cho, and Ani Manichaikul
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Science - Abstract
Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality. Here, the authors analyse whole genome sequence data and find new loci associated with lung function and COPD.
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- 2020
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3. Rapid decline in estimated glomerular filtration rate in sickle cell anemia: results of a multicenter pooled analysis
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Kenneth I. Ataga, Qingning Zhou, Vimal K. Derebail, Santosh L. Saraf, Jane S. Hankins, Laura R. Loehr, Melanie E. Garrett, Allison E. Ashley-Koch, Jianwen Cai, and Marilyn J. Telen
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2020
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4. Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study
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Kavita Sharma, Yejin Mok, Lucia Kwak, Sunil K. Agarwal, Patricia P. Chang, Anita Deswal, Amil M. Shah, Dalane W. Kitzman, Lisa M. Wruck, Laura R. Loehr, Gerardo Heiss, Josef Coresh, Wayne D. Rosamond, Scott D. Solomon, Kunihiro Matsushita, and Stuart D. Russell
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epidemiology ,heart failure with preserved ejection fraction ,outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all‐cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. Methods and Results Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1‐year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [P=0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [P=0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. Conclusions In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex‐ and race‐based differences in predictors of mortality may help strategize targeted management of HFpEF.
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- 2020
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5. Initiation of antihypertensive monotherapy and incident fractures among Medicare beneficiaries
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Jennifer L. Hargrove, Yvonne M. Golightly, Virginia Pate, Carri H. Casteel, Laura R. Loehr, Stephen W. Marshall, and Til Stürmer
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Fractures ,Older adults ,Epidemiology ,Antihypertensive initiation ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Research suggests antihypertensive medications are associated with fractures in older adults, however results are inconsistent and few have examined how the association varies over time. We sought to examine the association between antihypertensive class and incident non-vertebral fractures among older adults initiating monotherapy according to time since initiation. Methods We used a new-user cohort design to identify Medicare beneficiaries (≥ 65 years of age) initiating antihypertensive monotherapy during 2008–2011 using a 20% random sample of Fee-For-Service Medicare beneficiaries enrolled in parts A (inpatient services), B (outpatient services), and D (prescription medication) coverage. Starting the day after the initial antihypertensive prescription, we followed beneficiaries for incident non-vertebral fractures. We used multinomial logistic regression models to estimate propensity scores for initiating each antihypertensive drug class. Using these propensity scores, we weighted beneficiaries to achieve the same baseline covariate distribution as beneficiaries initiating with angiotensin-converting enzyme inhibitors. Lastly, we used weighted Cox proportional hazard models to estimate hazard ratios (HRs) of having an incident fractures according to antihypertensive class and time since initiation. Results During 2008–2011, 122,629 Medicare beneficiaries initiated antihypertensive monotherapy (mean age 75, 61% women, 86% White). Fracture rates varied according to days since initiation and antihypertensive class. Beneficiaries initiating with thiazides had the highest fracture rate in the first 14 days following initiation (438 per 10,000 person-years, 95% confidence interval (CI): 294–628; HR: 1.40, 0.78–2.52). However, beneficiaries initiating with calcium channel blockers had the highest fracture rate during the 15–365 days after initiation (435 per 10,000 person-years, 95% CI: 404–468; HR: 1.11, 1.00–1.24). Beneficiaries initiating with angiotensin-receptor blockers had the lowest fracture rates during the initial 14 days (333 per 10,000 person-years, 190–546, HR: 0.92, 0.49–1.75) and during 15–365 days after initiation (321 per 10,000 person-years, 287–358, HR: 0.96, 0.84–1.09). Conclusion The association between antihypertensives and fractures varied according to class and time since initiation. Results suggest that when deciding upon antihypertensive therapy, clinicians may want to consider possible fracture risks when choosing between antihypertensive drug classes.
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- 2017
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6. American Heart Association's Life Simple 7 and Risk of Atrial Fibrillation in a Population Without Known Cardiovascular Disease: The ARIC (Atherosclerosis Risk in Communities) Study
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Parveen K. Garg, Wesley T. O'Neal, Lin Y. Chen, Laura R. Loehr, Nona Sotoodehnia, Elsayed Z. Soliman, and Alvaro Alonso
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atrial fibrillation ,prevention ,risk factors/global assessment ,risk prediction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThe American Heart Association has defined metrics of ideal cardiovascular health known as Life's Simple 7 (LS7) to prevent cardiovascular disease. We examined the association between LS7 and incident atrial fibrillation (AF) in a biracial cohort of middle‐ and older‐aged adults without known cardiovascular disease. Methods and ResultsThis analysis included 13 182 ARIC (Atherosclerosis Risk in Communities) study participants (mean baseline age=54±5.7 years; 56% women; 25% black) free of AF and cardiovascular disease. An overall LS7 score was calculated as the sum of the LS7 component scores and classified as inadequate (0‐4), average (5‐9), or optimal (10‐14) cardiovascular health. The primary outcome was incident AF, identified primarily by ECG and hospital discharge coding of AF through December 31, 2014. A total of 2266 (17%) incident AF cases were detected over a median follow‐up of 25.1 years. Compared with the inadequate category (n=1057), participants in the average (n=8629) and optimal (n=3496) categories each had a lower risk of developing AF in a multivariable Cox proportional hazards model (hazard ratio 0.59, 95% confidence interval 0.51, 0.67 for average; and hazard ratio 0.38, 95% confidence interval 0.32, 0.44 for optimal). In a similar model, a 1‐point‐higher LS7 score was associated with a 12% lower risk of incident AF (hazard ratio 0.88, 95% confidence interval 0.86, 0.89). ConclusionsA higher LS7 score is strongly associated with a lower risk of AF in individuals without baseline cardiovascular disease. Determining whether interventions that improve the population's cardiovascular health also reduce AF incidence is needed.
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- 2018
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7. Association of Atrial Fibrillation With Cognitive Decline and Dementia Over 20 Years: The ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study)
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Lin Y. Chen, Faye L. Norby, Rebecca F. Gottesman, Thomas H. Mosley, Elsayed Z. Soliman, Sunil K. Agarwal, Laura R. Loehr, Aaron R. Folsom, Josef Coresh, and Alvaro Alonso
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atrial fibrillation ,cognition ,cohort study ,dementia ,epidemiology ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundPrevious studies have reported that atrial fibrillation (AF) is associated with cognitive decline and dementia. These studies, however, had limited follow‐up, were based mostly on white and highly selected populations, and did not account for attrition. We evaluated the association of incident AF with 20‐year change in cognitive performance (accounting for attrition) and incident dementia in the ARIC (Atherosclerosis Risk in Communities) Study. Methods and ResultsWe analyzed data from 12 515 participants (mean age, 56.9 [SD, 5.7] years in 1990–1992; 56% women and 24% black) from 1990 to 1992 through 2011 to 2013. Incident AF was ascertained from study ECGs and hospital discharge codes. Cognitive tests were performed in 1990 to 1992, 1996 to 1998, and 2011 to 2013. Incident dementia was clinician adjudicated. We used generalized estimating equations and Cox proportional hazards models to assess the association of time‐dependent AF with change in Z scores of cognitive tests and incident dementia, respectively. During 20 years, 2106 participants developed AF and 1157 participants developed dementia. After accounting for cardiovascular risk factors, including ischemic stroke, the average decline over 20 years in global cognitive Z score was 0.115 (95% confidence interval, 0.014–0.215) greater in participants with AF than in those without AF. Further adjustment for attrition by multiple imputation by chained equations strengthened the association. In addition, incident AF was associated with an increased risk of dementia (hazard ratio, 1.23; 95% confidence interval, 1.04–1.45), after adjusting for cardiovascular risk factors, including ischemic stroke. ConclusionsAF is associated with greater cognitive decline and increased risk of dementia, independent of ischemic stroke. Because cognitive decline is a precursor to dementia, our findings prompt further investigation to identify specific treatments for AF that will delay the trajectory of cognitive decline and, thus, prevent dementia in patients with AF.
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- 2018
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8. Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study
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Junichi Ishigami, Morgan E. Grams, Rakhi P. Naik, Melissa C. Caughey, Laura R. Loehr, Shinichi Uchida, Josef Coresh, and Kunihiro Matsushita
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anemia ,anemia and chronic kidney disease ,cardiovascular disease ,chronic kidney disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundReduced estimated glomerular filtration rate (eGFR) and elevated urinary albumin‐to‐creatinine ratio (ACR) individually increase risk of cardiovascular disease (CVD). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels. Methods and ResultsUsing 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996–1998, we explored the cross‐sectional association of eGFR and ACR with hemoglobin levels and their longitudinal associations with CVD (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (
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- 2018
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9. Association of Age at Menopause With Incident Heart Failure: A Prospective Cohort Study and Meta‐Analysis
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Duke Appiah, Pamela J. Schreiner, Ellen W. Demerath, Laura R. Loehr, Patricia P. Chang, and Aaron R. Folsom
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epidemiology ,heart failure ,menopause ,women's health ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundEarly age (
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- 2016
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10. Longitudinal study of glomerular hyperfiltration in adults with sickle cell anemia: a multicenter pooled analysis
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Kenneth I. Ataga, Qingning Zhou, Santosh L. Saraf, Jane S. Hankins, Emily J. Ciccone, Laura R. Loehr, Allison E. Ashley-Koch, Melanie E. Garrett, Jianwen Cai, Marilyn J. Telen, and Vimal K. Derebail
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Adult ,Male ,Young Adult ,Humans ,Hydroxyurea ,Female ,Anemia, Sickle Cell ,Longitudinal Studies ,Hematology ,Renal Insufficiency, Chronic ,Glomerular Filtration Rate - Abstract
Glomerular hyperfiltration is common in young sickle cell anemia patients and precedes development of overt kidney disease. In this multicenter pooled cohort, we characterized hyperfiltration and its decline to normal range in adult patients. Glomerular filtration rate (GFR) was estimated using the creatinine-based 2009 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation omitting race adjustment and the 2021 CKD-EPI equation. Using CKD-EPI–2009, 506 patients had baseline estimated GFR (eGFR) ≥90 mL/min per 1.73 m2, median age of 24 (interquartile range [IQR], 19-34) years and 5.17 years of follow-up. The prevalence of hyperfiltration (eGFR ≥140 and ≥130 mL/min per 1.73 m2 for men and women, respectively) was 38.3%. Using CKD-EPI–2009, baseline hyperfiltration was less likely with older age (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.73-0.83; P < .0001), male sex (OR, 0.32; 95% CI, 0.18-0.58; P = .0002), and higher weight (OR, 0.96; 95% CI, 0.94-0.99; P = .001). Using CKD-EPI–2021, hyperfiltration was similarly less likely with older age (OR, 0.75; 95% CI, 0.70-0.81; P < .0001), male sex (OR, 0.24; 95% CI, 0.13-0.44; P < .0001), and higher weight (OR, 0.97; 95% CI, 0.95-0.99; P = .004). In patients with baseline hyperfiltration, eGFR declined to normal values at a median age of 26.2 years. Using CKD-EPI–2009, this decline was associated with male sex (HR, 2.20; 95% CI, 1.26-3.87; P = .006), systolic blood pressure (hazard ratio [HR], 1.02; 95% CI, 1.01-1.04; P = .01), and hydroxyurea use (HR, 1.74; 95% CI, 1.002-3.03; P = .05). Using CKD-EPI–2021, decline of eGFR to normal was only associated with male sex (HR, 3.39; 95% CI, 2.01-5.69; P < .0001). Decline to normal eGFR range from hyperfiltration occurs earlier in males, those on hydroxyurea, and with higher systolic blood pressure.
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- 2022
11. Polygenic transcriptome risk scores for COPD and lung function improve cross-ethnic portability of prediction in the NHLBI TOPMed program
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Xiaowei Hu, Dandi Qiao, Wonji Kim, Matthew Moll, Pallavi P. Balte, Leslie A. Lange, Traci M. Bartz, Rajesh Kumar, Xingnan Li, Bing Yu, Brian E. Cade, Cecelia A. Laurie, Tamar Sofer, Ingo Ruczinski, Deborah A. Nickerson, Donna M. Muzny, Ginger A. Metcalf, Harshavardhan Doddapaneni, Stacy Gabriel, Namrata Gupta, Shannon Dugan-Perez, L. Adrienne Cupples, Laura R. Loehr, Deepti Jain, Jerome I. Rotter, James G. Wilson, Bruce M. Psaty, Myriam Fornage, Alanna C. Morrison, Ramachandran S. Vasan, George Washko, Stephen S. Rich, George T. O’Connor, Eugene Bleecker, Robert C. Kaplan, Ravi Kalhan, Susan Redline, Sina A. Gharib, Deborah Meyers, Victor Ortega, Josée Dupuis, Stephanie J. London, Tuuli Lappalainen, Elizabeth C. Oelsner, Edwin K. Silverman, R. Graham Barr, Timothy A. Thornton, Heather E. Wheeler, Michael H. Cho, Hae Kyung Im, and Ani Manichaikul
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Pulmonary Disease, Chronic Obstructive ,Risk Factors ,Genetics ,Humans ,National Heart, Lung, and Blood Institute (U.S.) ,Transcriptome ,Lung ,Article ,United States ,Genetics (clinical) - Abstract
While polygenic risk scores (PRSs) enable early identification of genetic risk for chronic obstructive pulmonary disease (COPD), predictive performance is limited when the discovery and target populations are not well matched. Hypothesizing that the biological mechanisms of disease are shared across ancestry groups, we introduce a PrediXcan-derived polygenic transcriptome risk score (PTRS) to improve cross-ethnic portability of risk prediction. We constructed the PTRS using summary statistics from application of PrediXcan on large-scale GWASs of lung function (forced expiratory volume in 1 s [FEV(1)] and its ratio to forced vital capacity [FEV(1)/FVC]) in the UK Biobank. We examined prediction performance and cross-ethnic portability of PTRS through smoking-stratified analyses both on 29,381 multi-ethnic participants from TOPMed population/family-based cohorts and on 11,771 multi-ethnic participants from TOPMed COPD-enriched studies. Analyses were carried out for two dichotomous COPD traits (moderate-to-severe and severe COPD) and two quantitative lung function traits (FEV(1) and FEV(1)/FVC). While the proposed PTRS showed weaker associations with disease than PRS for European ancestry, the PTRS showed stronger association with COPD than PRS for African Americans (e.g., odds ratio [OR] = 1.24 [95% confidence interval [CI]: 1.08–1.43] for PTRS versus 1.10 [0.96–1.26] for PRS among heavy smokers with ≥ 40 pack-years of smoking) for moderate-to-severe COPD. Cross-ethnic portability of the PTRS was significantly higher than the PRS (paired t test p
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- 2022
12. Abstract P624: Peripheral Artery Disease and Long-Term Risk of Femur Fracture Among Older Adults: The Atherosclerosis Risk in Communities Study
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Mengkun Chen, Shoshana Ballew, Yejin Mok, Yingying Sang, Andrea Schneider, Morgan Grams, Laura R Loehr, Hirofumi Tanaka, Elizabeth Selvin, Josef Coresh, and Kuni Matsushita
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Femur fracture can have devastating consequences in older patients. Lower extremity peripheral artery disease (PAD) reduces physical function, which can in turn increase the risk of falls. However, less is known regarding the association of PAD with incident femur fracture in older adults. Hypothesis: PAD is associated with a higher risk of incident femur fracture independent of potential confounders. Methods: We included 5,276 participants from ARIC Visit 5 (2011-2013) (mean age 76 [standard deviation: 5] years, 57% women and 22% self-identified Black race). Femur fractures were defined as an outpatient encounter or hospitalization with ICD-9 codes: 820-821 or ICD-10 codes: S72. We quantified the association of PAD status at baseline, based on ankle-brachial index (ABI) ≤0.9 or clinical history of PAD, with incident femur fracture using multivariable Cox regression and follow-up until 2019. Results: There were 224 incident femur fractures over a median follow-up of 7.2 [IQI 5.6-7.8] years. The incidence rate of femur fracture was almost 2-times higher in participants with PAD compared to those without a history of PAD and ABI 1.11-1.20 (reference group) (10.5 [7.5-14.8] vs. 5.5 [4.3-6.9] per 1,000 person-years). This association persisted after accounting for demographic (hazards ratio [HR]: 1.86 [95% CI 1.23-2.84] in Model 1) and other confounders (HR 1.59 [1.04-2.46] in Model 2) (Table). When we excluded participants with a clinical history of PAD, low ABI (≤0.9) remained significantly associated with incident femur fracture compared to the reference group (HR 1.94 [1.18-3.19]). Our findings were consistent in demographic and clinical subgroups (e.g., by sex and diabetes status). Conclusions: In community-dwelling older adults, PAD, even when not clinically diagnosed, was associated with an increased risk of femur fracture. Clinicians and patients should be aware of this complication of PAD and consider preventive measures to avoid falls (e.g., exercise counseling, and making home safer).
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- 2023
13. Racial Differences in Trends and Prognosis of Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction: the Atherosclerosis Risk in Communities (ARIC) Surveillance Study
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Lena Mathews, Ning Ding, Yingying Sang, Laura R. Loehr, Jung-Im Shin, Naresh M. Punjabi, Alain G. Bertoni, Deidra C. Crews, Wayne D. Rosamond, Josef Coresh, Chiadi E. Ndumele, Kunihiro Matsushita, and Patricia P. Chang
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Health (social science) ,Sociology and Political Science ,Health Policy ,Anthropology ,Public Health, Environmental and Occupational Health - Abstract
Racial disparities in guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) have not been fully documented in a community setting.In the ARIC Surveillance Study (2005-2014), we examined racial differences in GDMT at discharge, its temporal trends, and the prognostic impact among individuals with hospitalized HFrEF, using weighted regression models to account for sampling design. Optimal GDMT was defined as beta blockers (BB), mineralocorticoid receptor antagonist (MRA) and ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Acceptable GDMT included either one of BB, MRA, ACEI/ARB or hydralazine plus nitrates (H-N).Of 16,455 (unweighted n = 3,669) HFrEF cases, 47% were Black. Only ~ 10% were discharged with optimal GDMT with higher proportion in Black than White individuals (11.1% vs. 8.6%, p 0.001). BB use was 80% in both racial groups while Black individuals were more likely to receive ACEI/ARB (62.0% vs. 54.6%) and MRA (18.0% vs. 13.8%) than Whites, with a similar pattern for H-N (21.8% vs. 10.1%). There was a trend of decreasing use of optimal GDMT in both groups, with significant decline of ACEI/ARB use in Whites (- 2.8% p 0.01) but increasing H-N use in both groups (+ 6.5% and + 9.2%, p 0.01). Only ACEI/ARB and BB were associated with lower 1-year mortality.Optimal GDMT was prescribed in only ~ 10% of HFrEF patients at discharge but was more so in Black than White individuals. ACEI/ARB use declined in Whites while H-N use increased in both races. GDMT utilization, particularly ACEI/ARB, should be improved in Black and Whites individuals with HFrEF.
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- 2022
14. Frequent Premature Atrial Contractions Are Associated With Poorer Cognitive Function in the Atherosclerosis Risk in Communities (ARIC) Study
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Lin Y. Chen, Pamela L. Lutsey, Mary R. Rooney, Alvaro Alonso, Elsayed Z. Soliman, Faye L. Norby, Ankit Maheshwari, Laura R. Loehr, Samuel C. Dudley, Thomas H. Mosley, and Josef Coresh
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Male ,medicine.medical_specialty ,Cross-sectional study ,Premature atrial contraction ,Neuropsychological Tests ,Risk Assessment ,Risk Factors ,Internal medicine ,Prevalence ,medicine ,Humans ,Dementia ,Cognitive Dysfunction ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,General Medicine ,Odds ratio ,Atherosclerosis ,medicine.disease ,Health Surveys ,Cross-Sectional Studies ,Logistic Models ,Multivariate Analysis ,Ambulatory ,Electrocardiography, Ambulatory ,Female ,Atrial Premature Complexes ,business ,Body mass index - Abstract
To evaluate the association of premature atrial contraction (PAC) frequency with cognitive test scores and prevalence of dementia or mild cognitive impairment (MCI).We conducted a cross-sectional analysis using Atherosclerosis Risk in Communities study visit 6 (January 1, 2016, through December 31, 2017) data. We included 2163 participants without atrial fibrillation (AF) (age mean ± SD, 79±4 years; 1273 (58.9%) female; and 604 (27.97.0% Black) who underwent cognitive testing and wore a leadless, ambulatory electrocardiogram monitor for 14 days. We categorized PAC frequency based on the percent of beats: less than 1%, minimal; 1% to5%, occasional; greater than or equal to 5%, frequent. We derived cognitive domain-specific factor scores (memory, executive function, language, and global z-score). Dementia and MCI were adjudicated.During a mean analyzable time of 12.6±2.6 days, 339 (15.7%) had occasional PACs and 107 (4.9%) had frequent PACs. Individuals with frequent PACs (vs minimal) had lower executive function factor scores by 0.30 (95% CI, -0.46 to -0.14) and lower global factor scores by 0.20 (95% CI, -0.33 to -0.07) after multivariable adjustment. Individuals with frequent PACs (vs minimal) had higher odds of prevalent dementia or MCI after multivariable adjustment (odds ratio, 1.74; 95% CI, 1.09 to 2.79). These associations were unchanged with additional adjustment for stroke.In community-dwelling older adults without AF, frequent PACs were cross-sectionally associated with lower executive and global cognitive function and greater prevalence of dementia or MCI, independently of stroke. Our findings lend support to the notion that atrial cardiomyopathy may be a driver of AF-related outcomes. Further research to confirm these associations prospectively and to elucidate underlying mechanisms is warranted.
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- 2021
15. Evaluating Equations for Estimated Glomerular Filtration Rate (eGFR) in Patients with Sickle Cell Disease (SCD)
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Vimal K Derebail, Laura Y Zhou, Laila Elsherif, Kammie L Patillo, David Wichlan, Kristina Landes, Paula McCune, Laura R Loehr, Robert M Cronin, Payal C Desai, Jianwen Cai, and Kenneth I Ataga
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
16. Low Liver Enzymes and Risk of Dementia: The Atherosclerosis Risk in Communities (ARIC) Study
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Gerardo Heiss, Alvin G. Thomas, Yifei Lu, Ron C. Hoogeveen, Elizabeth Selvin, A. Richey Sharrett, A. Sidney Barritt, Laura R. Loehr, James R Pike, Priya Palta, and Thomas H. Mosley
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Male ,Percentile ,medicine.medical_specialty ,digestive system ,Article ,Cohort Studies ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Liver enzyme ,medicine ,Humans ,Dementia ,Aspartate Aminotransferases ,Aric study ,Aged ,business.industry ,Incidence ,General Neuroscience ,Medical record ,Hazard ratio ,Alanine Transaminase ,General Medicine ,Middle Aged ,medicine.disease ,digestive system diseases ,Psychiatry and Mental health ,Clinical Psychology ,Atherosclerosis Risk in Communities ,Liver ,Female ,030211 gastroenterology & hepatology ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery - Abstract
Background: Low levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the low physiologic range, surrogate markers for reduced liver metabolic function, are associated with cerebral hypometabolism, impairment in neurotransmitter production and synaptic maintenance, and a higher prevalence of dementia. It is unknown whether a prospective association exists between low liver enzyme levels and incident dementia. Objective: To determine whether low levels of ALT and AST are associated with higher risk of incident dementia. Methods: Plasma ALT and AST were measured on 10,100 study participants (mean age 63.2 years, 55% female, 22% black) in 1996–1998. Dementia was ascertained from comprehensive neuropsychological assessments, annual contact, and medical record surveillance. Cox proportional hazards regression was used to estimate the association. Results: During a median follow-up of 18.3 years (maximum 21.9 years), 1,857 individuals developed dementia. Adjusted for demographic factors, incidence rates of dementia were higher at the lower levels of ALT and AST. Compared to the second quintile, ALT values
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- 2021
17. Abstract P229: The Association Of Cumulative Socioeconomic Status And Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study
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LaShaunta M Glover, Chantel Martin, Reuben Adatorwovor, Laura R Loehr, Brooke Staley, Kari E North, and Mario Sims
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: The burden of type 2 diabetes (T2D) is disproportionately higher among racial and ethnic minorities, particularly African American individuals who have low socioeconomic status (SES). According to the cumulative SES life-course model, stressful experiences in early life and later life can accumulate to influence disease risk. Yet, little is known about the association between cumulative SES, or the combined effects of different SES phenotypes (i.e., education, wealth, income, etc.), over the life course and development of T2D. Objective: To estimate the association of cumulative SES and incident T2D among men and women without T2D and cardiovascular disease at baseline (2000-2004) from the Jackson Heart Study (JHS) (n=3078). Methods: Using cohort data from JHS (mean age 52.8 years; 1969 women, 1109 men), we derived standardized cumulative SES scores at baseline, conceptualized using 6 SES indicators (e.g. educational attainment, wealth, income, occupation, employment status and mother’s education) and dichotomized the score as high SES (median and above - referent) and low SES (below the median). Incident T2D was defined at exam 2 (2005-2008) or exam 3 (2009-2013) based on a fasting glucose ≥126 mg/dL, or HbA1c ≥ 6.5, or those who had been on diabetic medication 2 weeks prior to these visits, or those who reported a physician diagnosis. Interval censoring proportional hazards regression was used to estimate the association between cumulative SES and incident T2D using hazard ratios (HR, 95% confidence interval-CI), where time-to-event was approximated as the interval between the first visit and the visit in which T2D was ascertained. Sex differences were evaluated using interaction terms and descriptive statistics. The fully-adjusted model included baseline covariates: age, waist circumference, health behaviors, and family history of diabetes. Results: There were 544 total incident T2D cases and 65% (351) of cases were characterized as having low SES. The dichotomized cumulative score was associated with incident T2D ( p Conclusion: Low cumulative SES was not significantly associated with development of T2D when adjusting for potential confounders. Future work should consider examination of adverse experiences related to low SES and other environmental factors such as built environment and neighborhood SES.
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- 2022
18. A Dyadic Growth Modeling Approach for Examining Associations Between Weight Gain and Lung Function Decline
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David R. Jacobs, Benjamin Smith, Joseph E. Schwartz, Talea Cornelius, Miriam J. Johnson, Pallavi Balte, Sachin Yende, David C. Currow, Ravi Kalhan, George T. O'Connor, Wendy B. White, Richard A. Kronmal, Surya P. Bhatt, Elizabeth C. Oelsner, Laura R. Loehr, and Patricia A. Cassano
- Subjects
Spirometry ,education.field_of_study ,Vital capacity ,medicine.diagnostic_test ,Epidemiology ,business.industry ,Population ,respiratory system ,respiratory tract diseases ,Pulmonary function testing ,03 medical and health sciences ,FEV1/FVC ratio ,0302 clinical medicine ,030228 respiratory system ,medicine ,030212 general & internal medicine ,medicine.symptom ,business ,education ,Body mass index ,Weight gain ,Cohort study ,Demography - Abstract
The relationship between body weight and lung function is complex. Using a dyadic multilevel linear modeling approach, treating body mass index (BMI; weight (kg)/height (m)2) and lung function as paired, within-person outcomes, we tested the hypothesis that persons with more rapid increase in BMI exhibit more rapid decline in lung function, as measured by forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and their ratio (FEV1:FVC). Models included random intercepts and slopes and adjusted for sociodemographic and smoking-related factors. A sample of 9,115 adults with paired measurements of BMI and lung function taken at ≥3 visits were selected from a pooled set of 5 US population-based cohort studies (1983–2018; mean age at baseline = 46 years; median follow-up, 19 years). At age 46 years, average annual rates of change in BMI, FEV1, FVC, and FEV1:FVC ratio were 0.22 kg/m2/year, −25.50 mL/year, −21.99 mL/year, and −0.24%/year, respectively. Persons with steeper BMI increases had faster declines in FEV1 (r = −0.16) and FVC (r = −0.26) and slower declines in FEV1:FVC ratio (r = 0.11) (all P values
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- 2020
19. Nine-Year Ethanol Intake Trajectories and Their Association With 15-Year Cognitive Decline Among Black and White Adults
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Natalia Petruski-Ivleva, Kari E. North, Laura R. Loehr, Gerardo Heiss, Sarah B Jones, Anna Kucharska-Newton, Donglin Zeng, Priya Palta, Shelly-Ann Love, and Mariaelisa Graff
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Epidemiology ,business.industry ,Cognition ,medicine.disease ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Dementia ,030212 general & internal medicine ,Effects of sleep deprivation on cognitive performance ,Ethanol intake ,Cognitive decline ,Association (psychology) ,business ,Cognitive impairment ,030217 neurology & neurosurgery ,Demography - Abstract
Faster rates of age-related cognitive decline might result in early onset of cognitive impairment and dementia. The relationship between ethanol intake and cognitive decline, although studied extensively, remains poorly understood. Previous studies used single measurements of ethanol, and few were conducted in diverse populations. We assessed the association of 9-year trajectories of ethanol intake (1987–1998) with 15-year rate of decline in cognitive performance from mid- to late life (1996–2013) among 2,169 Black and 8,707 White participants of the US Atherosclerosis Risk in Communities study using multivariable linear regression models. We hypothesized that stable, low to moderate drinking would be associated with lesser 15-year cognitive decline, and stable, heavy drinking with greater 15-year cognitive decline. Stable, low to moderate drinking (for Blacks, adjusted mean difference (MD) = 0.03 (95% confidence interval (CI): −0.13, 0.19); for Whites, adjusted MD = 0.02 (95% CI: −0.05, 0.08)) and stable, heavy drinking (for Blacks, adjusted MD = 0.08 (95% CI: −0.34, 0.50); for Whites, adjusted MD = −0.03 (95% CI: −0.18, 0.11)) in midlife compared with stable never-drinking were not associated with 15-year decline in general cognitive function from mid- to late life. No association was observed for the stable former and “mostly” drinking trajectories with 15-year cognitive decline. Stable low, low to moderate, and stable heavy drinking in midlife are not associated with lesser and greater cognitive decline, respectively, from mid- to late life among Black and White adults.
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- 2020
20. Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study
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Ravi Kalhan, David R. Jacobs, Amanda R. Mathew, Lewis J. Smith, Anne B. Newman, George T. O'Connor, Aaron R. Folsom, David Couper, Joseph E. Schwartz, Sachin Yende, Elizabeth C. Oelsner, Surya P. Bhatt, Richard A. Kronmal, Stephanie J. London, N.D. Freedman, Pallavi Balte, Laura R. Loehr, Wendy B. White, and Patricia A. Cassano
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Pulmonary and Respiratory Medicine ,Spirometry ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Population ,Secondary data ,Anthropometry ,Former Smoker ,respiratory tract diseases ,behavior and behavior mechanisms ,medicine ,Smoking cessation ,business ,education ,Developed country ,Cohort study ,Demography - Abstract
Summary Background Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease. Methods We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption. Findings 25 352 participants (ages 17–93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3–20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66–31·37) in sustained never-smokers, 34·97 mL per year (34·36–35·57) in former smokers, and 39·92 mL per year (38·92–40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95% CI 1·24–2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35–10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption ( Interpretation Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage. Funding National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.
- Published
- 2020
21. Association of insulin resistance, from mid-life to late-life, with aortic stiffness in late-life: the Atherosclerosis Risk in Communities Study
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Wayne D. Rosamond, Michelle L. Meyer, Anna K. Poon, Gerardo Heiss, Elizabeth Selvin, Joshua W. Knowles, Laura R. Loehr, Donglin Zeng, James S. Pankow, and Hirofumi Tanaka
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Blood Glucose ,Male ,Carotid-femoral pulse wave velocity ,medicine.medical_specialty ,Percentile ,Aging ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Triglyceride and glucose index ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,Vascular Stiffness ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Homeostatic model assessment of insulin resistance ,medicine ,Humans ,Insulin ,Prospective Studies ,Angiology ,Aged ,Original Investigation ,business.industry ,Age Factors ,Aortic stiffness ,Mean age ,medicine.disease ,Prognosis ,Triglyceride to high-density lipoprotein cholesterol ratio ,Lipids ,Arterial stiffness ,United States ,Atherosclerosis Risk in Communities ,Cross-Sectional Studies ,Cardiovascular Diseases ,lcsh:RC666-701 ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
BackgroundInsulin resistance may contribute to aortic stiffening that leads to end-organ damage. We examined the cross-sectional association and prospective association of insulin resistance and aortic stiffness in older adults without diabetes.MethodsWe analyzed 2571 men and women at Visit 5 (in 2011–2013), and 2350 men and women at repeat examinations from baseline at Visit 1 (in 1987–1989) to Visit 5 (in 2011–2013). Linear regression was used to estimate the difference in aortic stiffness per standard unit of HOMA-IR, TG/HDL-C, and TyG at Visit 5. Linear mixed effects were used to assess if high, as opposed to non-high, aortic stiffness (> 75th percentile) was preceded by a faster annual rate of change in log-HOMA-IR, log-TG/HDL-C, and log-TyG from Visit 1 to Visit 5.ResultsThe mean age of participants was 75 years, 37% (n = 957) were men, and 17% (n = 433) were African American. At Visit 5, higher HOMA-IR, higher TG/HDL-C, and higher TyG were associated with higher aortic stiffness (16 cm/s per SD (95% CI 6, 27), 29 cm/s per SD (95% CI 18, 40), and 32 cm/s per SD (95% CI 22, 42), respectively). From Visit 1 to Visit 5, high aortic stiffness, compared to non-high aortic stiffness, was not preceded by a faster annual rate of change in log-HOMA-IR from baseline to 9 years (0.030 (95% CI 0.024, 0.035) vs. 0.025 (95% CI 0.021, 0.028); p = 0.15) or 9 years onward (0.011 (95% CI 0.007, 0.015) vs. 0.011 (95% CI 0.009, 0.013); p = 0.31); in log-TG/HDL-C from baseline to 9 years (0.019 (95% CI 0.015, 0.024) vs. 0.024 (95% CI 0.022, 0.026); p = 0.06) or 9 years onward (− 0.007 (95% CI − 0.010, − 0.005) vs. − 0.009 (95% CI − 0.010, − 0.007); p = 0.08); or in log-TyG from baseline to 9 years (0.002 (95% CI 0.002, 0.003) vs. 0.003 (95% CI 0.003, 0.003); p = 0.03) or 9 years onward (0 (95% CI 0, 0) vs. 0 (95% CI 0, 0); p = 0.08).ConclusionsAmong older adults without diabetes, insulin resistance was associated with aortic stiffness, but the putative role of insulin resistance in aortic stiffness over the life course requires further study.
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- 2020
22. Abstract MP07: Metabolic Signature Improves Heart Failure Risk Prediction In Older Adults
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Brian Claggett, Amil M. Shah, Joseph S. Rossi, Gerardo Heiss, Eric Boerwinkle, David Aguilar, Sunil K. Agarwal, Carlos Rodriguez, Patricia P. Chang, Kunihiro Matsushita, Bing Yu, Laura R. Loehr, Quynh Nhu Nguyen, Stuart D. Russell, Guning Liu, and Brandon Stacey
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Metabolomics ,business.industry ,Physiology (medical) ,Heart failure ,Metabolome ,Medicine ,Profiling (information science) ,Computational biology ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Abstract
Introduction: Circulating metabolome profiling holds promise in predicting HF risk, but its prediction performance among older adults is not well established. Hypothesis: We hypothesize that metabolic signatures are associated with the risk of HF and its subtypes (HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)), and they can improve HF risk prediction beyond established risk factors. Methods: We measured 828 serum metabolites among 4,030 African and European Americans free of HF from the Atherosclerosis Risk in Communities (ARIC) study visit 5 (2011-2013). We regressed incident HF on each metabolite using Cox proportional hazards models. A metabolite risk score (MRS) was derived by summing individual metabolite levels weighted by beta coefficients estimated from least absolute shrinkage and selection operator (LASSO) regularized regressions. We regressed incident HF, HFpEF and HFrEF on the MRS. Harrell’s C-statistics were calculated to evaluate risk discrimination. We replicated the association between MRS and HF in 3,697 independent ARIC participants with metabolite measured at visit 1 (1987-1989). Results: Among 4,030 participants, the mean (SD) age was 76 (5) years. Adjusting for HF risk factors, 302 metabolites were associated with incident HF (false discovery rate < 0.05). One SD increase of the MRS, constructed from 51 metabolites selected by LASSO, was associated with two to three-fold high risk of HF, HFpEF and HFrEF in the fully adjusted models ( Table ). Five-year risk prediction analysis showed that C statistics improved from 0.850 to 0.884 by adding MRS over ARIC HF risk factors, kidney function and NT-proBNP (ΔC (95%CI) = 0.034 (0.017,0.052)). In the replication analysis, a more parsimonious MRS constructed using 15 metabolites, was associated with incident HF ( Table ). Conclusions: We identified a metabolic signature that was associated with the risk of HF and improved HF risk prediction. Our findings may shed light on pathways in HF development and at-risk populations.
- Published
- 2021
23. The prevalence of atrial fibrillation on 48-hour ambulatory electrocardiography in African Americans compared to Whites: The Atherosclerosis Risk in Communities (ARIC) study
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Elsayed Z. Soliman, Lynne E. Wagenknecht, Gerardo Heiss, Lin Y. Chen, Thomas H. Mosley, Eric A. Whitsel, Lisa M. Wruck, Alvaro Alonso, Laura R. Loehr, Anna K. Poon, and David Couper
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Male ,medicine.medical_specialty ,Time Factors ,030204 cardiovascular system & hematology ,Logistic regression ,Asymptomatic ,Article ,White People ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Atrial Fibrillation ,Odds Ratio ,Prevalence ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Aged ,Ambulatory electrocardiography ,business.industry ,Atrial fibrillation ,Odds ratio ,medicine.disease ,United States ,Black or African American ,Atherosclerosis Risk in Communities ,Cohort ,Electrocardiography, Ambulatory ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background A lower prevalence of atrial fibrillation (AF), but paradoxically higher burden of cardiovascular disease risk factors, has been observed among African Americans compared to Whites in studies of AF identified by mostly 12-lead electrocardiograms (ECGs) and clinically. Methods We performed 48-hour ambulatory electrocardiography (aECG) in a biracial sample of 1,193 participants in the Atherosclerosis Risk in Communities (ARIC) (mean age = 78 years, 62% African Americans, 64% female). Atrial fibrillation was identified from aECG, study visit ECGs, and discharge codes from cohort hospitalizations. We used covariate-adjusted logistic regression to estimate prevalence odds ratios (ORs) for AF in African Americans versus Whites, with adjustment for sampling and nonresponse. Results African Americans were more likely than Whites to have hypertension and diabetes but less likely to have coronary heart disease. The prevalence of AF detected by aECG or ARIC study ECG (adjusted for age and coronary heart disease) was lower in African Americans than Whites (2.7% vs 5.0%). White men had a higher (although not significant) AF prevalence of 7.8% compared to the other race and gender groups at 2.3%-2.8%. The adjusted OR for AF was 0.49 (0.24-0.99) comparing African Americans to Whites. Findings were similar when AF was defined to include prior AF hospitalizations (OR = 0.42, 0.25-0.72). There were no significant differences by race for asymptomatic or paroxysmal AF. Conclusions Atrial fibrillation was less prevalent in African American than white older adults, regardless of detection method. Although overall detection of new AF cases with aECG was low, future studies should consider longer-term monitoring to characterize AF by race.
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- 2019
24. Age-Dependent Associations Between 25-Hydroxy Vitamin D Levels and COPD Symptoms: Analysis of SPIROMICS
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Russell P. Bowler, Nirupama Putcha, Todd T. Brown, Prescott G. Woodruff, Igor Barjaktarevic, Robert Paine, Robert A. Wise, Alejandro P. Comellas, Laura R. Loehr, M. Bradley Drummond, Wassim W. Labaki, David Couper, MeiLan K. Han, Stephen C. Lazarus, Trisha M. Parekh, Robert M. Burkes, and Christopher B. Cooper
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Pulmonary and Respiratory Medicine ,Aging ,medicine.medical_specialty ,Chronic Obstructive Pulmonary Disease ,Pulmonary disease ,vitamin D ,Age dependent ,Origianl Research ,Clinical Research ,Internal medicine ,Complementary and Integrative Health ,medicine ,Vitamin D and neurology ,COPD ,Lung ,Nutrition ,business.industry ,Comorbidity score ,Symptom burden ,medicine.disease ,COPD outcomes ,Blood draw ,Walk test ,Respiratory ,COPD epidemiology ,COPD symptoms ,business - Abstract
Introduction: Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata. Methods: Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George’s Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans’ Specific Activity Questionnaire, and the 6-minute walk test distance. Results: In the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group. Discussion: When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.
- Published
- 2021
25. Infertility and Pregnancy Loss in Hispanic/Latino Women with Chronic Kidney Disease: Results from the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)
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Vimal K. Derebail, Susan L. Hogan, Yichun Hu, Monica L. Reynolds, Ana C. Ricardo, Christina Cordero, Laura R. Loehr, Carmen R. Isasi, and James P. Lash
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Infertility ,Pregnancy ,business.industry ,Environmental health ,Hispanic latino ,Community health ,medicine ,medicine.disease ,business ,Hchs sol ,Kidney disease - Abstract
Background: Hispanic/Latino individuals are less likely to receive optimal treatment for chronic kidney disease (CKD) than non-Hispanic whites. This may be particularly detrimental for women of reproductive age as CKD may increase risk for infertility, menstrual irregularities, and pregnancy loss. While these maternal outcomes have been associated with advanced CKD, their occurrence in mild to moderate CKD is unclear. Methods: Using baseline (2008-2011) and second study visit (2014-2017) data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we assessed the association between CKD and self-reported infertility, cessation of menses, hysterectomy, and nonviable pregnancy loss (experienced at less than 24 weeks gestation) in women of reproductive age (18-45 years). Multivariable survey logistic regression analyses were used to compute prevalence odds ratios with 95% confidence intervals (OR, 95% CI). Results: Of the 2,589 women included (mean age 31.4 years), 4.6% were considered to have CKD. In adjusted analyses, women with CKD did not have a significantly increased odds of infertility (OR 1.02, 95% CI 0.42 - 2.49), cessation of menses (OR 1.25, 95% CI 0.52 - 3.04) or hysterectomy (OR 1.17, 95% CI 0.61 - 2.25) compared to those without CKD. In those with CKD, the adjusted odds of a nonviable pregnancy loss was increased when considering pregnancies occurring after baseline visit (OR 2.11, 95% CI 0.63 - 7.02) but not statistically significance. Conclusion: In our Hispanic/Latino cohort, the presence of mild to moderate CKD did not confer an additional risk of our outcomes of interest. Examining nonviable pregnancy loss after CKD diagnosis in a larger sample warrants further study.
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- 2020
26. Rapid decline in estimated glomerular filtration rate in sickle cell anemia: results of a multicenter pooled analysis
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Allison E. Ashley-Koch, Melanie E. Garrett, Qingning Zhou, Santosh L. Saraf, Kenneth I. Ataga, Vimal K. Derebail, Laura R. Loehr, Jane S. Hankins, Jianwen Cai, and Marilyn J. Telen
- Subjects
medicine.medical_specialty ,business.industry ,Renal function ,Hematology ,Anemia, Sickle Cell ,medicine.disease ,Gastroenterology ,Sickle cell anemia ,Text mining ,Pooled analysis ,Internal medicine ,medicine ,Humans ,business ,Letters to the Editor ,Glomerular Filtration Rate - Abstract
Not available.
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- 2020
27. Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study
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Amil M. Shah, Gerardo Heiss, Dalane W. Kitzman, Scott D. Solomon, Patricia P. Chang, Anita Deswal, Laura R. Loehr, Kavita Sharma, Stuart D. Russell, Kunihiro Matsushita, Wayne D. Rosamond, Lucia Kwak, Lisa M. Wruck, Sunil K. Agarwal, Yejin Mok, and Josef Coresh
- Subjects
heart failure with preserved ejection fraction ,Male ,medicine.medical_specialty ,Surveillance study ,Cardiomyopathy ,030204 cardiovascular system & hematology ,outcomes ,White People ,Body Mass Index ,03 medical and health sciences ,Race (biology) ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Epidemiology ,Humans ,Medicine ,030212 general & internal medicine ,Original Research ,Aged ,Heart Failure ,business.industry ,Racial Groups ,Stroke Volume ,Prognosis ,medicine.disease ,United States ,Black or African American ,Heart failure ,Cardiology ,epidemiology ,Female ,Mortality/Survival ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business - Abstract
Background Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all‐cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. Methods and Results Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1‐year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [ P =0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [ P =0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. Conclusions In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex‐ and race‐based differences in predictors of mortality may help strategize targeted management of HFpEF.
- Published
- 2020
28. Association of low-intensity smoking with respiratory and lung cancer mortality
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Laura R. Loehr, George T. O'Connor, Joseph E. Schwartz, Anne B. Newman, Wendy B. White, Elizabeth C. Oelsner, Ravi Kalhan, N.D. Freedman, Paulo H M Chaves, Miranda R. Jones, David R. Jacobs, Lewis J. Smith, Sachin Yende, Benjamin M. Smith, Surya P. Bhatt, David Couper, Pallavi Balte, Amanda R. Mathew, Stephanie J. London, and Richard A. Kronmal
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Mean age ,medicine.disease ,respiratory tract diseases ,Never smokers ,Internal medicine ,Relative risk ,behavior and behavior mechanisms ,medicine ,Respiratory system ,business ,education ,Lung cancer - Abstract
Background: The number of current smokers has reached its lowest level to date in the US but the proportion of smokers smoking Aim: To assess relative risks of respiratory and lung cancer mortality in low-intensity smokers. Methods: Data from 4 US general population cohorts were harmonized and pooled. Current smokers were categorized by self-reported CPD ( Results: Of 18,730 participants (mean age 61 yrs, 56% women, 69% white, 13% current smokers, 17 yrs median follow-up), 649 (IDR=20/10,000 person-years) died from respiratory causes while 560 (IDR=17) died from lung cancer. Compared to never smokers, those with Conclusions: Risk of respiratory and lung cancer deaths among low-intensity current smokers vs never smokers, is non-trivial: in this study, this risk was equivalent to at least half that seen in those with 20+CPD.
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- 2020
29. Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study
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Anna K. Poon, Laura R. Loehr, Elsayed Z. Soliman, Eric A. Whitsel, Gerardo Heiss, Takeki Suzuki, and Lynne E. Wagenknecht
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Blood Glucose ,Male ,medicine.medical_specialty ,Percentile ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Cardiac autonomic function ,030204 cardiovascular system & hematology ,Autonomic Nervous System ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,Ambulatory electrocardiograms ,Heart Rate ,Internal medicine ,Diabetes mellitus ,Homeostatic model assessment of insulin resistance ,medicine ,Heart rate variability ,Humans ,Insulin ,030212 general & internal medicine ,Prospective Studies ,Triglycerides ,Aged ,business.industry ,Age Factors ,Heart ,Odds ratio ,medicine.disease ,Confidence interval ,United States ,Quartile ,lcsh:RC666-701 ,Cardiology ,Homeostatic model assessment ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Research Article - Abstract
Background Prior studies have shown insulin resistance is associated with reduced cardiac autonomic function measured at rest, but few studies have determined whether insulin resistance is associated with reduced cardiac autonomic function measured during daily activities. Methods We examined older adults without diabetes with 48-h ambulatory electrocardiography (n = 759) in an ancillary study of the Atherosclerosis Risk in Communities Study. Insulin resistance, the exposure, was defined by quartiles for three indexes: 1) the homeostatic model assessment of insulin resistance (HOMA-IR), 2) the triglyceride and glucose index (TyG), and 3) the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Low heart rate variability, the outcome, was defined by Results The average age was 78 years, 66% (n = 497) were women, and 58% (n = 438) were African American. Estimates of association were not robust at all levels of HOMA-IR, TyG, and TG/HDL-C, but suggest that high indexes were associated consistently with indicators of vagal activity. High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low RMSSD (OR: 1.68 (1.00, 2.81), OR: 2.03 (1.21, 3.39), and OR: 1.73 (1.01, 2.91), respectively). High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low HF (OR: 1.90 (1.14, 3.18), OR: 1.98 (1.21, 3.25), and OR: 1.76 (1.07, 2.90), respectively). Conclusions In older adults without diabetes, insulin resistance was associated with reduced cardiac autonomic function – specifically and consistently for indicators of vagal activity – measured during daily activities. Primary prevention of insulin resistance may reduce the related risk of cardiac autonomic dysfunction.
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- 2020
30. Smoking Reduction Among Current Smokers and Cause-Specific Mortality: The NHLBI Pooled Cohorts Study
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Elizabeth C. Oelsner, Paulo H M Chaves, William B. White, Anne B. Newman, George T. O'Connor, Amanda R. Mathew, J. Gibilaro, Patricia A. Cassano, Joseph E. Schwartz, Sachin Yende, David R. Jacobs, Richard A. Kronmal, Ravi Kalhan, Lewis J. Smith, Miranda R. Jones, Aaron R. Folsom, Laura R. Loehr, N.D. Freedman, Benjamin M. Smith, Surya P. Bhatt, Pallavi Balte, David Couper, and Stephanie J. London
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business.industry ,Medicine ,Cause specific mortality ,Current (fluid) ,business ,Smoking Reduction ,Demography - Published
- 2020
31. Associations Between Metabolic Syndrome and Longitudinal Respiratory Outcomes: The NHLBI Pooled Cohorts Study
- Author
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Elizabeth C. Oelsner, William B. White, Richard A. Kronmal, David R. Jacobs, Anne B. Newman, Paulo H M Chaves, Ravi Kalhan, Lewis J. Smith, Joseph E. Schwartz, Pallavi Balte, David Couper, Stephanie J. London, Patricia A. Cassano, Sachin Yende, Paul L. Enright, Laura R. Loehr, George T. O'Connor, and Benjamin M. Smith
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Medicine ,Respiratory system ,Metabolic syndrome ,business ,medicine.disease - Published
- 2020
32. Association of Ventricular Arrhythmias With Dementia: The Atherosclerosis Risk in Communities (ARIC) Study
- Author
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Mary R. Rooney, Faye L. Norby, Rebecca F. Gottesman, Thomas H. Mosley, Josef Coresh, Ankit Maheshwari, Elsayed Z. Soliman, Alvaro Alonso, Lin Y. Chen, Laura R. Loehr, Ryan J. Koene, and Michael Zhang
- Subjects
Tachycardia ,Male ,medicine.medical_specialty ,Cross-sectional study ,Population ,Comorbidity ,Ventricular tachycardia ,Article ,White People ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Dementia ,Humans ,030212 general & internal medicine ,Prospective Studies ,education ,Prospective cohort study ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,medicine.disease ,Atherosclerosis ,Health Surveys ,Ventricular Premature Complexes ,United States ,Black or African American ,Cross-Sectional Studies ,Ambulatory ,Cardiology ,Electrocardiography, Ambulatory ,Tachycardia, Ventricular ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
ObjectiveWe performed a cross-sectional analysis to determine whether nonsustained ventricular tachycardia (NSVT) and premature ventricular contractions (PVCs) were associated with dementia in a population-based study.MethodsWe included 2,517 (mean age 79 years, 26% Black) participants who wore a 2-week ambulatory continuous ECG recording device in 2016 to 2017. NSVT was defined as a wide-complex tachycardia ≥4 beats with a rate >100 bpm. We calculated NSVT and PVC burden as the number of episodes per day. Dementia was adjudicated by experts. We used logistic regression to assess the associations of NSVT and PVCs with dementia.ResultsThe mean recording time of the Zio XT Patch was 12.6 ± 2.6 days. There were 768 (31%) participants with NSVT; prevalence was similar in White and Black participants. There were 134 (6.5%) dementia cases (5% in White, 10% in Black participants). After multivariable adjustment, there was no overall association between NSVT and dementia; however, there was a significant race interaction (p < 0.001). In Black participants, NSVT was associated with a 3.67 times higher adjusted odds of dementia (95% confidence interval [CI] 1.92–7.02) compared to those without NSVT, whereas in White participants NSVT was not associated with dementia (odds ratio [95% CI] 0.64 [0.37–1.10]). In Black participants only, a higher burden of PVCs was associated with dementia.ConclusionsPresence of NSVT and a higher burden of NSVT and PVCs are associated with dementia in elderly Black people. Further research to confirm this novel finding and to elucidate the underlying mechanisms is warranted.
- Published
- 2020
33. Association of Sleep Apnea, Diagnosed by Self-Reported Physician Diagnosis or Hospital Discharge Codes, With Atrial Fibrillation and Ectopy Using Ambulatory Electrocardiogram in the ARIC Study
- Author
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Takeki Suzuki, Elsayed Z. Soliman, Michelle L. Meyer, Lin Y. Chen, Laura R. Loehr, Alvaro Alonso, and Kapuaola S. Gellert
- Subjects
medicine.medical_specialty ,Ambulatory electrocardiogram ,business.industry ,Sleep apnea ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Sleep apnea syndromes ,Physiology (medical) ,Internal medicine ,Hospital discharge ,Cardiology ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Aric study - Published
- 2020
34. Goal‐Striving Stress and Incident Cardiovascular Disease in Blacks: The Jackson Heart Study
- Author
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Mario Sims, Emily C. O'Brien, Laura R. Loehr, Sharrelle Barber, Loretta R. Cain-Shields, Tanya M. Spruill, and LáShauntá M. Glover
- Subjects
Gerontology ,Adult ,Male ,obesity ,Race and Ethnicity ,hypertension ,Time Factors ,Epidemiology ,Social Determinants of Health ,Health Status ,Disease ,030204 cardiovascular system & hematology ,goal‐striving stress ,Risk Assessment ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Mississippi ,Sex Factors ,cardiovascular disease ,Diabetes mellitus ,Medicine ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Prospective Studies ,Original Research ,Aged ,Aged, 80 and over ,business.industry ,Incidence ,JHS (Jackson Heart Study) ,Spotlight on Psychosocial Factors and Cardiovascular Disease ,Middle Aged ,medicine.disease ,blacks ,Prognosis ,Obesity ,Race Factors ,Black or African American ,Socioeconomic Factors ,Cardiovascular Diseases ,Heart Disease Risk Factors ,diabetes mellitus ,Female ,Cardiology and Cardiovascular Medicine ,business ,Goals ,Stress, Psychological - Abstract
Background Goal‐striving stress (GSS), the stress from striving for goals, is associated with poor health. Less is known about its association with cardiovascular disease (CVD). Methods and Results We used data from the JHS (Jackson Heart Study), a study of CVD among blacks (21–95 years old) from 2000 to 2015. Participants free of CVD at baseline (2000–2004) were included in this analysis (n=4648). GSS was examined in categories (low, moderate, high) and in SD units. Incident CVD was defined as fatal or nonfatal stroke, coronary heart disease (CHD), and/or heart failure. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident CVD by levels of GSS, adjusting for demographics, socioeconomic status, health behaviors, risk factors, and perceived stress. The distribution of GSS categories was as follows: 40.77% low, 33.97% moderate, and 25.26% high. Over an average of 12 years, there were 140 incident stroke events, 164 CHD events, and 194 heart failure events. After full adjustment, high (versus low) GSS was associated with a lower risk of stroke (HR, 0.38; 95% CI, 0.17–0.83) and a higher risk of CHD (HR, 1.91; 95% CI, 1.10–3.33) among women. A 1‐standard deviation unit increase in GSS was associated with a 31% increased risk of CHD (HR, 1.31; 95% CI, 1.10–1.56) among women. Conclusions Higher GSS may be a risk factor for developing CHD among women; however, it appears to be protective of stroke among women. These analyses should be replicated in other samples of black individuals.
- Published
- 2020
35. Abstract P424: Low Liver Enzymes, Cognitive Performance and Dementia. The Atherosclerosis Risk in Communities Neurocognitive Study (aric-ncs)
- Author
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James R Pike, Laura R. Loehr, Alvin G. Thomas, Gerardo Heiss, Elizabeth Selvin, Yifei Lu, Priya Palta, David S. Knopman, A. Richey Sharrett, and Thomas H. Mosley
- Subjects
medicine.medical_specialty ,business.industry ,Cognition ,medicine.disease ,Atherosclerosis Risk in Communities ,Physiology (medical) ,Internal medicine ,Liver enzyme ,medicine ,Dementia ,Effects of sleep deprivation on cognitive performance ,Alanine aminotransferase ,Cardiology and Cardiovascular Medicine ,business ,Cognitive impairment ,Neurocognitive - Abstract
Introduction: Low levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) among older adults are associated with mortality, and reportedly with lower cognitive performance, biomarkers of neurodegeneration, and dementia. We tested the associations of liver enzymes with cognition in ARIC-NCS. Methods: We studied 3191 participants (mean age 79 years, 59% female, 23% black) free of chronic liver disease and cirrhosis, and with AST:ALT ratio ≤2 at visit in 2016-2017. Serum ALT and AST were examined continuously and by quintiles, with the 3 rd quintile as the distribution-based modal reference range. Cognitive status (normal, mild cognitive impairment [MCI], dementia) was ascertained by an expert adjudication panel. A composite global cognition score was estimated from memory, executive function, and language tests. We used demographic and ApoE4 adjusted multinomial logistic and linear regressions. Results: Participants were classified as cognitively unimpaired (2375), MCI (602) or dementia (214). Lower levels of ALT and AST, and a higher AST:ALT ratio were associated with higher prevalence of dementia and lower global cognition scores ( Figure ). The prevalence odds ratio of dementia and MCI for the 1 st quintile, vs 3 rd quintile of ALT, were 1.73 (95% CI:1.06-2.81) and 1.27 (0.92-1.76), respectively. The corresponding estimates for AST were 1.71 (1.03-2.84) and 1.17 (0.87-1.59). Global cognition scores were lower in the 1 st vs 3 rd quintiles of ALT and AST by 0.13 (0.06-0.21) and 0.08 (0-0.15) standard deviation units, respectively. Additional adjustment for alcohol intake did not change the results. Conclusions: Liver hypometabolism is linked to reduced brain glucose metabolism, impaired production of neurotransmitters and synaptic maintenance, systemic insulin resistance and inflammation, while hepatic metabolite profiles are altered in dementia. Prospective assessments are warranted to characterize the role of hepatic metabolic dysfunction in cognitive impairment among older adults.
- Published
- 2020
36. Whole genome sequence analysis of pulmonary function and COPD in 19,996 multi-ethnic participants
- Author
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Namrata Gupta, Peter Durda, Elizabeth C. Oelsner, Martha L. Daviglus, Martin D. Tobin, James G. Wilson, Liana K. Preudhomme, Laura R. Loehr, Ingo Ruczinski, Pallavi Balte, Ramachandran S. Vasan, R. Graham Barr, Phuwanat Sakornsakolpat, Stephanie J. London, Robert M. Reed, Elaine Cornell, Josée Dupuis, Dandi Qiao, Dmitry Prokopenko, Russell P. Tracy, Alanna C. Morrison, Robert C. Kaplan, Cathy C. Laurie, Sina A. Gharib, Donna M. Muzny, Kent D. Taylor, Cecelia A. Laurie, Wonji Kim, Stephen S. Rich, Brian E. Cade, Kristin M. Burkart, Tamar Sofer, George T. O'Connor, Chiara Batini, Louise V. Wain, Leslie A. Lange, Ani Manichaikul, Susan Redline, Yanlin Ma, Bruce M. Psaty, Xutong Zhao, Yongmei Liu, Chaojie Yang, Edwin K. Silverman, David J. Vandenberg, Deborah A. Nickerson, George J. Papanicolaou, Bing Yu, L. Adrienne Cupples, Kathleen C. Barnes, François Aguet, Silva Kasela, Stacey Gabriel, Kristin G. Ardlie, Xiuqing Guo, Gonçalo R. Abecasis, Shannon Dugan-Perez, Harshavardhan Doddapaneni, Jerome I. Rotter, Ginger A. Metcalf, W. Craig Johnson, Michelle Daya, Nick Shrine, Sarah A Gagliano Taliun, Traci M. Bartz, Jiwon Lee, Deepti Jain, Tuuli Lappalainen, and Michael H. Cho
- Subjects
0301 basic medicine ,Male ,TOPMed Lung Working Group ,General Physics and Astronomy ,Genome-wide association study ,Genome-wide association studies ,Pulmonary function testing ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Polymorphism (computer science) ,80 and over ,2.1 Biological and endogenous factors ,DNA sequencing ,Aetiology ,lcsh:Science ,Lung ,Genetics ,African Americans ,Aged, 80 and over ,COPD ,education.field_of_study ,Multidisciplinary ,Chronic obstructive pulmonary disease ,Intracellular Signaling Peptides and Proteins ,Single Nucleotide ,Middle Aged ,Biobank ,Protein Inhibitors of Activated STAT ,030220 oncology & carcinogenesis ,Respiratory ,Respiratory Physiological Phenomena ,Small Ubiquitin-Related Modifier Proteins ,Female ,Biotechnology ,Adult ,Chronic Obstructive ,Chronic Obstructive Pulmonary Disease ,Science ,Population ,Alpha-Ketoglutarate-Dependent Dioxygenase FTO ,and over ,Biology ,Polymorphism, Single Nucleotide ,General Biochemistry, Genetics and Molecular Biology ,Article ,Pulmonary Disease ,03 medical and health sciences ,NHLBI Trans-Omics for Precision Medicine (TOPMed) Consortium ,medicine ,Humans ,Genetic Predisposition to Disease ,Polymorphism ,education ,Aged ,Whole genome sequencing ,Whole Genome Sequencing ,Human Genome ,Calcium-Binding Proteins ,General Chemistry ,Precision medicine ,medicine.disease ,respiratory tract diseases ,Black or African American ,030104 developmental biology ,Good Health and Well Being ,Genetic Loci ,Feasibility Studies ,lcsh:Q ,2.4 Surveillance and distribution ,Follow-Up Studies ,Genome-Wide Association Study - Abstract
Chronic obstructive pulmonary disease (COPD), diagnosed by reduced lung function, is a leading cause of morbidity and mortality. We performed whole genome sequence (WGS) analysis of lung function and COPD in a multi-ethnic sample of 11,497 participants from population- and family-based studies, and 8499 individuals from COPD-enriched studies in the NHLBI Trans-Omics for Precision Medicine (TOPMed) Program. We identify at genome-wide significance 10 known GWAS loci and 22 distinct, previously unreported loci, including two common variant signals from stratified analysis of African Americans. Four novel common variants within the regions of PIAS1, RGN (two variants) and FTO show evidence of replication in the UK Biobank (European ancestry n ~ 320,000), while colocalization analyses leveraging multi-omic data from GTEx and TOPMed identify potential molecular mechanisms underlying four of the 22 novel loci. Our study demonstrates the value of performing WGS analyses and multi-omic follow-up in cohorts of diverse ancestry., Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality. Here, the authors analyse whole genome sequence data and find new loci associated with lung function and COPD.
- Published
- 2020
37. Trends in Hospitalizations and Survival of Acute Decompensated Heart Failure in Four US Communities (2005–2014)
- Author
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Laura R. Loehr, Joseph S. Rossi, Stuart D. Russell, Suma H Konety, Wayne D. Rosamond, Carlos J. Rodriguez, Lisa M. Wruck, Patricia P. Chang, Sunil K. Agarwal, and Eyal Shahar
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Acute decompensated heart failure ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,White People ,03 medical and health sciences ,Patient Admission ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Epidemiology ,Case fatality rate ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Aric study ,Aged ,Retrospective Studies ,Heart Failure ,Ejection fraction ,business.industry ,Age Factors ,Stroke Volume ,Retrospective cohort study ,Health Status Disparities ,Stroke volume ,Middle Aged ,medicine.disease ,United States ,Black or African American ,Outcome and Process Assessment, Health Care ,Treatment Outcome ,Heart failure ,Female ,Cardiology and Cardiovascular Medicine ,business ,Demography - Abstract
Background: Community trends of acute decompensated heart failure (ADHF) in diverse populations may differ by race and sex. Methods: The ARIC study (Atherosclerosis Risk in Communities) sampled heart failure-related hospitalizations (≥55 years of age) in 4 US communities from 2005 to 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification codes. ADHF hospitalizations were validated by standardized physician review and computer algorithm, yielding 40 173 events after accounting for sampling design (unweighted n=8746). Results: Of the ADHF hospitalizations, 50% had reduced ejection fraction, and 39% had preserved EF (HFpEF). HF with reduced ejection fraction was more common in black men and white men, whereas HFpEF was most common in white women. Average age-adjusted rates of ADHF were highest in blacks (38.1 per 1000 black men, 30.5 per 1000 black women), with rates differing by HF type and sex. ADHF rates increased over the 10 years (average annual percentage change: black women +4.3%, black men +3.7%, white women +1.9%, white men +2.6%), mostly reflecting more acute HFpEF. Age-adjusted 28-day and 1-year case fatality proportions were ≈10% and 30%, respectively, similar across race-sex groups and HF types. Only blacks showed decreased 1-year mortality over time (average annual percentage change: black women –5.4%, black men –4.6%), with rates differing by HF type (average annual percentage change: black women HFpEF –7.1%, black men HF with reduced ejection fraction –4.7%). Conclusions: Between 2005 and 2014, trends in ADHF hospitalizations increased in 4 US communities, primarily driven by acute HFpEF. Survival at 1 year was poor regardless of EF but improved over time for black women and black men.
- Published
- 2018
38. Harmonization of Respiratory Data From 9 US Population-Based Cohorts
- Author
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Ravi Kalhan, R. Graham Barr, Patricia A. Cassano, Yiyi Zhang, Laura R. Loehr, Andrew E. Moran, Joseph E. Schwartz, Richard A. Kronmal, Aaron R. Folsom, Leslie A. Lange, Pallavi Balte, Fawn Yeh, Robert C. Kaplan, John L. Hankinson, Anne B. Newman, Stanford Mwasongwe, Ana Navas Acien, Paul L. Enright, Sachin Yende, David Couper, Stephanie J. London, Lewis J. Smith, George T. O'Connor, David R. Jacobs, Wendy B. White, and Elizabeth C. Oelsner
- Subjects
Spirometry ,education.field_of_study ,COPD ,medicine.diagnostic_test ,Epidemiology ,business.industry ,Population ,MEDLINE ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,030212 general & internal medicine ,Young adult ,education ,business ,Demography ,Asthma ,Cause of death ,Cohort study - Abstract
Chronic lower respiratory diseases (CLRDs) are the fourth leading cause of death in the United States. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed prebronchodilator spirometry and were harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for noncardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRD-related or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in 9 cohorts followed-up for CLRD-related mortality over 653,380 person-years during 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% white, 22% black, 28% Hispanic/Latino, and 5% American Indian. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry examinations (13%), there were 105,696 valid examinations (median, 2 per participant). Of 29,351 participants followed for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost to follow-up at 10 years. The NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.
- Published
- 2018
39. Initiation of antihypertensive monotherapy and incident fractures among Medicare beneficiaries
- Author
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Til Stürmer, Stephen W. Marshall, Yvonne M. Golightly, Carri Casteel, Laura R. Loehr, Jennifer L. Hargrove, and Virginia Pate
- Subjects
Gerontology ,medicine.medical_specialty ,medicine.drug_class ,Epidemiology ,Antihypertensive initiation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,Medical prescription ,Antihypertensive drug ,business.industry ,lcsh:Public aspects of medicine ,Hazard ratio ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,lcsh:RA1-1270 ,Original Contribution ,General Medicine ,lcsh:RC86-88.9 ,Confidence interval ,3. Good health ,Older adults ,Propensity score matching ,Biostatistics ,business ,Fractures ,Cohort study - Abstract
Background Research suggests antihypertensive medications are associated with fractures in older adults, however results are inconsistent and few have examined how the association varies over time. We sought to examine the association between antihypertensive class and incident non-vertebral fractures among older adults initiating monotherapy according to time since initiation. Methods We used a new-user cohort design to identify Medicare beneficiaries (≥ 65 years of age) initiating antihypertensive monotherapy during 2008–2011 using a 20% random sample of Fee-For-Service Medicare beneficiaries enrolled in parts A (inpatient services), B (outpatient services), and D (prescription medication) coverage. Starting the day after the initial antihypertensive prescription, we followed beneficiaries for incident non-vertebral fractures. We used multinomial logistic regression models to estimate propensity scores for initiating each antihypertensive drug class. Using these propensity scores, we weighted beneficiaries to achieve the same baseline covariate distribution as beneficiaries initiating with angiotensin-converting enzyme inhibitors. Lastly, we used weighted Cox proportional hazard models to estimate hazard ratios (HRs) of having an incident fractures according to antihypertensive class and time since initiation. Results During 2008–2011, 122,629 Medicare beneficiaries initiated antihypertensive monotherapy (mean age 75, 61% women, 86% White). Fracture rates varied according to days since initiation and antihypertensive class. Beneficiaries initiating with thiazides had the highest fracture rate in the first 14 days following initiation (438 per 10,000 person-years, 95% confidence interval (CI): 294–628; HR: 1.40, 0.78–2.52). However, beneficiaries initiating with calcium channel blockers had the highest fracture rate during the 15–365 days after initiation (435 per 10,000 person-years, 95% CI: 404–468; HR: 1.11, 1.00–1.24). Beneficiaries initiating with angiotensin-receptor blockers had the lowest fracture rates during the initial 14 days (333 per 10,000 person-years, 190–546, HR: 0.92, 0.49–1.75) and during 15–365 days after initiation (321 per 10,000 person-years, 287–358, HR: 0.96, 0.84–1.09). Conclusion The association between antihypertensives and fractures varied according to class and time since initiation. Results suggest that when deciding upon antihypertensive therapy, clinicians may want to consider possible fracture risks when choosing between antihypertensive drug classes. Electronic supplementary material The online version of this article (10.1186/s40621-017-0125-8) contains supplementary material, which is available to authorized users.
- Published
- 2017
40. Feasibility of a healthcare system-based tetralogy of Fallot patient registry
- Author
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Eric G. Jernigan, Jennifer S. Nelson, Audrey L. Khoury, Muntasir H. Chowdhury, and Laura R. Loehr
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,030225 pediatrics ,Epidemiology ,North Carolina ,medicine ,Humans ,Registries ,Retrospective Studies ,Tetralogy of Fallot ,Patient registry ,Descriptive statistics ,business.industry ,Incidence ,General Medicine ,Middle Aged ,medicine.disease ,Family medicine ,Pediatrics, Perinatology and Child Health ,Feasibility Studies ,Female ,Electronic data ,Diagnosis code ,Morbidity ,Outcomes research ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Follow-Up Studies ,Healthcare system - Abstract
BackgroundPatient-reported outcomes and epidemiological studies in adults with tetralogy of Fallot are lacking. Recruitment and longitudinal follow-up investigation across institutions is particularly challenging. Objectives of this study were to assess the feasibility of recruiting adult patients with tetralogy of Fallot for a patient-reported outcomes study, describe challenges for recruitment, and create an interactive, online tetralogy of Fallot registry.MethodsAdult patients living with tetralogy of Fallot, aged 18–58 years, at the University of North Carolina were identified using diagnosis code query. A survey was designed to collect demographics, symptoms, history, and birth mother information. Recruitment was attempted by phone (Part I, n=20) or by email (Part II, n=20). Data analysis included thematic grouping of recruitment challenges and descriptive statistics. Feasibility threshold was 75% for recruitment and for data fields completed per patient.ResultsIn Part I, 60% (12/20) were successfully contacted and eight (40%) were enrolled. Demographics and birth mother information were obtained for all enrolled patients. In Part II, 70% (14/20) were successfully contacted; 30% (6/20) enrolled and completed all data fields linked to REDCap database; the median time for survey completion was 8 minutes. Half of the patients had cardiac operations/procedures performed at more than one hospital. Automatic electronic data entry from the online survey was uncomplicated.ConclusionsAlthough recruitment (54%) fell below our feasibility threshold, enrolled individuals were willing to complete phone or online surveys. Incorrect contact information, privacy concerns, and patient-reported time constraints were challenges for recruitment. Creating an online survey and linked database is technically feasible and efficient for patient-reported outcomes research.
- Published
- 2017
41. Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation
- Author
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Eric A. Whitsel, Sunil K. Agarwal, Gerardo Heiss, Faye L. Norby, Elsayed Z. Soliman, Valentin Fuster, Laura R. Loehr, Josef Coresh, Alvaro Alonso, and Lin Y. Chen
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Population ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,Atherosclerosis Risk in Communities ,0302 clinical medicine ,Internal medicine ,Heart rate ,Cohort ,Cardiology ,Medicine ,Heart rate variability ,Cardiology and Cardiovascular Medicine ,business ,education ,030217 neurology & neurosurgery ,Balance (ability) - Abstract
Background Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear. Objectives This study sought to study the association between HRV and risk of AF. Methods This study included 11,715 middle-aged adults in the ARIC (Atherosclerosis Risk In Communities) cohort with heart rate and HRV measures obtained from 2-min electrocardiogram recordings performed at baseline (1987 to 1989). These measures included SD of normal-to-normal RR intervals, high-frequency (HF) (0.15 to 0.40 Hz), low-frequency (0.04 to 0.15 Hz), and the low-frequency/HF ratio (denoting a greater sympathetic to parasympathetic dominance). Incident AF cases were ascertained by electrocardiogram at ARIC follow-up visits, hospital discharge diagnosis, or death certificates through 2011. Results During an average follow-up of 19.4 years, 1,580 or 13.5% of participants developed AF. A baseline heart rate Conclusions Cardiac autonomic dysfunction denoted by low resting short-term HRV was associated with higher AF incidence. A low heart rate may be associated with higher AF risk. Further studies are needed to determine whether interventions in the general population to restore autonomic balance may prevent AF.
- Published
- 2017
42. Prevalence and Characteristics of Subclinical Atrial Fibrillation in a Community-Dwelling Elderly Population
- Author
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Elsayed Z. Soliman, Lin Y. Chen, Aaron R. Folsom, Faye L. Norby, Michael Zhang, Pamela L. Lutsey, Alvaro Alonso, Mary R. Rooney, Thomas H. Mosley, Josef Coresh, Rebecca F. Gottesman, and Laura R. Loehr
- Subjects
medicine.medical_specialty ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Population ,Atrial fibrillation ,medicine.disease ,Physiology (medical) ,Internal medicine ,Elderly population ,medicine ,Cardiology and Cardiovascular Medicine ,education ,Aric study ,business ,Electrocardiography ,Subclinical infection - Abstract
Background: The prevalence of subclinical atrial fibrillation (AF) in the elderly general population is unclear. We sought to define the prevalence of subclinical AF in a community-based elderly population and to characterize subclinical AF and the incremental diagnostic yield of 4 versus 2 weeks of continuous ECG monitoring. Methods: We conducted a cross-sectional analysis within the community-based multicenter observational ARIC study (Atherosclerosis Risk in Communities) using visit 6 (2016–2017) data. The 2616 ARIC study participants who wore a leadless, ambulatory ECG monitor (Zio XT Patch) for up to 2 weeks were aged 79±5 years, 42% men, and 26% black. In a subset, 386 participants without clinically recognized AF wore the monitor twice, each time for up to 2 weeks. We characterized the prevalence of subclinical AF (ie, AF detected on the Zio XT Patch without clinically recognized AF) over 2 weeks of monitoring and the diagnostic yield of 4 versus 2 weeks of monitoring. Results: The prevalence of subclinical AF was 2.5%; the prevalence of subclinical AF was 3.3% among white men, 2.5% among white women, 2.1% among black men, and 1.6% among black women. Subclinical AF was mostly intermittent (75%). Among those with intermittent subclinical AF, 91% had AF burden ≤10% during the monitoring period. In a subset of 386 participants without clinical AF, 78% more subclinical AF was detected by 4 weeks versus 2 weeks of ECG monitoring. Conclusions: In our study, the prevalence of subclinical AF was lower than previously reported and monitoring beyond 2 weeks provided substantial incremental diagnostic yield. Future studies should focus on individuals with higher risk to increase diagnostic yield and consider continuous monitoring duration longer than 2 weeks.
- Published
- 2019
43. Polycystic Ovary Syndrome Signs and Metabolic Syndrome in Premenopausal Hispanic/Latina Women: the HCHS/SOL Study
- Author
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Martha L. Daviglus, Gregory A. Talavera, Daniela Sotres-Alvarez, Jianwen Cai, Anne Z. Steiner, Laura R. Loehr, Michelle L. Meyer, and Larry Cousins
- Subjects
Adult ,medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,Clinical Biochemistry ,Population ,Context (language use) ,Biochemistry ,Body Mass Index ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Endocrinology ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,education ,Acne ,Menstrual cycle ,media_common ,Metabolic Syndrome ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Biochemistry (medical) ,nutritional and metabolic diseases ,Odds ratio ,Hispanic or Latino ,medicine.disease ,Polycystic ovary ,female genital diseases and pregnancy complications ,United States ,Online Only ,Cross-Sectional Studies ,Premenopause ,Female ,Metabolic syndrome ,business ,Body mass index ,Polycystic Ovary Syndrome - Abstract
Context Polycystic ovary syndrome (PCOS), a condition of androgen excess in women, is associated with cardiometabolic risk factors; however, this association is not fully characterized in a population-based sample of premenopausal women and high-risk groups such as Hispanics/Latinas. Objective We examined the association of PCOS signs and metabolic syndrome (MetS) in premenopausal Hispanic/Latina women. Methods This cross-sectional analysis includes 1427 women age 24 to 44 years from the Hispanic Community Health Study/Study of Latinos. PCOS signs included menstrual cycle greater than 35 days or irregular, self-reported PCOS, and oral contraceptive use to regulate periods or acne, and a composite of 1 or more PCOS signs. We calculated odds ratios (OR) and 95% CI for MetS, accounting for sociodemographic factors and the complex survey design; an additional model included body mass index (BMI). Results The mean age was 34 years and 30% reported any PCOS sign. The odds of MetS were higher in women reporting cycles greater than 35 days or irregular (OR 1.63; CI: 1.07-2.49) vs cycles 24 to 35 days, self-reported PCOS (OR 2.49; CI: 1.38-4.50) vs no PCOS, and any PCOS sign (OR 1.58; CI: 1.10-2.26) vs none. We found no association between OC use to regulate periods or acne and MetS (OR 1.1; CI: 0.6-1.8). When adjusting for BMI, only the association of self-reported PCOS and MetS was attenuated (OR 1.78; CI: 0.92-3.44). Conclusions In Hispanic/Latina women, irregular menstrual cycles, self-reported PCOS, and any PCOS sign were associated with MetS and could indicate women at metabolic disease risk.
- Published
- 2019
44. Asthma COPD Overlap Is Associated with Increased Mortality and Respiratory Events, the NHLBI Pooled Cohorts Study
- Author
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David R. Jacobs, Joseph E. Schwartz, Ravi Kalhan, Robert C. Kaplan, George T. O'Connor, Nirupama Putcha, Laura R. Loehr, Patricia A. Cassano, Pallavi Balte, Richard A. Kronmal, Paulo H M Chaves, Lewis J. Smith, David Couper, Stephanie J. London, Elizabeth C. Oelsner, William B. White, and Sachin Yende
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Medicine ,Asthma copd overlap ,Respiratory system ,business - Published
- 2019
45. Abstract MP21: Heart Failure Risk Associated With Optimal Levels of Modifiable HF Risk Factors: The Atherosclerosis Risk in Communities Study (ARIC)
- Author
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Lucia Kwak, Roger S. Blumenthal, Kunihiro Matsushita, Justin B. Echouffo-Tcheugui, Aaron R. Folsom, Gerardo Heiss, Joseph Coresh, Elizabeth Selvin, Chiadi E Ndumele, Roberta Florido, Laura R. Loehr, Christie M. Ballantyne, Carine E. Hamo, and Vijay Nambi
- Subjects
Atherosclerosis Risk in Communities ,business.industry ,Physiology (medical) ,Heart failure ,Environmental health ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Abstract
Background: Several heart failure (HF) risk factors, including hypertension, diabetes mellitus, obesity, and physical activity, are well described. However, the degree to which optimization of these modifiable risk factors might impact the incidence of HF is not yet fully defined. Hypothesis: We hypothesized more optimal control of major modifiable HF risk factors is associated with progressively lower HF risk. Methods: We performed a prospective analysis of 13,534 ARIC participants (mean age 57, 55% female), examining HF risk associations of different cutpoints of glycemia (HbA1c), systolic blood pressure (SBP), body mass index (BMI) and physical activity (assessed at Visit 2 [1990-92], except for physical activity assessed at Visit 1 (1987-89]). Optimal risk factor control was defined as HbA1c < 7%, SBP < 120 mmHg, BMI 18.5-25 kg/m 2 , and AHA-recommended activity levels. Severely uncontrolled risk factors were defined as HbA1c > 8%, SBP > 160 mmHg, BMI > 35 kg/m 2 and no exercise physical activity. Intermediate values were considered mild to moderately uncontrolled. Cox models simultaneously including all risk factors were constructed to assess associations of risk factor levels with incident HF (by discharge codes) after Visit 2 through 2016. Results: There were 2,827 HF events over a median 24 years of follow-up. Risk gradations were seen across categorizations of each risk factor (Table). In the full model, relative to optimal control, HRs were 2.06 for BMI ≥ 35 kg/m 2 , 1.16 for poor physical activity, 2.31 for HbA1c > 8% and 1.80 for SBP ≥ 160 mmHg. No risk gradient was seen from SBP < 120 to 140 mmHg among hypertensives. Incidence rates (per 1000 PYs) were 7.9 for all optimally controlled risk factors, 14.5 for 3-4 mild to moderately uncontrolled risk factors and 39.5 for 3-4 severely uncontrolled risk factors. Conclusion: Optimal control of modifiable risk factors is strongly linked to lower HF risk. Our findings suggest prioritizing optimization of existing risk factors may be central to successful strategies to prevent HF onset.
- Published
- 2019
46. Serum Metabolomics and Incidence of Atrial Fibrillation (from the Atherosclerosis Risk in Communities Study)
- Author
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Bing Yu, Wesley T. O'Neal, Lin Y. Chen, Eric Boerwinkle, Laura R. Loehr, Alvaro Alonso, Yan V. Sun, and Elsayed Z. Soliman
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Metabolite ,030204 cardiovascular system & hematology ,Gastroenterology ,White People ,Article ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Metabolomics ,Uridine ,Proportional Hazards Models ,Proportional hazards model ,business.industry ,Incidence (epidemiology) ,Incidence ,Hazard ratio ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Atherosclerosis ,Confidence interval ,Pyrrolidinones ,Black or African American ,030104 developmental biology ,chemistry ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Glycocholic Acid ,Cohort study - Abstract
We have previously identified associations of 2 circulating secondary bile acids (glycocholenate and glycolithocolate sulfate) with atrial fibrillation (AF) risk in 1,919 blacks in the Atherosclerosis Risk in Communities cohort. We aimed to replicate these findings in an independent sample of 2,003 white and black Atherosclerosis Risk in Communities participants, and performed a new metabolomic analysis in the combined sample of 3,922 participants, followed between 1987 and 2013. Metabolomic profiling was done in baseline serum samples using gas and liquid chromatography mass spectrometry. AF was ascertained from electrocardiograms, hospitalizations, and death certificates. We used multivariable Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of AF by 1 standard deviation difference of metabolite levels. Over a mean follow-up of 20 years, 608 participants developed AF. Glycocholenate sulfate was associated with AF in the replication and combined samples (HR 1.10, 95% CI 1.00, 1.21 and HR 1.13, 95% CI 1.04, 1.22, respectively). Glycolithocolate sulfate was not related to AF risk in the replication sample (HR 1.02, 95% CI 0.92, 1.13). An analysis of 245 metabolites in the combined cohort identified 3 additional metabolites associated with AF after multiple-comparison correction: pseudouridine (HR 1.18, 95% CI 1.10, 1.28), uridine (HR 0.86, 95% CI 0.79, 0.93) and acisoga (HR 1.17, 95% CI 1.09, 1.26). In conclusion, we replicated a prospective association among a previously identified secondary bile acid, glycocholenate sulfate, and AF incidence, and identified new metabolites involved in nucleoside and polyamine metabolism as markers of AF risk.
- Published
- 2019
47. The Association Between Parity and Subsequent Cardiovascular Disease in Women: The Atherosclerosis Risk in Communities Study
- Author
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Clare, Oliver-Williams, Catherine J, Vladutiu, Laura R, Loehr, Wayne D, Rosamond, and Alison M, Stuebe
- Subjects
Heart Failure ,breastfeeding ,Myocardial Infarction ,Pregnancy Outcome ,Coronary Disease ,Original Articles ,Middle Aged ,United States ,White People ,Black or African American ,Cohort Studies ,Stroke ,Parity ,Breast Feeding ,Cardiovascular Diseases ,Pregnancy ,Risk Factors ,cardiovascular disease ,Humans ,Female ,Follow-Up Studies ,Proportional Hazards Models - Abstract
Background: Previous studies are inconclusive on the relationship between parity and cardiovascular disease (CVD), with few evaluating multiple cardiovascular outcomes. It is also unclear if any relationship between parity and CVD is independent of breastfeeding. We examined the associations between parity and cardiovascular outcomes, including breastfeeding adjustment. Materials and Methods: Data were from 8,583 White and African American women, 45–64 years of age, in the Atherosclerosis Risk in Communities Study. Coronary heart disease (CHD), myocardial infarction (MI), heart failure, and strokes were ascertained from 1987 to 2016 by annual interviews and hospital surveillance. Parity and breastfeeding were self-reported. Cox proportional hazards regression estimated hazard ratios (HR) for the association between parity and cardiovascular outcomes, adjusting for baseline sociodemographic, clinical and lifestyle factors, and breastfeeding. Results: Women reported no pregnancies (6.0%), or having 0 (1.6%), 1–2 (36.2%), 3–4 (36.4%), or 5+ (19.7%) live births. During 30 years follow-up, there were 1,352 CHDs, 843 MIs, 750 strokes, and 1,618 heart failure events. Compared with women with 1–2 prior births, those with prior pregnancies and no live births had greater incident CHD (HR = 1.64, 95% confidence interval 1.14–2.42) and heart failure risk (1.46, 1.04–2.05), after adjustment for baseline characteristics. Women with 5+ births had greater risk of CHD (1.29, 1.10–1.52) and hospitalized MI (1.38, 1.13–1.69), after adjustment for baseline characteristics and breastfeeding. Conclusions: In a diverse U.S. cohort, a history of 5+ live births is associated with CHD risk, specifically, MI, independent of breastfeeding. Having a prior pregnancy and no live birth is associated with greater CHD and heart failure risk.
- Published
- 2018
48. Electrocardiographic Advanced Interatrial Block and Atrial Fibrillation Risk in the General Population
- Author
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Alvaro Alonso, Elsayed Z. Soliman, Laura R. Loehr, Lin Y. Chen, Zhu Ming Zhang, and Wesley T. O'Neal
- Subjects
Male ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Risk Assessment ,Article ,Diagnosis, Differential ,Electrocardiography ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Heart Conduction System ,Risk Factors ,Thromboembolism ,Internal medicine ,Atrial Fibrillation ,Prevalence ,Humans ,Medicine ,Interatrial Block ,Prospective Studies ,030212 general & internal medicine ,Poisson regression ,education ,education.field_of_study ,business.industry ,Proportional hazards model ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,Confounding ,Middle Aged ,United States ,Survival Rate ,Heart Block ,Population Surveillance ,Cardiology ,symbols ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Body mass index - Abstract
Although advanced interatrial block (aIAB) is an established electrocardiographic phenotype, its prevalence, incidence, and prognostic significance in the general population are unclear. We examined the prevalence, incidence, and prognostic significance of aIAB in 14,625 (mean age = 54 ± 5.8 years; 26% black; 55% female) participants from the Atherosclerosis Risk in Communities (ARIC) study. aIAB was detected from digital electrocardiograms recorded during 4 study visits (1987 to 1989, 1990 to 1992, 1993 to 1995, and 1996 to 1998). Risk factors for the development of aIAB were examined using multivariable Poisson regression models with robust variance estimates. Cox regression was used to compute hazard ratios and 95% CIs for the association between aIAB, as a time-dependent variable, and atrial fibrillation (AF). AF was ascertained from study electrocardiogram data, hospital discharge records, and death certificates thorough 2010. A total of 69 participants (0.5%) had aIAB at baseline, and 193 (1.3%) developed aIAB during follow-up. The incidence for aIAB was 2.27 (95% CI 1.97 to 2.61) per 1,000 person-years. Risk factors for aIAB development included age, male gender, white race, antihypertensive medication use, low-density lipoprotein cholesterol, body mass index, and systolic blood pressure. In a Cox regression analysis adjusted for sociodemographics, cardiovascular risk factors, and potential confounders, aIAB was associated with an increased risk for AF (hazard ratio 3.09, 95% CI 2.51 to 3.79). In conclusion, aIAB is not uncommon in the general population. Risk factors for developing aIAB are similar to those for AF, and the presence of aIAB is associated with an increased risk for AF.
- Published
- 2016
49. Temporal Trends in Hospitalization for Acute Decompensated Heart Failure in the United States, 1998–2011
- Author
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Sunil K. Agarwal, Laura R. Loehr, Jacqueline D. Wright, Kunihiro Matsushita, Miguel Quibrera, Gerardo Heiss, Patricia P. Chang, Wayne D. Rosamond, Lisa M. Wruck, and Josef Coresh
- Subjects
Male ,Gerontology ,medicine.medical_specialty ,Acute decompensated heart failure ,Epidemiology ,Minnesota ,Original Contributions ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,Mississippi ,0302 clinical medicine ,International Classification of Diseases ,Residence Characteristics ,North Carolina ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aged ,Heart Failure ,Discharge diagnosis ,Maryland ,business.industry ,Primary position ,Middle Aged ,medicine.disease ,Confidence interval ,Hospitalization ,Atherosclerosis Risk in Communities ,Heart failure ,Acute Disease ,Emergency medicine ,Female ,business ,Cohort study - Abstract
Estimates of the numbers and rates of acute decompensated heart failure (ADHF) hospitalization are central to understanding health-care utilization and efforts to improve patient care. We comprehensively estimated the frequency, rate, and trends of ADHF hospitalization in the United States. Based on Atherosclerosis Risk in Communities (ARIC) Study surveillance adjudicating 12,450 eligible hospitalizations during 2005–2010, we developed prediction models for ADHF separately for 3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 428 discharge diagnosis groups: 428 primary, 428 nonprimary, or 428 absent. We applied the models to data from the National Inpatient Sample (11.5 million hospitalizations of persons aged ≥55 years with eligible ICD-9-CM codes), an all-payer, 20% probability sample of US community hospitals. The average estimated number of ADHF hospitalizations per year was 1.76 million (428 primary, 0.80 million; 428 nonprimary, 0.83 million; 428 absent, 0.13 million). During 1998–2004, the rate of ADHF hospitalization increased by 2.0%/year (95% confidence interval (CI): 1.8, 2.5) versus a 1.4%/year (95% CI: 0.8, 2.1) increase in code 428 primary hospitalizations (P < 0.001). In contrast, during 2005–2011, numbers of ADHF hospitalizations were stable (−0.5%/year; 95% CI: −1.4, 0.3), while the numbers of 428-primary hospitalizations decreased by −1.5%/year (95% CI: −2.2, −0.8) (P for contrast = 0.03). In conclusion, the estimated number of hospitalizations with ADHF is approximately 2 times higher than the number of hospitalizations with ICD-9-CM code 428 in the primary position. The trend increased more steeply prior to 2005 and was relatively flat after 2005.
- Published
- 2016
50. Late Breaking Abstract - Accelerated lung function decline in former and light smokers: NHLBI Pooled Cohorts Study
- Author
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Elizabeth C. Oelsner, Joseph E. Schwartz, David Couper, Richard A. Kronmal, Stephanie J. London, Pallavi Balte, Aaron R. Folsom, George T. O'Connor, Surya P. Bhatt, Wendy B. White, Laura R. Loehr, Sachin Yende, Amanda Matthew, David R. Jacobs, Lewis J. Smith, Ravi Kalhan, Anne B. Newman, and Patricia A. Cassano
- Subjects
Spirometry ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Population ,Light smoker ,Former Smoker ,respiratory tract diseases ,03 medical and health sciences ,FEV1/FVC ratio ,0302 clinical medicine ,030228 respiratory system ,medicine ,Smoking cessation ,030212 general & internal medicine ,business ,education ,Smoking Reduction ,Lung function ,Demography - Abstract
Background: Limited data suggest normalization of lung function decline with smoking cessation and slower decline with smoking reduction; yet, mechanistic studies suggest ongoing risk. Aims: To test whether former and “light” smoking are associated with accelerated lung function decline compared to never smoking. Methods: The NHLBI Pooled Cohorts Study harmonized spirometry and other measures from US population-based cohorts. Smoking status was self-reported as never, former, or current at each exam. Light current smoking was defined as Results: 25,552 participants from 6 cohorts (mean age 53 years) contributed 70,411 spirometry exams over a median of 7 years. Forty percent were never smokers (NS), 28% sustained former smokers (FS), 10% sustained current smokers (CS), and 23% reported variable status. In adjusted models, compared to NS, FS demonstrated 1.8 mL/year faster FEV1 decline (95% CI, 1.3-2.4) and 19% faster FEV1/FVC decline (95% CI, 14%-24%); these were 20% and 25% of effect sizes for CS. Lung function decline was faster in current light smokers than NS or FS (P Conclusions: Former and light smoking were associated with faster lung function decline than never smoking.
- Published
- 2018
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