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Walking and Calcified Atherosclerotic Plaque in the Coronary Arteries: The National Heart, Lung, and Blood Institute Family Heart Study.
Imran TF, Patel Y, Ellison RC, Carr JJ, Arnett DK, Pankow JS, Heiss G, Hunt SC, Gaziano JM, Djoussé L
(2016) Arterioscler Thromb Vasc Biol 36: 1272-7
MeSH Terms: Adult, Aged, Aortic Diseases, Aortography, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Coronary Vessels, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Multidetector Computed Tomography, National Heart, Lung, and Blood Institute (U.S.), Plaque, Atherosclerotic, Prevalence, Protective Factors, Risk Assessment, Risk Factors, Risk Reduction Behavior, Surveys and Questionnaires, United States, Vascular Calcification, Walking
Show Abstract · Added September 29, 2016
OBJECTIVE - Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification.
APPROACH AND RESULTS - In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ≤3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35-0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52-0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36-0.81) for >15 to 22.5 Met-h/wk, (P trend=0.01). The walking-CAC relationship remained significant for those with body mass index ≥25 (P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking-aortic calcification association was not significant.
CONCLUSIONS - Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.
© 2016 American Heart Association, Inc.
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25 MeSH Terms
Pulmonary hypertension: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases.
Austin ED, Kawut SM, Gladwin MT, Abman SH
(2014) Ann Am Thorac Soc 11 Suppl 3: S178-85
MeSH Terms: Chronic Disease, Congresses as Topic, Humans, Hypertension, Pulmonary, Lung Diseases, National Heart, Lung, and Blood Institute (U.S.), Primary Prevention, United States
Show Abstract · Added May 29, 2014
Pulmonary vascular dysfunction (PVD) precedes the onset of clinical signs and symptoms of pulmonary arterial hypertension (PAH). PAH is defined by the elevation of pulmonary arterial pressure, which often progresses to right ventricular (RV) dysfunction and failure. PAH affects subjects of all ages, and is associated with diverse medical conditions, most of which are rare. Several factors pose immediate challenges to the development of strategies for primary prevention of PAH, including: (1) the idiopathic or primary form of the disease is extremely rare, limiting screening practicality; (2) methods for the detection of preclinical PVD are currently not established; (3) the understanding of determinants of pulmonary vascular growth, structure, and function in normal and PAH states is insufficient; (4) relatively small numbers of "at-risk" subjects are available for long-term studies to accurately assess disease development; and (5) preventative therapies for PVD are lacking. Despite these limitations, leveraging known at-risk patient populations for study, as well as growing progress across multiple disciplines, ranging from systems biology to advanced and more sensitive functional imaging modalities, may facilitate the opportunity to significantly improve primary prevention research and implementation over the next decade.
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8 MeSH Terms
Asthma: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases.
Jackson DJ, Hartert TV, Martinez FD, Weiss ST, Fahy JV
(2014) Ann Am Thorac Soc 11 Suppl 3: S139-45
MeSH Terms: Asthma, Chronic Disease, Congresses as Topic, Humans, Lung Diseases, National Heart, Lung, and Blood Institute (U.S.), Primary Prevention, United States
Show Abstract · Added May 27, 2014
Asthma is a common disease with enormous public health costs, and its primary prevention is an ambitious and important goal. Understanding of how host and environmental factors interact to cause asthma is incomplete, but persistent questions about mechanisms should not stop clinical research efforts aimed at reducing the prevalence of childhood asthma. Achieving the goal of primary prevention of asthma will involve integrated and parallel sets of research activities in which mechanism-oriented studies of asthma inception proceed alongside clinical intervention studies to test biologically plausible prevention ideas. For example, continued research is needed, particularly in young children, to uncover biomarkers that identify asthma risk and provide potential targets of intervention, and to improve understanding of the role of microbial factors in asthma risk and disease initiation. In terms of clinical trials that could be initiated now or in the near future, we recommend three interventions for testing: (1) preventing asthma through prophylaxis against respiratory syncytial virus and human rhinovirus infections of the airway; (2) immune modulation, using prebiotics, probiotics, and bacterial lysates; and (3) prevention of allergen sensitization and allergic inflammation, using anti-IgE. These interventions should be tested while other, more universal prevention measures that may promote lung health are also investigated. These potential universal lung health measures include prevention of preterm delivery; reduced exposure of the fetus and young infant to environmental pollutants, including tobacco smoke; prevention of maternal and child obesity; and management of psychosocial stress.
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8 MeSH Terms
Challenges facing early career academic cardiologists.
Tong CW, Ahmad T, Brittain EL, Bunch TJ, Damp JB, Dardas T, Hijar A, Hill JA, Hilliard AA, Houser SR, Jahangir E, Kates AM, Kim D, Lindman BR, Ryan JJ, Rzeszut AK, Sivaram CA, Valente AM, Freeman AM
(2014) J Am Coll Cardiol 63: 2199-208
MeSH Terms: Academic Medical Centers, Cardiology, Career Choice, Humans, Mentors, National Heart, Lung, and Blood Institute (U.S.), Physicians, United States
Show Abstract · Added May 4, 2014
Early career academic cardiologists currently face unprecedented challenges that threaten a highly valued career path. A team consisting of early career professionals and senior leadership members of American College of Cardiology completed this white paper to inform the cardiovascular medicine profession regarding the plight of early career cardiologists and to suggest possible solutions. This paper includes: 1) definition of categories of early career academic cardiologists; 2) general challenges to all categories and specific challenges to each category; 3) obstacles as identified by a survey of current early career members of the American College of Cardiology; 4) major reasons for the failure of physician-scientists to receive funding from National Institute of Health/National Heart Lung and Blood Institute career development grants; 5) potential solutions; and 6) a call to action with specific recommendations.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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8 MeSH Terms
Adult height and prevalence of coronary artery calcium: the National Heart, Lung, and Blood Institute Family Heart Study.
Miedema MD, Petrone AB, Arnett DK, Dodson JA, Carr JJ, Pankow JS, Hunt SC, Province MA, Kraja A, Gaziano JM, Djousse L
(2014) Circ Cardiovasc Imaging 7: 52-7
MeSH Terms: Adult, Age Factors, Aged, Body Height, Chi-Square Distribution, Coronary Angiography, Coronary Artery Disease, Female, Humans, Linear Models, Male, Middle Aged, Multivariate Analysis, National Heart, Lung, and Blood Institute (U.S.), Odds Ratio, Prevalence, Risk Factors, Tomography, X-Ray Computed, United States, Vascular Calcification
Show Abstract · Added February 15, 2014
BACKGROUND - Adult height has been hypothesized to be inversely associated with coronary heart disease; however, studies have produced conflicting results. We sought to examine the relationship between adult height and the prevalence of coronary artery calcium (CAC), a direct measure of subclinical atherosclerosis and surrogate marker of coronary heart disease.
METHODS AND RESULTS - We evaluated the relationship between adult height and CAC in 2703 participants from the National Heart, Lung, and Blood Institute Family Heart Study who underwent cardiac computed tomography. We used generalized estimating equations to calculate the prevalence odds ratios for the presence of CAC (CAC>0) across sex-specific quartiles of height. The mean age of the sample was 54.8 years, and 60.2% of participants were female. There was an inverse association between adult height and CAC. After adjusting for age, race, field center, waist circumference, smoking, alcohol, physical activity, systolic blood pressure, antihypertensive medications, diabetes mellitus, diabetic medications, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, lipid-lowering medications, and income, individuals in the tallest quartile had 30% lower odds of having prevalent CAC. The odds ratios (95% confidence intervals) for the presence of CAC across consecutive sex-specific quartiles of height were 1.0 (reference), 1.15 (0.86-1.53), 0.95 (0.73-1.22), and 0.70 (0.53-0.93), and P for trend<0.01. There was no evidence of effect modification for the relationship between adult height and CAC by age or socioeconomic status.
CONCLUSIONS - The results of our study suggest an inverse, independent association between adult height and CAC.
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20 MeSH Terms
PNPLA3 gene-by-visceral adipose tissue volume interaction and the pathogenesis of fatty liver disease: the NHLBI family heart study.
Graff M, North KE, Franceschini N, Reiner AP, Feitosa M, Carr JJ, Gordon-Larsen P, Wojczynski MK, Borecki IB
(2013) Int J Obes (Lond) 37: 432-8
MeSH Terms: Alcohol Drinking, Body Mass Index, Fatty Liver, Female, Gene Frequency, Genetic Predisposition to Disease, Genome-Wide Association Study, Genotype, Humans, Insulin Resistance, Intra-Abdominal Fat, Lipase, Liver, Male, Membrane Proteins, Middle Aged, National Heart, Lung, and Blood Institute (U.S.), Obesity, Polymorphism, Single Nucleotide, Radiography, Subcutaneous Fat, Abdominal, Triglycerides, United States
Show Abstract · Added February 15, 2014
BACKGROUND - Fatty liver disease (FLD) is characterized by increased intrahepatic triglyceride content with or without inflammation and is associated with obesity, and features of the metabolic syndrome. Several recent genome-wide association studies have reported an association between single-nucleotide polymorphism rs738409 in the (patatin-like phospholipase domain-containing protein 3) PNPLA3 gene and FLD. Liver attenuation (LA; hounsfield units, HU) by computed tomography is a non-invasive measure of liver fat, with lower values of HU indicating higher liver fat content. Clinically, a LA value of 40 HU indicates moderate-to-severe hepatic steatosis.
OBJECTIVE - We investigated whether missense rs738409 PNPLA3 interacted with abdominal visceral adipose tissue (VAT) volume (cm) to reduce LA (that is, increased liver fat) in 1019 European American men and 1238 European American women from the Family Heart Study.
METHODS - We used linear regression to test the additive effect of genotype, abdominal VAT, and their multiplicative interaction on LA adjusted for age, body mass index, high-density lipoprotein-cholesterol, insulin resistance, serum triglycerides, abdominal subcutaneous adipose tissue and alcohol intake.
RESULTS - In men and women combined, the interaction between each copy of the rs738409 variant allele (minor allele frequency 0.23) and 100 cm/150 mm slice VAT decreased LA by 2.68±0.35 HU (P<0.01). The interaction of 100 cm VAT and the variant allele was associated with a greater decrease in LA in women than men (-4.8±0.6 and -2.2±0.5 HU, respectively).
CONCLUSIONS - The interaction between genotype and VAT volume suggest key differences in the role of PNPLA3 genotype in conjunction with abdominal VAT in liver fat accrual. The stronger association of the PNPLA3 genotype and liver fat in women suggests that women may be more sensitive to liver fat accumulation in the setting of increased visceral fat, compared with men. The presence of the PNPLA3 variant genotype, particularly in the context of high VAT content may have an important role in FLD.
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23 MeSH Terms
How to approach genome wars in sepsis?
Hawiger J, Musser JM
(2011) Crit Care 15: 1007
MeSH Terms: Genomics, Humans, National Heart, Lung, and Blood Institute (U.S.), Sepsis, United States
Show Abstract · Added December 10, 2013
Sepsis continues to pose a clear challenge as one of the most difficult and costly problems to treat and prevent. Sepsis is caused by systemic or localized infections that damage the integrity of microcirculation in multiple organs. The challenge of sepsis and its long-term sequelae was addressed by the National Institutes of Health National Heart Lung and Blood Institute Division of Blood Diseases and Resources. Defining sepsis as severe endothelial dysfunction syndrome that causes multiorgan failure in response to intravascular or extravascular microbial agents, the National Heart Lung and Blood Institute panel proposed the concept of genome wars as a platform for new diagnostic, therapeutic, and preventive approaches to sepsis.
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5 MeSH Terms
Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop.
Fishman GI, Chugh SS, Dimarco JP, Albert CM, Anderson ME, Bonow RO, Buxton AE, Chen PS, Estes M, Jouven X, Kwong R, Lathrop DA, Mascette AM, Nerbonne JM, O'Rourke B, Page RL, Roden DM, Rosenbaum DS, Sotoodehnia N, Trayanova NA, Zheng ZJ
(2010) Circulation 122: 2335-48
MeSH Terms: Biomarkers, Death, Sudden, Cardiac, Health Planning Guidelines, Humans, National Heart, Lung, and Blood Institute (U.S.), Phenotype, Predictive Value of Tests, Risk Factors, United States
Added June 26, 2014
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9 MeSH Terms
Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute.
Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, Tu JV, Levy D
(2009) Circulation 119: 3070-7
MeSH Terms: Age of Onset, Aged, Aged, 80 and over, Blood Pressure, Cohort Studies, Female, Heart Failure, Humans, Male, Massachusetts, Middle Aged, National Heart, Lung, and Blood Institute (U.S.), Prognosis, Risk Factors, Sex Factors, Stroke Volume, Survival Rate, Time Factors, United States, Ventricular Function, Left
Show Abstract · Added April 15, 2014
BACKGROUND - The contributions of risk factors and disease pathogenesis to heart failure with preserved ejection fraction (HFPEF) versus heart failure with reduced ejection fraction (HFREF) have not been fully explored.
METHODS AND RESULTS - We examined clinical characteristics and risk factors at time of heart failure onset and long-term survival in Framingham Heart Study participants according to left ventricular ejection fraction < or =45% (n=314; 59%) versus >45% (n=220; 41%) and hierarchical causal classification. Heart failure was attributed to coronary heart disease in 278 participants (52%), valvular heart disease in 42 (8%), hypertension in 140 (26%), or other/unknown causes in 74 (14%). Multivariable predictors of HFPEF (versus HFREF) included elevated systolic blood pressure (odds ratio [OR]=1.13 per 10 mm Hg; 95% confidence interval [CI], 1.04 to 1.22), atrial fibrillation (OR=4.23; 95% CI, 2.38 to 7.52), and female sex (OR=2.29; 95% CI, 1.35 to 3.90). Conversely, prior myocardial infarction (OR=0.32; 95% CI, 0.19 to 0.53) and left bundle-branch block QRS morphology (OR=0.21; 95% CI, 0.10 to 0.46) reduced the odds of HFPEF. Long-term prognosis was grim, with a median survival of 2.1 years (5-year mortality rate, 74%), and was equally poor in men and women with HFREF or HFPEF.
CONCLUSIONS - Among community patients with new-onset heart failure, there are differences in causes and time-of-onset clinical characteristics between those with HFPEF versus HFREF. In people with HFREF, mortality is increased when coronary heart disease is the underlying cause. These findings suggest that heart failure with reduced left ventricular systolic function and heart failure with preserved left ventricular systolic function are partially distinct entities, with potentially different approaches to early detection and prevention.
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20 MeSH Terms