Publications by authors named "Erin D Michos"

531 Publications

Pulmonary Blood Volume Among Older Adults in the Community: The MESA Lung Study.

Circ Cardiovasc Imaging 2022 Aug 8:101161CIRCIMAGING122014380. Epub 2022 Aug 8.

Department of Medicine, Columbia University Medical Center, New York, NY (E.A.H., G.T.H., B.M.S., R.G.B.).

Background: The pulmonary vasculature is essential for gas exchange and impacts both pulmonary and cardiac function. However, it is difficult to assess and its characteristics in the general population are unknown. We measured pulmonary blood volume (PBV) noninvasively using contrast enhanced, dual-energy computed tomography to evaluate its relationship to age and symptoms among older adults in the community.

Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) is an ongoing community-based, multicenter cohort. All participants attending the most recent MESA exam were selected for contrast enhanced dual-energy computed tomography except those with estimated glomerular filtration rate <60 mL/min per 1.73 m. PBV was calculated by material decomposition of dual-energy computed tomography images. Multivariable models included age, sex, race/ethnicity, education, height, weight, smoking status, pack-years, and scanner model.

Results: The mean age of the 727 participants was 71 (range 59-94) years, and 55% were male. The race/ethnicity distribution was 41% White, 29% Black, 17% Hispanic, and 13% Asian. The mean±SD PBV in the youngest age quintile was 547±180 versus 433±194 mL in the oldest quintile (<0.001), with an approximately linear decrement of 50 mL per 10 years of age ([95% CI, 32-67]; <0.001). Findings were similar with multivariable adjustment. Lower PBV was associated independently with a greater dyspnea after a 6-minute walk (=0.04) and greater composite dyspnea symptom scores (=0.02). Greater PBV was also associated with greater height, weight, lung volume, Hispanic race/ethnicity, and nonsmoking history.

Conclusions: Pulmonary blood volume was substantially lower with advanced age and was associated independently with greater symptoms scores in the elderly.
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http://dx.doi.org/10.1161/CIRCIMAGING.122.014380DOI Listing
August 2022

Temporal trends in atherosclerotic cardiovascular disease risk among U.S. adults. Analysis of the National Health and Nutrition Examination Survey (NHANES), 1999-2018.

Eur J Prev Cardiol 2022 Aug 3. Epub 2022 Aug 3.

Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown.

Background: Atherosclerotic cardiovascular diseases are a significant cause of disability and mortality. Study of trends in cardiovascular risk at a population level helps understand the overall cardiovascular health and the impact of primary prevention efforts.

Aim: To assess trends in the estimated 10-year atherosclerotic cardiovascular disease(ASCVD) risk among U.S. adults from 1999-2000 to 2017-2018 with no established cardiovascular disease(CVD).

Methods: Serial cross-sectional analysis of National Health and Nutrition Examination Survey(NHANES) data from 1999-2000 to 2017-2018(10 cycles), including 24022 US adults aged 40-79 years with no reported atherosclerotic cardiovascular disease(ASCVD). ASCVD risk was assessed using the pooled cohort equations (PCE).

Results: There was a significant temporal decline in the mean 10-year ASCVD risk from 13.5% (95%CI, 12.5-14.4) in 1999-2000 to 11.1% (10.5-11.7) in 2011-2012 (ptrend <  0.001) and to 12.0% (11.3-12.7) in 2017-2018 (overall ptrend = 0.001), with the mean ASCVD risk score remaining stable from 2013-2014 through 2017-2018 (ptrend =  0.056). A declining trend in ASCVD risk was noted in females, non-Hispanic Blacks and those with income < 3 times the poverty threshold with ptrend of <0.001, 0.002, and 0.007, respectively. Mean total cholesterol and prevalence of smokers showed a downward trend (ptrend <0.001 for both) whereas type 2 diabetes and mean BMI showed an upward trend (ptrend <0.001 for both).

Conclusion: The 20-year trend of ASCVD risk among NHANES participants 40-79 years, as assessed by the use of PCE, showed a non-linear downward trend from 1999-2000 to 2017-2018. The initial and significant decline in estimated ASCVD risk from 1999-2000 to 2011-2012 subsequently stabilized, with no significant change from 2013-2014 to 2017-2018. Mean BMI and prevalence of diabetes mellitus increased while mean serum cholesterol levels and prevalence of smoking declined during the study period. Our findings support invigoration of efforts aimed at prevention of CVD, including primordial prevention of CVD risk factors.
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http://dx.doi.org/10.1093/eurjpc/zwac161DOI Listing
August 2022

Diabetes Duration and Subclinical Myocardial Injury: The Atherosclerosis Risk in Communities Study (ARIC).

Clin Chem 2022 Jul 27. Epub 2022 Jul 27.

Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA.

Background: Diabetes exerts adverse effects on the heart, and a longer diabetes duration is associated with greater heart failure risk. We studied diabetes duration and subclinical myocardial injury, as reflected by high-sensitivity cardiac troponin (hs-cTnT).

Methods: We analyzed 9052 participants without heart failure or coronary heart disease (mean age 63 years, 58% female, 21% Black, 15% with diabetes) at The Atherosclerosis Risk in Communities Study (ARIC) Visit 4 (1996 to 1998). Diabetes duration was calculated based on diabetes status at Visits 1 (1987 to 1989) through 4, or using self-reported age of diabetes diagnosis prior to Visit 1. We used multinomial logistic regression to determine the association of diabetes duration with increased (≥14 ng/L) or detectable (≥6 ng/L) Visit 4 hs-cTnT, relative to undetectable hs-cTnT, adjusted for demographics and cardiovascular risk factors.

Results: The prevalence of increased Visit 4 hs-cTnT was higher in persons with longer diabetes duration, from 12% for those with diabetes 0 to <5 years up to 31% among those with diabetes for ≥15 years (P for trend <0.0001). New onset diabetes at Visit 4 was associated with 1.92× higher relative risk (95% CI, 1.27-2.91) of increased hs-cTnT than no diabetes. Longer diabetes duration was associated with greater myocardial injury, with duration ≥15 years associated with 9.29× higher risk (95% CI, 5.65-15.29) for increased hs-cTnT and 2.07× (95% CI, 1.24-3.16) for detectable hs-cTnT, compared to no diabetes.

Conclusions: Longer diabetes duration is strongly associated with subclinical myocardial injury. Interventional studies are needed to assess whether the prevention and delay of diabetes onset can mitigate early myocardial damage.
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http://dx.doi.org/10.1093/clinchem/hvac117DOI Listing
July 2022

Supranormal Left Ventricular Ejection Fraction, Stroke Volume, and Cardiovascular Risk: Findings From Population-Based Cohort Studies.

JACC Heart Fail 2022 Aug;10(8):583-594

Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

Background: Supranormal ejection fraction by echocardiography in clinically referred patient populations has been associated with an increased risk of cardiovascular disease (CVD). The prognostic implication of supranormal left ventricular ejection fraction (LVEF)-assessed by cardiac magnetic resonance (CMR)-in healthy, community-dwelling individuals is unknown.

Objectives: The purpose of this study is to investigate the prognostic implication of supranormal LVEF as assessed by CMR and its inter-relationship with stroke volume among community-dwelling adults without CVD.

Methods: Participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) cohorts free of CVD who underwent CMR with LVEF above the normal CMR cutoff (≥57%) were included. The association between cohort-specific LVEF categories and risk of clinically adjudicated major adverse cardiovascular events (MACE) was assessed using adjusted Cox models. Subgroup analysis was also performed to evaluate the association of LVEF and risk of MACE among individuals stratified by left ventricular stroke volume index.

Results: The study included 4,703 participants from MESA and 2,287 from DHS with 727 and 151 MACE events, respectively. In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs Q1) in both cohorts after accounting for potential confounders (MESA: HR = 1.27 [95% CI: 1.01-1.60], P = 0.04; DHS: HR = 1.72 [95% CI: 1.05-2.79], P = 0.03). A significant interaction was found between the continuous measures of LVEF and left ventricular stroke volume index (P interaction = 0.02) such that higher LVEF was significantly associated with an increased risk of MACE among individuals with low but not high stroke volume.

Conclusions: Among community-dwelling adults without CVD, LVEF in the supranormal range is associated with a higher risk of adverse cardiovascular outcomes, particularly in those with lower stroke volume.
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http://dx.doi.org/10.1016/j.jchf.2022.05.007DOI Listing
August 2022

Recent Updates in Hypertriglyceridemia Management for Cardiovascular Disease Prevention.

Curr Atheroscler Rep 2022 Jul 27. Epub 2022 Jul 27.

Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524-C, Baltimore, MD, 21287, USA.

Purpose Of Review: Mounting evidence continues to support the causal role of triglyceride-rich lipoproteins (TRL) in the development of atherosclerotic cardiovascular disease (ASCVD). Substantial residual ASCVD risk remains among high-risk patients who have elevated triglycerides despite reduction in low-density lipoprotein cholesterol (LDL-C) with statin therapy. Ongoing research efforts have focused on evaluating triglyceride-lowering therapies among patients with hypertriglyceridemia.

Recent Findings: The REDUCE-IT trial showed that the addition of icosapent ethyl, a highly purified form of eicosapentaenoic acid (EPA), can reduce vascular events among statin-treated individuals with elevated triglycerides who have either clinical ASCVD or diabetes plus another risk factor. Although additional evidence for EPA has emerged from other trials, conflicting results have been reported by subsequent trials that tested different omega-3 fatty acid formulations. Randomized clinical trials have not demonstrated incremental ASCVD benefit of fibrates on background of statin therapy, but fibrates are used to help prevent pancreatitis in patients with severe hypertriglyceridemia. Selective inhibitors of apolipoprotein C-III (apoC3) and angiopoietin-like protein 3 (ANGPTL3), proteins that are involved in metabolism of TRLs by regulating lipoprotein lipase, have been tested in selected patient populations and showed significant reduction in triglyceride and LDL-C levels. Statin therapy continues to be the cornerstone of pharmacologic reduction of cardiovascular risk. High-dose EPA in the form of icosapent ethyl has been demonstrated to have cardiovascular benefit on top of statins in persons with elevated triglycerides at high ASCVD risk. Ongoing clinical trials are evaluating novel selective therapies such as apoC3 and ANGPTL3 inhibitors.
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http://dx.doi.org/10.1007/s11883-022-01052-4DOI Listing
July 2022

Influenza Vaccination for Cardiovascular Prevention: Further Insights from the IAMI Trial and an Updated Meta-analysis.

Curr Cardiol Rep 2022 Jul 25. Epub 2022 Jul 25.

Division of Cardiology, Johns Hopkins University School of Medicine, Blalock 524-C, Baltimore, MD, 21287, USA.

Purpose Of Review: Influenza infection is a significant, well-established cause of cardiovascular disease (CVD) and CV mortality. Influenza vaccination has been shown to reduce major adverse cardiovascular events (MACE) and CV mortality. Therefore, major society guidelines have given a strong recommendation for its use in patients with established CVD or high risk for CVD. Nevertheless, influenza vaccination remains underutilized. Historically, influenza vaccination is administered to stable outpatients. Until recently, the safety and efficacy of influenza vaccination among patients with acute myocardial infarction (MI) had not been established.

Recent Findings: The recently published Influenza Vaccination after Myocardial Infarction (IAMI) trial showed that influenza vaccination within 72 h of hospitalization for MI led to a significant 28% reduction in MACE and a 41% reduction in CV mortality, without any excess in serious adverse events. Additionally, we newly performed an updated meta-analysis of randomized clinical trials (RCTs) including IAMI and the recent Influenza Vaccine to Prevent Adverse Vascular Events (IVVE) trial. In pooled analysis of 8 RCTs with a total of 14,420 patients, influenza vaccine, as compared with control/placebo, was associated with significantly lower risk of MACE at follow-up [RR 0.75 (95%CI 0.57-0.97), I 56%]. The recent IAMI trial showed that influenza vaccination in patients with recent MI is safe and efficacious at reducing CV morbidity and mortality. Our updated meta-analysis confirms a 25% reduction in MACE. The influenza vaccine should be strongly encouraged in all patients with CVD and incorporated as an essential facet of post-MI care and secondary CVD prevention.
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http://dx.doi.org/10.1007/s11886-022-01748-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9310360PMC
July 2022

Coronary artery calcium and atherosclerotic cardiovascular disease risk in women with early menopause: The Multi-Ethnic Study of Atherosclerosis (MESA).

Am J Prev Cardiol 2022 Sep 13;11:100362. Epub 2022 Jun 13.

Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine; Baltimore, MD, USA.

Background And Aims: We aimed to determine the utility of coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk stratification in women with and without early menopause (EM).

Methods: To examine the association between CAC and incident ASCVD, we performed Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling using data from 2,456 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA) with or without EM, defined as occurring at <45 years of age.

Results: The cohort was 64.1 ± 9.1 years old and 28.0% experienced EM. There were 291 ASCVD events over 12.5 ± 3.6 year follow-up with a higher event rate among those with EM compared to those without EM of 13.6 vs. 9.0 per 1,000 year follow-up ( < 0.01). Women with EM had a slightly lower prevalence of CAC = 0 (55.1%) than women without EM (59.7%) ( = 0.04) despite no difference in mean age. Among women with CAC = 0, the cumulative incidence of ASCVD at 10 years was low-to-borderline for women with (5.4%) and without EM (3.2%) ( = 0.06). However, women with EM had a significantly higher 15-year risk with an adjusted HR of 1.96 (95% CI: 1.26-3.04). In multivariable Cox models, women with CAC ≥ 1 had progressively increased ASCVD risk that did not significantly differ by EM status.

Conclusion: In MESA, >50% of middle-aged postmenopausal women with EM had CAC = 0, similar to those without EM. Among women with CAC = 0, those with EM had a low to borderline 10-year risk of ASCVD, but the 15-year risk was significantly higher for women with EM versus those without EM. When CAC ≥ 1, the incidence of ASCVD was similar for women with and without EM. These findings support the use of CAC to help improve ASCVD risk stratification in women with EM.

Condensed Abstract: This study investigated the association between coronary artery calcium (CAC) and incident atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women with and without early menopause (EM). We found that >50% of women had CAC = 0 and an associated low-to-borderline 10-year cumulative incidence of ASCVD. However, the risk for ASCVD was significantly higher for women with EM after 15-years follow-up. Additional research is needed to better understand the differences in long-term ASCVD risk between women with and without EM who have CAC = 0.
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http://dx.doi.org/10.1016/j.ajpc.2022.100362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234594PMC
September 2022

P2Y12 Inhibitors versus Aspirin Monotherapy for Long-term Secondary Prevention of Atherosclerotic Cardiovascular Disease Events: A Systematic Review and Meta-analysis.

Curr Probl Cardiol 2022 Jun 25;47(10):101292. Epub 2022 Jun 25.

Department of Medical Education, University of Tennessee at Nashville, TN.

Patients with established atherosclerotic cardiovascular disease (ASCVD) need long-term antiplatelet therapy to decrease the risk of future ASCVD events. We searched PubMed, Cochrane Library, and ClinicalTrials.gov (inception through September 2021) for randomized controlled trials (RCTs) evaluating P2Y inhibitors vs aspirin for secondary prevention of ASCVD events. Seven RCTs including a total of 56,982 patients were included in this analysis. The median follow-up duration was 22.8 (IQR 12) months. When P2Y inhibitors were compared with aspirin as long-term antiplatelet therapy for secondary prevention of ASCVD events, there was a significant decrease in the risk of myocardial infarction [RR: 0.83; 95% CI: 0.72-0.94], and stroke [RR: 0.90; 95% CI: 0.83-0.99]. However, there was no significant difference in all-cause mortality [RR: 1.02; 95% CI: 0.92-1.12], or cardiovascular mortality [RR: 0.95; 95% CI: 0.83-1.08] between P2Y inhibitors and aspirin users. Additionally, there was no significant difference in major bleeding events [RR: 0.88; 95% CI: 0.74-1.04], or all bleeding events [RR: 1.09; 95% CI: 0.90-1.33] between P2Y inhibitors and aspirin groups. Use of P2Y inhibitor monotherapy is associated with lower rates of myocardial infarction and stroke in ASCVD patients without any significant difference in mortality, or bleeding compared to aspirin monotherapy.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101292DOI Listing
June 2022

Gender gap in annual preventive care services in France.

EClinicalMedicine 2022 Jul 27;49:101469. Epub 2022 May 27.

INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.

Background: In France, screening for cardiovascular risk factors is recommended during annual preventive visits. However, data are lacking on the temporal trend in women's uptake to preventive care services, and in cardiovascular and mortality outcomes The aim of the study was to investigate the participation and mortality of women in annual preventive care services in a major preventive medicine center in France.

Method: Ee conducted repeated cross-sectional studies including a total of 366,270 individuals who had a first examination at the Centre d'Investigations Préventives et Cliniques, France, between January 1992 and December 2011.

Findings: Women's participation was low below 50 years of age, then increases from 50 to 70 years, and is lower for women older than 70 years. The gap in female participation was more pronounced among individuals with high education, low social deprivation, and no depressive symptoms. Compared with the general population, the screened population had significantly lower standardized mortality ratios (SMRs) among both men and women, for all age ranges. Screened women aged 18-49 years showed a lower mortality gain compared with men of the same age; SMRs did not differ significantly by sex for individuals over 50 years.

Interpretation: In this community-based sample, compared with men, women's participation to annual preventive care services was lower, and screened women had a lower mortality gain. Despite the demonstrated benefit of annual check-ups on health, there is a gender gap in adherence to preventive programs and in efficiency of screening programs, especially in the young age range. This gap in cardiovascular disease prevention may result in poorer cardiovascular health in women. Urgent adaptations to overcome this gender gap in preventive screening in France are warranted.

Funding: Bamba Gaye is supported by the Fondation Recherche Médicale grant.
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http://dx.doi.org/10.1016/j.eclinm.2022.101469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9156877PMC
July 2022

Starting a Research Career in Cardiology: Advice for Fellows in Training and Early-Career Cardiologists.

Methodist Debakey Cardiovasc J 2022 3;18(3):49-58. Epub 2022 Jun 3.

Ciccarone Center for the Prevention of Cardiovascular Disease and Johns Hopkins University School of Medicine, Baltimore, Maryland, US.

Launching an academic career in cardiology can be challenging. Mentorship has long been considered a core component in the academic career advancement of trainees across different disciplines and career stages, including cardiovascular disease. But simply having a mentor may not be sufficient to embark on a successful academic journey in cardiology. In this paper, we share advice on starting a research career in cardiology from both the mentee and mentor viewpoints. These perspectives reflect academic career guidance models developed at the Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health, which is funded by an American Heart Association Strategic Focused Network grant, to emphasize training. Core principles include encouraging mentees to develop a unique professional identity cultivated by a diverse, collaborative, and effective mentorship and sponsorship team.
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http://dx.doi.org/10.14797/mdcvj.1108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165677PMC
June 2022

Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training.

Methodist Debakey Cardiovasc J 2022 3;18(3):14-23. Epub 2022 Jun 3.

Johns Hopkins University School of Medicine, Baltimore, Maryland, US.

Maternal mortality is rising in the United States, and cardiovascular disease is the leading cause. Adverse pregnancy outcomes such as preeclampsia and gestational diabetes heighten the risk of cardiovascular complications during pregnancy and the peripartum period and are associated with long-term cardiovascular risks. The field of cardio-obstetrics is a subspecialty within adult cardiology that focuses on the management of women with or at high risk for heart disease who are considering pregnancy or have become pregnant. There is growing recognition of the need for more specialists with dedicated expertise in cardio-obstetrics to improve the cardiovascular care of this high-risk patient population. Current recommendations for cardiovascular fellowship training programs accredited by the Accreditation Council for Graduate Medical Education involve establishing core competency in the knowledge of managing heart disease in pregnancy. However, little granular detail is available of what such training should entail, which can lead to knowledge gaps. Additionally, dedicated advanced subspecialty training in this area is not commonly offered. Multidisciplinary collaborative teams have been shown to improve outcomes in cardiac patients during pregnancy, and cardiovascular fellows-in-training interested in cardio-obstetrics should have the opportunity to participate in and contribute to a pregnancy heart team. In this document, we describe a proposed specialized cardio-obstetrics training pathway that could serve to adequately prepare trainees to competently and comprehensively care for women with cardiovascular disease before, during, and after pregnancy.
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http://dx.doi.org/10.14797/mdcvj.1101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165665PMC
June 2022

Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations.

Prog Cardiovasc Dis 2022 Jun 17. Epub 2022 Jun 17.

Division of Cardiology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA, United States of America. Electronic address:

Background: Dementia and cardiovascular diseases contribute to a significant disability and healthcare utilization in the elderly.

Objective: The in-hospital treatment patterns and outcomes of heart failure (HF) and acute myocardial infarction (AMI) are not well-studied in this population.

Methods: We used the National Inpatient Sample database to identify AMI and HF hospitalizations in adults ≥65 years between 2016 and 2018.

Results: A total of 2,466,369 HF hospitalizations (277,900 with dementia [11.3%]) and 1,094,155 AMI hospitalizations (100,365 with dementia [9.2%]) were identified. Patients with dementia were older (mean age 83.8 vs 78.6 years for HF, and 83.0 vs 75.8 years for AMI) with female predominance (59.0% for HF and 56.0% for AMI) than those without dementia. In adjusted analysis, patients with dementia had higher in-hospital mortality (HF 4.7% vs 3.1%, aOR 1.33 [1.27-1.39] and AMI 9.9% vs 5.9%, aOR 1.23 [1.17-1.30]), p < 0.001) and lower mechanical circulatory support utilization. Patients with AMI and dementia were less likely to receive revascularization (including percutaneous coronary intervention, coronary artery bypass grafting, and thrombolysis), vasopressors, and invasive mechanical ventilation. They had a longer mean length of stay (LOS) (5.5 vs 5.3 days for HF and 5.1 vs 4.8 days for AMI, p < 0.001 for both), a lower inflation-adjusted cost of care for AMI ($15,486 vs $23,215, p < 0.001), and higher rates of transfer to rehabilitation facilities.

Conclusion: Patients with dementia admitted for HF or AMI had higher in-hospital mortality, a longer LOS, and were less likely to receive aggressive revascularization interventions after AMI.
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http://dx.doi.org/10.1016/j.pcad.2022.06.007DOI Listing
June 2022

Trends, Predictors, and Outcomes of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations: A National Inpatient Sample Analysis (2002-2019).

J Am Heart Assoc 2022 Jun 16:e025839. Epub 2022 Jun 16.

Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD.

Background Women with polycystic ovary syndrome (PCOS) have an increased risk of pregnancy-associated complications. However, data on peripartum cardiovascular complications remain limited. Hence, we investigated trends, outcomes, and predictors of cardiovascular complications associated with PCOS diagnosis during delivery hospitalizations in the United States. Methods and Results We used data from the National Inpatient Sample (2002-2019). (), or (), codes were used to identify delivery hospitalizations and PCOS diagnosis. A total of 71 436 308 weighted hospitalizations for deliveries were identified, of which 0.3% were among women with PCOS (n=195 675). The prevalence of PCOS, and obesity among those with PCOS, increased during the study period. Women with PCOS were older (median, 31 versus 28 years; <0.01) and had a higher prevalence of diabetes, obesity, and dyslipidemia. After adjustment for age, race and ethnicity, comorbidities, insurance, and income, PCOS remained an independent predictor of cardiovascular complications, including preeclampsia (adjusted odds ratio [OR], 1.56 [95% CI, 1.54-1.59]; <0.01), eclampsia (adjusted OR, 1.58 [95% CI, 1.54-1.59]; <0.01), peripartum cardiomyopathy (adjusted OR, 1.79 [95% CI, 1.49-2.13]; <0.01), and heart failure (adjusted OR, 1.76 [95% CI, 1.27-2.45]; <0.01), compared with no PCOS. Moreover, delivery hospitalizations among women with PCOS were associated with increased length (3 versus 2 days; <0.01) and cost of hospitalization ($4901 versus $3616; <0.01). Conclusions Women with PCOS had a higher risk of preeclampsia/eclampsia, peripartum cardiomyopathy, and heart failure during delivery hospitalizations. Moreover, delivery hospitalizations among women with PCOS diagnosis were associated with increased length and cost of hospitalization. This signifies the importance of prepregnancy consultation and optimization for cardiometabolic health to improve maternal and neonatal outcomes.
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http://dx.doi.org/10.1161/JAHA.121.025839DOI Listing
June 2022

Oxidative Stress and Menopausal Status: The Coronary Artery Risk Development in Young Adults Cohort Study.

J Womens Health (Larchmt) 2022 07 8;31(7):1057-1065. Epub 2022 Jun 8.

Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Low endogenous estrogen concentrations after menopause may contribute to higher oxidative stress and greater cardiovascular disease (CVD) risk. However, differences in oxidative stress between similarly aged premenopausal and postmenopausal women are not well-characterized on a population level. We hypothesized that urinary isoprostane concentrations, a standard measure of systemic oxidative stress, are higher in women who have undergone menopause compared to premenopausal women. We examined differences in urinary 8-isoprostane (iPF-III) and 2,3-dinor-8-isoprostane (iPF-III-M) indexed to urinary creatinine between 279 postmenopausal and 196 premenopausal women in the Coronary Artery Risk Development in Young Adults (CARDIA) study, using linear regression with progressive adjustment for sociodemographic factors and traditional CVD risk factors. Unadjusted iPF-III-M concentrations were higher among postmenopausal compared to premenopausal women (Median [25th, 75th percentile]: 1762 [1178, 2974] vs. 1535 [1067, 2462] ng/g creatinine;  = 0.01). Menopause was associated with 25.5% higher iPF-III-M (95% confidence interval [6.5-47.9]) adjusted for age, race, college education, and field center. Further adjustments for tobacco use (21.2% [2.9-42.6]) and then CVD risk factors (18.8% [0.1-39.6]) led to additional partial attenuation. Menopause was associated with higher iPF-III in Black but not White women. We conclude that postmenopausal women had higher oxidative stress, which may contribute to greater CVD risk. ClinicalTrials.gov Identifier: NCT00005130.
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http://dx.doi.org/10.1089/jwh.2021.0248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9299529PMC
July 2022

National trends and disparities in statin use for ischemic heart disease from 2006 to 2018: Insights from National Ambulatory Medical Care Survey.

Am Heart J 2022 Oct 27;252:60-69. Epub 2022 May 27.

Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX.

Background: Statins are a cornerstone guideline-directed medical therapy for secondary prevention of ischemic heart disease (IHD). However, recent temporal trends and disparities in statin utilization for IHD have not been well characterized.

Methods: This retrospective analysis included data from outpatient adult visits with IHD from the National Ambulatory Medical Care Survey (NAMCS) between January 2006 and December 2018. We examined the trends and predictors of statin utilization in outpatient adult visits with IHD.

Results: Between 2006 and 2018, we identified a total of 542,704,112 weighted adult ambulatory visits with IHD and of those 46.6% were using or prescribed statin. Middle age (50-74 years) (adjusted odds ratio [aOR] 1.65, 95% confidence interval [CI] 1.28-2.13 P < .001) and old age (≥75 years) (aOR = 1.66, CI 1.26-2.19, P < .001) compared to young age (18-49 years), and male sex (aOR = 1.35, CI 1.23-1.48, P < .001) were associated with greater likelihood of statin utilization, whereas visits with non-Hispanic (NH) Black patients (aOR = 0.75, CI 0.61-0.91, P = .005) and Hispanic patients (aOR = 0.74, CI 0.60-0.92, P = .006) were associated with decreased likelihood of statin utilization compared to NH White patient visits. Compared with private insurance, statin utilization was nominally lower in Medicare (aOR = 0.91, CI 0.80-1.02, P = .112), Medicaid (aOR = 0.78, CI 0.59-1.02, P = .072) and self-pay/no charge (aOR = 0.72, CI 0.48-1.09, P = .122) visits, however did not reach statistical significance. There was no significant uptake in statin utilization from 2006 (44.1%) to 2018 (46.2%) (P = .549).

Conclusions: Substantial gaps remain in statin utilization for patients with IHD, with no significant improvement in use between 2006 and 2018. Persistent disparities in statin prescription remain, with the largest treatment gaps among younger patients, women, and racial/ethnic minorities (NH Blacks and Hispanics).
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http://dx.doi.org/10.1016/j.ahj.2022.05.015DOI Listing
October 2022

Hepatocyte growth factor is associated with greater risk of extracoronary calcification: results from the multiethnic study of atherosclerosis.

Open Heart 2022 05;9(1)

Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Background: Hepatocyte growth factor (HGF) is a biomarker with potential for use in the diagnosis, treatment and prognostication of cardiovascular disease (CVD). Elevated HGF is associated with calcification in the coronary arteries. However, knowledge is limited on the role HGF may play in extracoronary calcification (ECC). This study examined whether HGF is associated with ECC in the aortic valve (AVC), mitral annulus (MAC), ascending thoracic aorta and descending thoracic aortic (DTAC).

Methods: At baseline, adults aged 45-84 years, free of CVD, in the Multi-Ethnic Study of Atherosclerosis had HGF and ECC measured by ELISA and cardiac CT scan, respectively. ECC measurements were repeated after an average of 2.4 years of follow-up. Prevalent ECC was defined as Agatston score >0 at baseline. Incident ECC was defined as Agatston score >0 at follow-up among participants with Agatston score=0 at baseline. We used Poisson and linear mixed-effects regression models to estimate the association between HGF and ECC, adjusted for sociodemographic and CVD risk factors.

Results: Of 6648 participants, 53% were women. Mean (SD) age was 62 (10) years. Median (IQR) of HGF was 905 (757-1087) pg/mL. After adjustment for CVD risk factors, the highest HGF levels (tertile 3) were associated with greater prevalence and extent of AVC, MAC and DTAC at baseline compared with the lowest tertile (tertile 1). Additionally, the risk of incident AVC and MAC increased by 62% and 45%, respectively, in demographic-adjusted models. However, the associations were not statistically significant in fully adjusted models. The highest HGF levels were also associated with 10% and 13% increase in MAC and DTAC progression, respectively, even after adjustment for CVD risk factors.

Conclusion: Higher HGF levels were significantly associated with a greater risk of calcification at some extracoronary sites, suggesting an alternate biological pathway that could be targeted to reduce CVD risk.
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http://dx.doi.org/10.1136/openhrt-2022-001971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9157354PMC
May 2022

Editors' message June 2022.

Am J Prev Cardiol 2022 Jun 17;10:100351. Epub 2022 May 17.

Division of Cardiology, Johns Hopkins University School of Medicine, United States.

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http://dx.doi.org/10.1016/j.ajpc.2022.100351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9130074PMC
June 2022

Fixed-Dose Combination (Polypill) for Cardiovascular Disease Prevention: A Meta-Analysis.

Am J Prev Med 2022 May 22. Epub 2022 May 22.

Cardiovascular Medicine Department, Heart, Vascular & Thoracic Institute (Miller Family), Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address:

Introduction: This meta-analysis was performed to assess the efficacy of fixed-dose combination (polypill) in reducing the risk of mortality and cardiovascular events.

Methods: Medline, Scopus, Web of Science, and Cochrane Central were searched during May 2021. All randomized trials investigating the efficacy of antihypertensive and lipid-lowering ± antiplatelet drug combinations in patients at cardiovascular risk were included. Outcomes were presented as risk ratios or standardized mean differences with 95% CIs.

Results: A total of 16 trials (N = 26,567 participants) were included. The risk reduction for all-cause mortality (risk ratio = 0.90; 95% CI = 0.79, 1.01; I = 0%; moderate certainty) and major adverse cardiac events (risk ratio=0.84; 95% CI=0.68, 1.04; I=51%; very low certainty) did not reach statistical significance in comparison with those of the control group. Subgroup analysis of studies that used an active control yielded similar results. However, significant reductions in major adverse cardiac event risk were observed in studies that exclusively targeted primary prevention, followed patients for ≥4 years, and had a low risk of bias. The polypill group had significantly higher adherence (risk ratio=1.18; 95% CI=1.06, 1.32; I=96%; very low certainty) and comprable rates of adverse side effects (risk ratio=1.10; 95% CI=0.98, 1.23; I=58%; moderate certainty) with those of the control group. Patients randomized to the polypill had significant reductions in systolic and diastolic blood pressure as well as in total and low-density lipoprotein cholesterol.

Conclusion: Despite reductions in cardiovascular risk factors, the observed mortality benefit for the polypill did not reach statistical significance. Further studies are needed to validate its clinical benefits and determine the patient populations likely to achieve such benefits.
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http://dx.doi.org/10.1016/j.amepre.2022.03.027DOI Listing
May 2022

Associations between endogenous sex hormones and FGF-23 among women and men in the Multi-Ethnic Study of Atherosclerosis.

PLoS One 2022 25;17(5):e0268759. Epub 2022 May 25.

Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.

Elevated levels of testosterone and fibroblast growth factor 23 (FGF-23) are both independently associated with a higher risk of cardiovascular disease (CVD). However, the relationship between sex hormones and FGF-23 is not well established. We explored the association between sex hormones and FGF-23 among middle-aged to older men and women in MESA. We studied 3,052 men and 2,868 postmenopausal women free of CVD at the time of enrollment with baseline serum sex hormones [total testosterone (T), free T, estradiol (E2) and sex hormone binding globulin (SHBG)] and intact FGF-23. In sex-stratified analyses, we examined the cross-sectional associations between log-transformed sex hormones (per 1 SD) and log-transformed FGF-23 using multiple linear regression adjusted for socio-demographics, CVD risk factors, estimated glomerular filtration rate and mineral metabolites (25-hydroxyvitamin D, calcium, phosphorus and parathyroid hormone). The mean (SD) age of study participants was 64 (10) years. The median (IQR) of FGF-23 was similar in women and men [38 (30-46) vs 38 (31-47) pg/mL]. In adjusted analyses, among women, 1 SD increment in free T was associated with 3% higher FGF-23 while SHBG was associated with 2% lower FGF-23. In men, 1 SD increment in E2 was associated with 6% higher FGF-23 whereas total T/E2 ratio was associated with 7% lower FGF-23. In conclusion, this exploratory analysis found that a more androgenic sex hormone profile was directly associated with FGF-23 in women and inversely associated with FGF-23 in men. Longitudinal studies are required to determine whether FGF-23 mediates the relationship between sex hormones and CVD risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268759PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132299PMC
May 2022

Impact of Body Mass Index on Mortality in Hospitalized Patients With Hypertrophic Cardiomyopathy.

Am J Cardiol 2022 07 18;175:106-109. Epub 2022 May 18.

Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.

Although obesity is associated with increased phenotypic expression in patients with hypertrophic cardiomyopathy (HC), the effect of body mass index (BMI) on in-hospital mortality in hospitalized patients with HC has not been established. We evaluated the National Inpatient Sample in the United States to identify all adults with HC hospitalized for cardiac illnesses between 2008 and 2017. Using International Classification of Diseases codes, the study cohort was stratified into underweight (BMI ≤19.9 kg/m), normal weight (BMI 20.0 to 24.9 kg/m), overweight (BMI 25.0 to 29.9 kg/m), class I (BMI 30.0 to 34.9 kg/m), class II (BMI 35.0 to 39.9 kg/m), and class III (BMI ≥40.0 kg/m) obesity. Multiple logistic regression analysis was used to analyze the independent association of various BMI categories and mortality. The study included a total of 2,392,325 hospitalizations (mean age-66.1 ± 12.2 years; 42.0% female). The patients with class III obesity (adjusted mortality rate [AMR] 3.3%, adjusted odds ratio [AOR] 1.53, 95% confidence interval [CI] 1.29 to 1.82, p <0.001) and underweight patients (AMR 4.4%, AOR 2.07, 95% CI 1.74-2.46, p <0.001) had higher in-hospital mortality whereas overweight patients (AMR 1.6%, AOR 0.26, 95% CI 0.19 to 0.34, p <0.001), patients with class I obesity (AMR 0.8%, AOR 0.35, 95% CI 0.27 to 0.45, p <0.001) and patients with class II obesity (AMR 0.8%, AOR 0.34, 95% CI 0.26 to 0.45, p <0.001) had lower mortality compared with patients with normal BMI (AMR 2.9%). In conclusion, BMI has a nonlinear U-shaped relation with in-hospital mortality in patients with HC. The patients who were underweight and morbidly obese had significantly higher mortality, whereas those patients with overweight, class I, and class II obesity had lower mortality than normal BMI.
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http://dx.doi.org/10.1016/j.amjcard.2022.04.011DOI Listing
July 2022

The Relationship of Falls With Achieved 25-Hydroxyvitamin D Levels From Vitamin D Supplementation: The STURDY Trial.

J Endocr Soc 2022 Jun 16;6(6):bvac065. Epub 2022 Apr 16.

Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21205, USA.

Context: The Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized trial enrolling older adults with low 25-hydroxyvitamin D [25(OH)D], demonstrated vitamin D supplementation ≥ 1000 IU/day did not prevent falls compared with 200 IU/day, with doses ≥ 2000 IU/day potentially showing safety concerns.

Objective: To examine associations of achieved and change in 25(OH)D concentrations after 3 months of vitamin D supplementation with fall risk.

Design: Observational analysis of trial data.

Setting: General community.

Participants: A total of 637 adults aged ≥ 70 with baseline 25(OH)D concentrations 10 to 29 ng/mL and elevated fall risk. Three-month on-treatment absolute 25(OH)D; absolute and relative changes from baseline.

Main Outcome Measures: Incident first fall (primary) and first consequential fall (injury or sought medical care) up to 24 months. Cox models were adjusted for sociodemographics, season, Short Physical Performance Battery, and body mass index.

Results: At baseline, mean (SD) age was 77.1 (5.4) years and 25(OH)D was 22.1 (5.1) ng/mL; 43.0% were women and 21.5% non-White. A total of 395 participants experienced ≥ 1 fall; 294 experienced ≥ 1 consequential fall. There was no association between absolute achieved 25(OH)D and incident first fall (30-39 vs < 30 ng/mL hazard ratio [HR], 0.93; 95% CI, 0.74-1.16; ≥40 vs < 30 ng/mL HR, 1.09; 95% CI, 0.82-1.46; adjusted overall  = 0.67), nor absolute or relative change in 25(OH)D. For incident consequential first fall, the HR (95% CI) comparing absolute 25(OH)D ≥ 40 vs < 30 ng/mL was 1.38 (0.99-1.90).

Conclusion: Achieved 25(OH)D concentration after supplementation was not associated with reduction in falls. Risk of consequential falls may be increased with achieved concentrations ≥ 40 ng/mL.

Trial Registration: ClinicalTrials.gov: NCT02166333.
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http://dx.doi.org/10.1210/jendso/bvac065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9113179PMC
June 2022

A Systematic Review and Meta-Analysis of the Association Between Polycystic Ovary Syndrome and Coronary Artery Calcification.

J Womens Health (Larchmt) 2022 06 16;31(6):762-771. Epub 2022 May 16.

Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Polycystic ovary syndrome (PCOS) is a common endocrine pathology affecting women of reproductive age characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. Coronary artery calcification (CAC) is a marker of subclinical atherosclerosis and prognostic of cardiovascular disease (CVD) risk. Some studies have shown that women with PCOS have a greater risk of CAC; however, a few others report contrary findings. The objective of this study is to examine and quantify the association between PCOS and CAC. We searched EMBASE, Google Scholar, PubMed, and Web of Science from inception to November 2021 to identify studies that provided information on PCOS and CAC. We used a random-effects model to aggregate the odds ratios (ORs) for CAC (score >0) among women with PCOS compared with controls adjusted for sociodemographic characteristics and CVD risk factors. From the 36 articles reviewed, 3 prospective cohort and 4 cross-sectional studies met the inclusion criteria with a total of 2341 participants. Six studies used CAC > 0 as an outcome and were included in the pooled analysis. Using the Hartung-Knapp-Sidik-Jonkman method, the pooled adjusted ORs for the associations between PCOS and the presence of CAC were 2.48 (95% confidence interval: 2.11-2.84) with no significant heterogeneity ( = 0.10%,  = 0.97) for the cohort studies and 1.88 (0.71-3.06) with no significant heterogeneity ( = 13.95%,  = 0.87) for the cross-sectional studies. In pooled analyses, women with PCOS had approximately twofold greater odds of having CAC compared with women without PCOS. However, additional prospective studies will be needed to further understand the relationship between PCOS and CAC.
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http://dx.doi.org/10.1089/jwh.2021.0608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9360175PMC
June 2022

Polycystic ovary syndrome: a "risk-enhancing" factor for cardiovascular disease.

Fertil Steril 2022 05;117(5):924-935

Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address:

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age and is hallmarked by hyperandrogenism, oligo-ovulation, and polycystic ovarian morphology. Polycystic ovary syndrome, particularly the hyperandrogenism phenotype, is associated with several cardiometabolic abnormalities, including obesity, dyslipidemia, elevated blood pressure, and prediabetes or type 2 diabetes. Many, but not all, studies have suggested that PCOS is associated with increased risk of cardiovascular disease (CVD), including coronary heart disease and stroke, independent of body mass index and traditional risk factors. Interpretation of the data from these observational studies is limited by the varying definitions and ascertainment of PCOS and CVD across studies. Recent Mendelian randomization studies have challenged the causality of PCOS with coronary heart disease and stroke. Future longitudinal studies with clearly defined PCOS criteria and newer genetic methodologies may help to determine association and causality. Nevertheless, CVD risk screening remains critical in this patient population, as improvements in metabolic profile and reduction in CVD risk are achievable with a combination of lifestyle management and pharmacotherapy. Statin therapy should be implemented in women with PCOS who have elevated atherosclerotic CVD risk. If CVD risk is uncertain, measurement of subclinical atherosclerosis (carotid plaque or coronary artery calcium) may be a useful tool to guide shared decision-making about initiation of statin therapy. Other medications, such as metformin and glucagon-like peptide-1 receptor agonists, also may be useful in reducing CVD risk in insulin-resistant populations. Additional research is needed to determine the best pathways to mitigate PCOS-associated CVD risk.
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http://dx.doi.org/10.1016/j.fertnstert.2022.03.009DOI Listing
May 2022

Improving risk prediction for pulmonary embolism in COVID-19 patients using echocardiography.

Pulm Circ 2022 Jan 8;12(1):e12036. Epub 2022 Mar 8.

Division of Cardiology Johns Hopkins School of Medicine Baltimore Maryland USA.

SARS-CoV-2 infection is associated with increased risk for pulmonary embolism (PE), a fatal complication that can cause right ventricular (RV) dysfunction. Serum D-dimer levels are a sensitive test to suggest PE, however lacks specificity in COVID-19 patients. The goal of this study was to identify a model that better predicts PE diagnosis in hospitalized COVID-19 patients using clinical, laboratory, and echocardiographic imaging predictors. We performed a cross-sectional study of 302 adult patients admitted to the Johns Hopkins Hospital (March 2020-February 2021) for COVID-19 infection who underwent transthoracic echocardiography and D-dimer testing; 204 patients had CT angiography. Clinical, laboratory and imaging predictors including, but not limited to, D-dimer and RV dysfunction were used to build prediction models for PE using logistic regression. Model discrimination was assessed using area under the receiver operator curve (AUC) and calibration using Hosmer-Lemeshow statistic. Internal validation was performed. The prevalence of PE was 7.6%. The model with positive D-dimer above 5 mg/L, RV dysfunction on echocardiography, and troponin had an AUC of 0.77, and cross-validated AUC of 0.74. D-dimer (>5 mg/L) had a positive association with PE (adj odds ratio = 4.40; 95% confidence interval: [1.80, 10.78]). We identified a model including clinical, imaging and laboratory variables that predicted PE in hospitalized COVID-19 patients. Positive D-dimer >5, RV dysfunction on echocardiography, and troponin were important predictors for calculating likelihood of PE diagnosis. This approach may be useful to aid in clinical decision-making related to diagnostic imaging and treatment. Prospective studies are needed to evaluate impact on patient outcomes.
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http://dx.doi.org/10.1002/pul2.12036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053003PMC
January 2022

Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases.

Front Cardiovasc Med 2022 12;9:874242. Epub 2022 Apr 12.

Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States.

Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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http://dx.doi.org/10.3389/fcvm.2022.874242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039512PMC
April 2022

Racial Differences in Delivery Outcomes Among Women With Peripartum Cardiomyopathy.

CJC Open 2022 Apr 16;4(4):373-377. Epub 2021 Dec 16.

Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Background: Peripartum cardiomyopathy (PPCM) is a rare idiopathic cardiomyopathy associated with pregnancy that occurs more frequently among Black women. However, less is known about the association of race/ethnicity with outcomes at the time of delivery in women with PPCM.

Methods: We used data from the 2016-2018 National Inpatient Sample (NIS) database to identify women with a diagnosis of PPCM based on International Classification of Diseases, 10th revision (ICD-10) codes. Using adjusted logistic regression, the association of race with PPCM and adverse cardiovascular (CV) outcomes with PPCM was evaluated across racial/ethnic groups (White, Black, Hispanic, Asian/Pacific Islander).

Results: Among 11,304,996 delivery hospitalizations, PPCM was present in 8735 (0.08%). After adjusting for CV risk factors (chronic hypertension, diabetes, and obesity) and socioeconomic factors (insurance status, hospital income, and residential income), Black and Native American women had greater adjusted odds of developing PPCM (adjusted odds ratio [aOR] 1.89; 95% confidence interval [CI] 1.66-2.15; aOR 1.60; 95% CI 1.02-2.50, respectively), compared with White women. In stratified analysis of CV events, however, Asian/Pacific Islander women with PPCM were the most likely to have CV complications (aOR 98; 95% CI 29-333 for pulmonary edema).

Conclusions: In the US, at the time of delivery hospitalization, Black and Native American women are the most likely to develop PPCM, despite adjustment for CV and socioeconomic risk factors, but Asian women have higher odds of having CV complications.
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http://dx.doi.org/10.1016/j.cjco.2021.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039541PMC
April 2022

Obesity, Galectin-3, and Incident Heart Failure: The ARIC Study.

J Am Heart Assoc 2022 05 2;11(9):e023238. Epub 2022 May 2.

Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.

Background Laboratory data suggest obesity is linked to myocardial inflammation and fibrosis, but clinical data are limited. We aimed to examine the association of obesity with galectin-3, a biomarker of cardiac inflammation and fibrosis, and the related implications for heart failure (HF) risk. Methods and Results We evaluated 8687 participants (mean age 63 years; 21% Black) at ARIC (Atherosclerosis Risk in Communities) Visit 4 (1996-1998) who were free of heart disease. We used adjusted logistic regression to estimate the association of body mass index (BMI) categories with elevated galectin-3 (≥75th sex-specific percentile) overall and across demographic subgroups, with tests for interaction. We used Cox proportional hazards models to assess the combined associations of galectin-3 and BMI with incident HF (through December 31, 2019). Higher BMI was associated with higher odds of elevated galectin-3 (odds ratio [OR], 2.32; 95% CI, 1.88-2.86) for severe obesity ([BMI ≥35 kg/m] versus normal weight [BMI 18.5-<25 kg/m]). There were stronger associations of BMI with elevated galectin-3 among women versus men and White versus Black participants (both -for-interaction <0.05). Elevated galectin-3 was similarly associated with incident HF among people with and without obesity (HR, 1.49; 95% CI, 1.18-1.88; and HR, 1.71; 95% CI, 1.38-2.11, respectively). People with severe obesity and elevated galectin-3 had >4-fold higher risk of HF (HR, 4.19; 95% CI, 2.98-5.88) than those with normal weight and galectin-3 <25th percentile. Conclusions Obesity is strongly associated with elevated galectin-3. Additionally, the combination of obesity and elevated galectin-3 is associated with marked HF risk, underscoring the importance of elucidating pathways linking obesity with cardiac inflammation and fibrosis.
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http://dx.doi.org/10.1161/JAHA.121.023238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238585PMC
May 2022
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