Publications by authors named "Kasra Moazzami"

67 Publications

Everyday Discrimination and Mental Stress-Induced Myocardial Ischemia.

Psychosom Med 2021 Jun;83(5):432-439

From the Department of Epidemiology (McKinnon, Shah, Moazzami, Sullivan, Elon, Vaccarino, Lewis), Rollins School of Public Health, Emory University; Division of Cardiology, Department of Medicine (Shah, Lima, Moazzami, Young, Almuwaqqat, Quyyumi, Vaccarino), Emory University School of Medicine, Atlanta; Atlanta VA Medical Center (Shah, Bremner), Decatur; Department of Radiology (Garcia), Emory University School of Medicine; Department of Psychiatry and Behavioral Sciences (Bremner, Raggi), Emory University School of Medicine, Atlanta, Georgia; and Mazankowski Alberta Heart Institute (Raggi), University of Alberta, Edmonton, Canada.

Objective: Mental stress-induced myocardial ischemia (MSIMI), a transient myocardial ischemic response to mental stress, is associated with poorer outcomes among patients with coronary heart disease and is more likely to occur among women. However, predictors of MSIMI are not well explored. The current study investigated the association between experiences of everyday discrimination and MSIMI among patients with recent myocardial ischemia and contrasted the results with conventional stress-induced myocardial ischemia (CSIMI). We examined sex differences in associations.

Methods: We studied 295 post-MI patients (145 women, 150 men). Provocation of myocardial ischemia with mental stress (speech task) and conventional stress (exercise or pharmacologic) was assessed by myocardial perfusion imaging. Frequency of exposure to everyday discrimination was assessed via questionnaire using the Everyday Discrimination Scale (EDS).

Results: The mean age was 51 years in both women and men, and the EDS score ranged from 10 to 38 (mean [standard deviation] = 17 [6] years). After multivariable analysis, each standard deviation increase in the EDS score (more frequent exposure) was associated with an increased odds of MSIMI (odds ratio [OR] = 1.57 [1.10-2.23]). The EDS score was not associated with CSIMI (OR = 0.86 [0.64-1.17]). Women demonstrated a twofold increase (OR = 1.96 [1.13-3.38], p = .02) in the adjusted odds of MSIMI, with each standard deviation increase in the EDS score compared with a 1.4-fold increase (OR = 1.40 [0.80-2.44], p = .24) among men; however, interaction was not statistically significant.

Conclusions: Among post-MI patients, everyday discrimination was positively associated with occurrence of MSIMI, but not with CSIMI; associations were more pronounced among women.
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http://dx.doi.org/10.1097/PSY.0000000000000941DOI Listing
June 2021

Neurobiological Pathways Linking Acute Mental Stress to Impairments in Executive Function in Individuals with Coronary Artery Disease.

J Alzheimers Dis Rep 2021 Feb 2;5(1):99-109. Epub 2021 Feb 2.

Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.

Background: Individuals with coronary artery disease (CAD) have worse executive function compared to the general population but the mechanisms are unknown.

Objective: To investigate the role of acute mental stress (MS) on the executive function of patients with CAD.

Methods: Participants with stable CAD underwent acute MS testing with simultaneous peripheral vascular function measurements and brain imaging using high resolution-positron emission tomography. Digital pulse wave amplitude was continuously measured using peripheral artery tonometry (PAT, Itamar Inc). Stress/rest PAT ratio (sPAT) of pulse wave amplitude during MS/baseline was calculated as a measure of microvascular constriction during MS. Plasma levels of catecholamine and interleukin-6 were assessed at baseline and after MS. Executive function was assessed both at baseline and at 2 years follow-up using the Trail Making Test parts A and B.

Results: We studied 389 individuals with brain data available for 148 participants. Of this population follow-up cognitive assessments were performed in 226 individuals (121 with brain imaging). After multivariable adjustment for baseline demographics, risk factors, and medication use, a lower sPAT, indicating greater vasoconstriction, a higher inferior frontal lobe activation with MS, and increases in norepinephrine and IL-6 levels with MS were all independently associated with greater time to complete Trail B test.-38.4pt.

Conclusion: In response to acute MS, greater peripheral vasoconstriction, higher inferior frontal lobe brain activation, and increases in the levels of norepinephrine and IL-6 are associated with worse executive function.
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http://dx.doi.org/10.3233/ADR-200287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990469PMC
February 2021

Impaired Peripheral Microvascular Function and Risk of Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease.

Arterioscler Thromb Vasc Biol 2021 05 18;41(5):1801-1809. Epub 2021 Mar 18.

Department of Epidemiology (A.Y., MG., S.M.S., C.L., K.M., A.J.S., B.P., I.U., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.

[Figure: see text].
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http://dx.doi.org/10.1161/ATVBAHA.121.316083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062308PMC
May 2021

Mental stress-induced myocardial ischemia and cognitive impairment in coronary atherosclerosis.

J Psychosom Res 2021 02 25;141:110342. Epub 2020 Dec 25.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America. Electronic address:

Objective: To understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time.

Methods: A cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale.

Results: We studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time.

Conclusion: MSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.
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http://dx.doi.org/10.1016/j.jpsychores.2020.110342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857648PMC
February 2021

Association between symptoms of psychological distress and cognitive functioning among adults with coronary artery disease.

Stress Health 2020 Dec 14. Epub 2020 Dec 14.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Greater psychological distress is associated with cognitive impairment in healthy adults. Whether such associations also exist in patients with coronary artery disease (CAD) is uncertain. We assessed cognitive function in 496 individuals with CAD using the verbal and visual memory subtests of the Wechsler Memory Scale and executive functioning measured by the Trail Making Test Parts A and B. We used a composite score of psychological distress derived through summation of Z-transformed psychological distress symptom scales (depression, posttraumatic stress, anxiety, anger, hostility and perceived stress) and scores for each individual psychological scale. Multivariable linear regression models were used to determine the association between memory scores (as outcomes) and the psychological distress scores (both composite score and individual scales). After adjusting for demographic and cardiovascular risk factors, a higher psychological distress score was independently associated with worse memory and executive functioning. Each standard deviation increase in psychological distress score was associated with 3% (95% confidence interval [CI], 1%-5%) to 5% (95% CI, 3-7%) worse cognitive performance (higher Trail A and Trail B, and lower verbal and visual memory scores). Among individuals with CAD, a higher level of psychological distress is independently associated with worse cognitive performance. These findings suggest that psychological risk factors play a role in cognitive trajectories of persons with CAD.
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http://dx.doi.org/10.1002/smi.3018DOI Listing
December 2020

Relation of High-sensitivity Cardiac Troponin I Elevation With Exercise to Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease.

Am J Cardiol 2020 12 15;136:1-8. Epub 2020 Sep 15.

Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address:

High sensitive cardiac troponin I (hs-cTnI) increases with inducible myocardial ischemia in patients with coronary artery disease (CAD). We aimed to assess if the change in hs-cTnI levels with exercise stress testing is associated with major adverse cardiac events (MACE). A cohort of 365 (age 62 ± 9 years, 77% men) patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging with treadmill testing. Plasma hs-cTnI level was measured at rest and at 45 min after stress. Multivariable Fine & Gray's subdistribution hazards models were used to determine the association between the change in hs-cTnI and MACE, a composite end point of cardiovascular death, myocardial infarction, and unstable angina requiring revascularization. During a median follow-up of 3 years, 39 (11%) patients experienced MACE. After adjustment, for each two-fold increment in hs-cTnI with stress, there was a 2.2 (95% confidence interval 1.3-3.6)-fold increase in the hazard for MACE. Presence of both a high resting hs-cTnI level (>median) and ≥ 20% stress-induced hs-cTnI elevation was associated with the highest incidence of MACE (subdistribution hazards models 4.6, 95% confidence interval 1.6 to 13.0) compared with low levels of both. Risk discrimination statistics significantly improved after addition of resting and change in hs-cTnI levels to a model including traditional risk factors and inducible ischemia (0.67 to 0.71). Conversely, adding inducible ischemia by SPECT did not significantly improve the C-statistic from a model including traditional risk factors, baseline and change in hs-cTnI (0.70 to 0.71). In stable CAD patients, higher resting levels and elevation of hs-cTnI with exercise are predictors of adverse cardiovascular outcomes beyond traditional cardiovascular risk factors and presence of inducible ischemia.
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http://dx.doi.org/10.1016/j.amjcard.2020.09.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057114PMC
December 2020

Sex differences in the inflammatory response to stress and risk of adverse cardiovascular outcomes among patients with coronary heart disease.

Brain Behav Immun 2020 11 8;90:294-302. Epub 2020 Sep 8.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.

Stress may contribute to progression of coronary heart disease (CHD) through inflammation, especially among women. Thus, we sought to examine whether increased inflammatory response to stress among patients with CHD is associated with a greater risk of cardiovascular events and whether this risk is higher in women. We examined inflammatory biomarkers known to increase with mental stress (speech task), including interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and matrix metallopeptidase-9 (MMP-9) among 562 patients with stable CHD. Inflammatory response, the difference between post-stress and resting values, was examined as a predictor of major adverse cardiovascular events (MACE) using subdistribution hazards models for competing risks adjusting for demographics, cardiovascular risk factors, and medications. MACE was defined as a composite endpoint of cardiovascular death, myocardial infarction, unstable angina with revascularization, and heart failure. All biomarkers were standardized. The mean age was 63 years (range 34-79) and 24% were women. During a median follow-up of 3 years, 71 patients experienced MACE. Overall, there was no significant association between inflammatory response to stress and risk of MACE, but there were sex-based interactions for IL-6 (p = 0.001) and MCP-1 (p = 0.01). The risk of MACE increased 56% (HR: 1.56; 95% CI: 1.21, 2.01; p = 0.001) and 30% (HR: 1.30; 95% 1.09, 1.55; p = 0.004) for each standard deviation increase in IL-6 and MCP-1 response to mental stress for women, respectively, while there was no association among men. Increased inflammation in response to stress is associated with future adverse cardiovascular outcomes among women with CHD.
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http://dx.doi.org/10.1016/j.bbi.2020.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872132PMC
November 2020

Association of mid-life serum lipid levels with late-life brain volumes: The atherosclerosis risk in communities neurocognitive study (ARICNCS).

Neuroimage 2020 12 1;223:117324. Epub 2020 Sep 1.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.

Background: Limited information exists regarding the association between midlife lipid levels and late-life total and regional brain volumes.

Methods: We studied 1872 participants in the longitudinal community-based Atherosclerosis Risk in Communities Neurocognitive Study. Serum lipid levels were measured in 1987-1989 (mean age, 53 ± 5 years). Participants underwent 3T brain MRI scans in 2011-2013. Brain volumes were measured using FreeSurfer image analysis software. Linear regression models were used to assess the associations between serum lipids and brain volumes modeled in standard deviation (SD) units, adjusting for potential confounders.

Results: In adjusted analyses, one SD higher low-density lipoprotein cholesterol (LDL) levels were associated with larger total brain volumes (β 0.033, 95% CI 0.006-0.060) as well as larger volumes of the temporal (β 0.038, 95% CI 0.003-0.074) and parietal lobes (β 0.044, 95% CI 0.009-0.07) and Alzheimer disease-related region (β 0.048, 95% CI 0.048-0.085). Higher triglyceride levels were associated with smaller total brain volumes (β -0.033, 95% CI -0.060, -0.007). The associations between LDL levels and brain volumes were modified by age (P for interaction <0.001), with higher LDL levels associated with larger total and regional brain volumes only among adults >53 years at baseline, and were attenuated after application of weights to account for informative attrition, although associations with the parietal and Alzheimer's disease-related region remained significant. High-density lipoprotein cholesterol was not associated with brain volumes.

Conclusion: Higher LDL levels in late midlife were associated with larger brain volumes later in life, while higher triglyceride levels were associated with smaller brain volumes. These associations were driven by adults >53 years at baseline.
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http://dx.doi.org/10.1016/j.neuroimage.2020.117324DOI Listing
December 2020

Circulating Progenitor Cells in Patients With Coronary Artery Disease and Renal Insufficiency.

JACC Basic Transl Sci 2020 Aug 12;5(8):770-782. Epub 2020 Aug 12.

Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Patients with coronary artery disease and renal insufficiency (RI) (estimated glomerular filtration rate <60 ml/min/1.73 m) are at an increased risk of cardiovascular events. The contribution of regenerative capacity, measured as circulating progenitor cell (CPC) counts, to this increased risk is unclear. CPCs were enumerated as cluster of differentiation (CD) 45 mononuclear cells expressing CD34+, CD133+, CXCR4+ (chemokine [C-X-C motif] receptor 4), and VEGF2R+ (vascular endothelial growth factor receptor 2) epitopes in 1,281 subjects with coronary artery disease (35% with RI). Patients with RI and low (median) were at a similar risk as those without RI.
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http://dx.doi.org/10.1016/j.jacbts.2020.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452291PMC
August 2020

Diet, Stress and Mental Health.

Nutrients 2020 Aug 13;12(8). Epub 2020 Aug 13.

Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA 30332, USA.

Introduction: There has long been an interest in the effects of diet on mental health, and the interaction of the two with stress; however, the nature of these relationships is not well understood. Although associations between diet, obesity and the related metabolic syndrome (MetS), stress, and mental disorders exist, causal pathways have not been established.

Methods: We reviewed the literature on the relationship between diet, stress, obesity and psychiatric disorders related to stress.

Results: Diet and obesity can affect mood through direct effects, or stress-related mental disorders could lead to changes in diet habits that affect weight. Alternatively, common factors such as stress or predisposition could lead to both obesity and stress-related mental disorders, such as depression and posttraumatic stress disorder (PTSD). Specific aspects of diet can lead to acute changes in mood as well as stimulate inflammation, which has led to efforts to assess polyunsaturated fats (PUFA) as a treatment for depression. Bidirectional relationships between these different factors are also likely. Finally, there has been increased attention recently on the relationship between the gut and the brain, with the realization that the gut microbiome has an influence on brain function and probably also mood and behavior, introducing another way diet can influence mental health and disorders. Brain areas and neurotransmitters and neuropeptides that are involved in both mood and appetite likely play a role in mediating this relationship.

Conclusions: Understanding the relationship between diet, stress and mood and behavior could have important implications for the treatment of both stress-related mental disorders and obesity.
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http://dx.doi.org/10.3390/nu12082428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468813PMC
August 2020

Racial disparities in sleep disturbances among patients with and without coronary artery disease: The role of clinical and socioeconomic factors.

Sleep Health 2020 10 18;6(5):570-577. Epub 2020 Aug 18.

Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia, USA; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address:

Objective: To investigate differences in sleep quality by race in participants with and without a prior myocardial infarction (MI).

Design: Case-control study.

Setting: Emory-affiliated hospitals in Atlanta, Georgia.

Participants: Two hundred seventy-three individuals (190 Black) ≤60 years of age with a verified MI in the previous 8 months, and 100 community controls (44 Black) without a history of MI.

Measurements: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Psychological factors were assessed using standardized questionnaires and clinical risk factors through medical history and chart review.

Results: A significant interaction existed between race and MI status on sleep quality (P= .01), such that Black individuals with a history of MI, but not controls, reported worse sleep quality than their non-Black counterparts. Among MI cases, being Black was independently associated with higher PSQI scores after adjusting for baseline demographics (B = 2.17, 95% confidence interval 1.17, 3.17, P = .006). Clinical risk factors, psychological factors and socioeconomic status (household income and years of education) all contributed equally to explain race-related disparities in sleep among MI cases. After further adjustment for these factors, the association was attenuated and no longer significant (B = 0.70, 95% confidence interval = -0.10, 1.21, P = .26).

Conclusion: Black post-MI patients, but not healthy controls, have significantly poorer sleep quality than non-Blacks. This difference is driven by a combination of factors, including clinical risk factors, psychological factors as well as adverse socioeconomic conditions among Black individuals with MI.
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http://dx.doi.org/10.1016/j.sleh.2020.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704917PMC
October 2020

Association Between Mental Stress-Induced Inferior Frontal Cortex Activation and Angina in Coronary Artery Disease.

Circ Cardiovasc Imaging 2020 08 10;13(8):e010710. Epub 2020 Aug 10.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.).

Background: The inferior frontal lobe is an important area of the brain involved in the stress response, and higher activation with acute mental stress may indicate a more severe stress reaction. However, it is unclear if activation of this region with stress correlates with angina in individuals with coronary artery disease.

Methods: Individuals with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech/arithmetic stressors in conjunction with high resolution positron emission tomography imaging of the brain. Blood flow to the inferior frontal lobe was evaluated as a ratio compared with whole brain flow for each scan. Angina was assessed with the Seattle Angina Questionnaire's angina frequency subscale at baseline and 2 years follow-up.

Results: We analyzed 148 individuals with coronary artery disease (mean age [SD] 62 [8] years; 69% male, and 35.8% Black). For every doubling in the inferior frontal lobe activation, angina frequency was increased by 13.7 units at baseline ([Formula: see text], 13.7 [95% CI, 6.3-21.7]; =0.008) and 11.6 units during follow-up ([Formula: see text], 11.6 [95% CI, 4.1-19.2]; =0.01) in a model adjusted for baseline demographics. Mental stress-induced ischemia and activation of other brain pain processing regions (thalamus, insula, and amygdala) accounted for 40.0% and 13.1% of the total effect of inferior frontal lobe activation on angina severity, respectively.

Conclusions: Inferior frontal lobe activation with mental stress is independently associated with angina at baseline and during follow-up. Mental stress-induced ischemia and other pain processing brain regions may play a contributory role.
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http://dx.doi.org/10.1161/CIRCIMAGING.120.010710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422935PMC
August 2020

Higher Activation of the Rostromedial Prefrontal Cortex During Mental Stress Predicts Major Cardiovascular Disease Events in Individuals With Coronary Artery Disease.

Circulation 2020 Aug 11;142(5):455-465. Epub 2020 Jun 11.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).

Background: Psychological stress is a risk factor for major adverse cardiovascular events (MACE) in individuals with coronary artery disease. Certain brain regions that control both emotional states and cardiac physiology may be involved in this relationship. The rostromedial prefrontal cortex (rmPFC) is an important brain region that processes stress and regulates immune and autonomic functions. Changes in rmPFC activity with emotional stress (reactivity) may be informative of future risk for MACE.

Methods: Participants with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech/arithmetic stressors and simultaneous brain imaging with high-resolution positron emission tomography brain imaging. We defined high rmPFC activation as a difference between stress and control scans greater than the median value for the entire cohort. Interleukin-6 levels 90 minutes after stress, and high-frequency heart rate variability during stress were also assessed. We defined MACE as a composite of cardiovascular death, myocardial infarction, unstable angina with revascularization, and heart failure hospitalization.

Results: We studied 148 subjects (69% male) with mean±SD age of 62±8 years. After adjustment for baseline demographics, risk factors, and baseline levels of interleukin-6 and high-frequency heart rate variability, higher rmPFC stress reactivity was independently associated with higher interleukin-6 and lower high-frequency heart rate variability with stress. During a median follow-up of 3 years, 34 subjects (21.3%) experienced a MACE. Each increase of 1 SD in rmPFC activation with mental stress was associated with a 21% increase risk of MACE (hazard ratio, 1.21 [95% CI, 1.08-1.37]). Stress-induced interleukin-6 and high-frequency heart rate variability explained 15.5% and 32.5% of the relationship between rmPFC reactivity and MACE, respectively. Addition of rmPFC reactivity to conventional risk factors improved risk reclassification for MACE prediction, and C-statistic improved from 0.71 to 0.76 (=0.03).

Conclusions: Greater rmPFC stress reactivity is associated with incident MACE. Immune and autonomic responses to mental stress may play a contributory role.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.119.044442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677173PMC
August 2020

Neural responses during acute mental stress are associated with angina pectoris.

J Psychosom Res 2020 07 11;134:110110. Epub 2020 Apr 11.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Radiology, Emory University School of Medicine, United States of America; Atlanta VA Medical Center, Decatur, GA, United States of America.

Angina pectoris is associated with increased risk of adverse cardiovascular events in coronary artery disease (CAD) patients, an effect not entirely attributable to the severity of CAD.

Objective: Examine brain correlates of mental stress in patients with CAD with and without a history of angina.

Methods: Participants (n = 170) with stable CAD completed the Seattle Angina Questionnaire along with other psychometric assessments. In this cross-sectional study, participants underwent laboratory-based mental stress testing using mental arithmetic and public speaking tasks along with control conditions in conjunction with positron emission tomography brain imaging using radiolabeled water. Brain activity during mental stress was compared between participants who did or did not report chest pain/angina in the previous month. A factor analysis was coupled with dominance analysis to identify brain regions associated with angina.

Results: Participants reporting angina in the past month experienced greater (p < .005) activations within the left: frontal lobe (z = 4.01), temporal gyrus (z = 3.32), parahippocampal gyrus (z = 3.16), precentral gyrus (z = 3.14), right fusiform gyrus (z = 3.07), and bilateral cerebellum (z = 3.50) and deactivations within the right frontal gyrus (z = 3.67), left precuneus (z = 3.19), and left superior temporal gyrus (z = 3.11) during mental stress. A factor containing the left motor areas, inferior frontal lobe, and operculum (average McFadden's number addition = 0.057) in addition to depression severity (0.10) and adulthood trauma exposure (0.064) correlated with angina history.

Conclusions: Self-reported angina in patients with stable CAD is associated with increased neural responses to stress in a network including the inferior frontal lobe, motor areas, and operculum, potentially indicating an upregulated pain perception response.
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http://dx.doi.org/10.1016/j.jpsychores.2020.110110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082434PMC
July 2020

Association of Posttraumatic Stress Disorder With Mental Stress-Induced Myocardial Ischemia in Adults After Myocardial Infarction.

JAMA Netw Open 2020 04 1;3(4):e202734. Epub 2020 Apr 1.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Importance: Posttraumatic stress disorder (PTSD) is prevalent among patients who survived an acute coronary syndrome and is associated with adverse outcomes, but the mechanisms underlying these associations are unclear.

Objective: To evaluate the association of PTSD with mental stress-induced myocardial ischemia among individuals who survived a myocardial infarction (MI).

Design, Setting, And Participants: This cross-sectional study included 303 patients aged 18 to 60 years enrolled from a university-affiliated network. Participants had a verified history of MI within 8 months. Data were collected from June 2011 to March 2016, and data analysis was conducted from March to June 2019.

Exposures: A clinical diagnosis of PTSD (lifetime and current) was obtained using the Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), and PTSD symptom subscales were assessed with the civilian version of the PTSD Symptom Checklist.

Main Outcomes And Measures: Patients received technetium 99m-labeled sestamibi myocardial perfusion imaging at rest, with mental stress (ie, a speech task) and conventional stress (ie, exercise or pharmacologic). A summed difference score (ie, the difference between stress and rest scores) was used to assess ischemia under both stress conditions.

Results: Among 303 participants (148 [48.8%] women; 198 [65.3%] African American; mean [SD] age, 51 [7] years), the prevalence of PTSD was 14.5% (44 patients). Patients with PTSD had a higher rate of ischemia with mental stress than those without PTSD (12 of 44 [27.3%] vs 38 of 259 [14.7%]; P = .04) and more than twice the mean number of ischemic segments (1.2 [95% CI, 0.5-1.8] vs 0.5 [95% CI, 0.3-0.7]; P < .001), but there was no difference in conventional stress ischemia (10 of 44 [22.7%] vs 60 of 259 [23.2%]; P = .91). Increasing levels of PTSD symptoms were associated with higher odds of ischemia with mental stress (adjusted odds ratio [OR] per 5-point score increase, 1.18; 95% CI 1.04-1.35; P = .01) but not with conventional stress (adjusted OR per 5-point score increase, 1.05; 95% CI, 0.92-1.21; P = .47). Reexperiencing trauma was the symptom cluster most robustly associated with the presence of ischemia with mental stress (adjusted OR per 5-point score increase, 1.87; 95% CI 1.21-2.91; P = .005), followed by avoidance and numbing (adjusted OR per 5-point score increase, 1.51; 95% CI, 1.07-2.14; P = .02).

Conclusions And Relevance: In this study of young and middle-aged individuals with MI, with a large representation of women and patients from racial/ethnic minority groups, PTSD was associated with the development of myocardial ischemia with mental stress. A higher ischemic response to mental stress represents a potential pathway associating PTSD with adverse outcomes after MI.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.2734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156990PMC
April 2020

Early onset inflammatory bowel disease: manifestations, genetics and diagnosis.

Turk J Pediatr 2019 ;61(5):637-647

Moazzami B, Moazzami K, Rezaei N. Early onset inflammatory bowel disease: manifestations, genetics and diagnosis. Turk J Pediatr 2019; 61: 637-647. Crohn`s disease and ulcerative colitis are immunologically mediated chronic inflammatory conditions, collectively referred to as inflammatory bowel diseases (IBD). While most studies have described the condition in the adult population, recent evidences suggest that IBD in children may represent an etiologically distinct disease from the adult onset IBD. Since a significant proportion of patients diagnosed with IBD demonstrate their clinical manifestations during childhood, knowledge about the disease progression, severity and diagnosis in this particular patient population is crucial. Therefore, in the present study, the clinical manifestations, recent advancements in the genetics of early onset IBD and the clinical approach to diagnoses of IBD in children are described.
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http://dx.doi.org/10.24953/turkjped.2019.05.001DOI Listing
July 2020

Circulating Progenitor Cells and Cognitive Impairment in Men and Women with Coronary Artery Disease.

J Alzheimers Dis 2020 ;74(2):659-668

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Background: Circulating progenitor cells (CPC) have been associated with memory function and cognitive impairment in healthy adults. However, it is unclear whether such associations also exist in patients with coronary artery disease (CAD).

Objective: To assess the association between CPCs and memory performance among individuals with CAD.

Methods: We assessed cognitive function in 509 patients with CAD using the verbal and visual Memory subtests of the Wechsler memory scale-IV and the Trail Making Test parts A and B. CPCs were enumerated with flow cytometry as CD45med/CD34+ blood mononuclear cells, those co-expressing other epitopes representing populations enriched for hematopoietic and endothelial progenitors.

Results: After adjusting for demographic and cardiovascular risk factors, lower number of endothelial progenitor cell counts were independently associated with lower visual and verbal memory scores (p for all < 0.05). There was a significant interaction in the magnitude of this association with race (p < 0.01), such that the association of verbal memory scores with endothelial progenitor subsets was present in Black but not in non-Black participants. No associations were present with the hematopoietic progenitor-enriched cells or with the Trail Making Tests.

Conclusion: Lower numbers of circulating endothelial progenitor cells are associated with cognitive impairment in patients with CAD, suggesting a protective effect of repair/regeneration processes in the maintenance of cognitive status. Impairment of verbal memory function was more strongly associated with lower CPC counts in Black compared to non-Black participants with CAD. Whether strategies designed to improve regenerative capacity will improve cognition needs further study.
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http://dx.doi.org/10.3233/JAD-191063DOI Listing
January 2020

Change in NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Level and Risk of Dementia in Multi-Ethnic Study of Atherosclerosis (MESA).

Hypertension 2020 02 23;75(2):316-323. Epub 2019 Dec 23.

From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.).

Cross-sectionally measured NT-proBNP (N-terminal pro-B-type natriuretic peptide) is related to incident dementia. However, data linking changes in NT-proBNP to risk of future dementia are lacking. We aimed to examine the association of change in NT-proBNP over 3.2 years with incident dementia. We included 4563 participants in MESA (Multi-Ethnic Study of Atherosclerosis) prospective cohort who were free of cardiovascular disease at enrollment, had NT-proBNP level measured at MESA exams 1 (baseline, 2000-2002) and 3 (2004-2005), and had no diagnosis of dementia before exam 3. The association of change in NT-proBNP level between MESA exams 1 through 3 and all-cause hospitalized dementia (by , codes) after MESA exam 3 (2004-2005) through 2015 was assessed using competing-risks Cox proportional hazard regression analysis. During 45 522 person-years of follow-up, 223 dementia cases were documented. Increase in log-NT-proBNP from MESA exams 1 through 3 was positively associated with incidence of dementia (multivariable hazard ratio, 1.28 [95% CI, 1.001-1.64]; =0.049). An increase of at least 25% in NT-proBNP level from MESA exam 1 through 3 was associated with a 55% (=0.02) increase in the risk of dementia in multivariable analysis. Addition of temporal NT-proBNP change to a model including risk factors and baseline NT-proBNP improved the prediction of dementia (Harrell C statistic from 0.85 to 0.87, =0.049). Increase in NT-proBNP is independently associated with future all-cause hospitalized dementia and offers a moderately better predictive performance for risk of dementia compared with risk factors and baseline NT-proBNP. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00005487.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.119.13952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482429PMC
February 2020

Neural Correlates of Stress and Abdominal Obesity in Patients With Coronary Artery Disease.

Psychosom Med 2020 04;82(3):272-280

From the Department of Epidemiology (Moazzami, Lima, Levantsevych, Kaseer, Martini, Haffar, Shah, Vaccarino), Rollins School of Public Health, Emory University; Emory Clinical Cardiovascular Research Institute (Moazzami, Lima, Levantsevych, Kaseer, Martini, Haffar, Quyyumi, Shah, Vaccarino), Department of Medicine, Division of Cardiology, Emory University School of Medicine; Department of Psychiatry and Behavioral Sciences (Wittbrodt, Bremner), and Department of Radiology and Imaging Sciences (Nye, Bremner), Emory University School of Medicine, Atlanta; and Atlanta VA Medical Center (Shah, Bremner), Decatur, Gerogia.

Objective: This study aimed to investigate the relationship between waist circumference as a measure of abdominal obesity and brain responses to stress among patients with coronary artery disease (CAD).

Methods: Patients with CAD (N = 151) underwent acute mental stress tasks in conjunction with high-resolution positron emission tomography and radiolabeled water imaging of the brain. Brain responses to mental stress were correlated with waist circumference.

Results: Waist circumference was positively correlated with increased activation in the right and left frontal lobes (β values ranging from 2.81 to 3.75 in the paracentral, medial, and superior gyri), left temporal lobe, left hippocampal, left amygdala, left uncus, and left anterior and posterior cingulate gyri (β values ranging from 2.93 to 3.55). Waist circumference was also negatively associated with the left and right parietal lobes, right superior temporal gyrus, and right insula and precuneus (β values ranging from 2.82 to 5.20).

Conclusion: Increased brain activation in the brain regions involved in the stress response and autonomic regulation of the cardiovascular system during psychological stress may underlie stress-induced overeating and abdominal obesity in patients with CAD.
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http://dx.doi.org/10.1097/PSY.0000000000000776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138710PMC
April 2020

Association Between Change in Circulating Progenitor Cells During Exercise Stress and Risk of Adverse Cardiovascular Events in Patients With Coronary Artery Disease.

JAMA Cardiol 2020 02;5(2):147-155

Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.

Importance: Stem and progenitor cells mobilize from the bone marrow in response to myocardial ischemia. However, the association between the change in circulating progenitor cell (CPC) counts and disease prognosis among patients with ischemia is unknown.

Objective: To investigate the association between the change in CPC counts during stress testing and the risk of adverse cardiovascular events in patients with stable coronary artery disease (CAD).

Design, Setting, And Participants: This prospective cohort study included a population-based sample of 454 patients with stable CAD who were recruited between June 1, 2011, and August 15, 2014, at Emory University-affiliated hospitals and followed up for 3 years. Data were analyzed from September 15, 2018, to October 15, 2018.

Exposures: Myocardial perfusion imaging with technetium Tc 99m sestamibi at rest and 30 to 60 minutes after conventional stress testing.

Main Outcomes And Measures: Circulating progenitor cells were enumerated with flow cytometry as CD34-expressing mononuclear cells (CD45med/CD34+), with additional quantification of subsets coexpressing the chemokine (C-X-C motif) receptor 4 (CD34+/CXCR4+). Changes in CPC counts were calculated as poststress minus resting CPC counts. Cox proportional hazards regression models were used to identify factors associated with the combined end point of cardiovascular death and myocardial infarction after adjusting for clinical covariates, including age, sex, race, smoking history, body mass index, and history of heart failure, hypertension, dyslipidemia, and diabetes.

Results: Of the 454 patients (mean [SD] age, 63 [9] years; 76% men) with stable CAD enrolled in the study, 142 (31.3%) had stress-induced ischemia and 312 (68.7%) did not, as measured by single-photon emission computed tomography. During stress testing, patients with stress-induced ischemia had a mean decrease of 20.2% (interquartile range [IQR], -45.3 to 5.5; P < .001) in their CD34+/CXCR4+ counts, and patients without stress-induced ischemia had a mean increase of 3.2% (IQR, -20.6 to 35.1; P < .001) in their CD34+/CXCR4+ counts. Twenty-four patients (5.2%) experienced adverse events. After adjustment, baseline CPC counts were associated with worse adverse outcomes, but this association was not present after stress-induced ischemia was included in the model. However, the change in CPC counts during exercise remained significantly associated with adverse events (hazard ratio, 2.59; 95% CI, 1.15-5.32, per 50% CD34+/CXCR4+ count decrease), even after adjustment for clinical variables and the presence of ischemia. The discrimination of risk factors associated with incident adverse events improved (increase in C statistic from 0.72 to 0.77; P = .003) with the addition of the change in CD34+/CXCR4+ counts to a model that included clinical characteristics, baseline CPC count, and ischemia.

Conclusions And Relevance: In this study of patients with CAD, a decrease in CPC counts during exercise is associated with a worse disease prognosis compared with the presence of stress-induced myocardial ischemia. Further studies are needed to evaluate whether strategies to improve CPC responses during exercise stress will be associated with improvements in the prognosis of patients with CAD.
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http://dx.doi.org/10.1001/jamacardio.2019.4528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902161PMC
February 2020

Atrial Fibrillation, Brain Volumes, and Subclinical Cerebrovascular Disease (from the Atherosclerosis Risk in Communities Neurocognitive Study [ARIC-NCS]).

Am J Cardiol 2020 01 26;125(2):222-228. Epub 2019 Oct 26.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.

The aim of the present study was to investigate the association between atrial fibrillation (AF) and total and regional brain volumes among participants in the community-based Atherosclerosis Risk in Communities Neurocognitive study (ARIC-NCS). A total of 1,930 participants (130 with AF) with a mean age of 76.3 ± 5.2, who underwent 3T brain MRI scans in 2011 to 2013 were included. Prevalent AF was ascertained from study ECGs and hospital discharge codes. Brain volumes were measured using FreeSurfer image analysis software. Markers of subclinical cerebrovascular disease included lobar microhemorrhages, subcortical microhemorrhages, cortical infarcts, subcortical infarcts, lacunar infarcts, and volume of white matter hyperintensities. Linear regression models were used to assess the associations between AF status and brain volumes. In adjusted analyses, AF was not associated with markers of subclinical cerebrovascular disease. However, AF was associated with smaller regional brain volumes (including temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all p <0.05]) after controlling for demographics, cardiovascular risk factors, prevalent cardiovascular disease, and markers of subclinical cerebrovascular disease. Subgroup analysis revealed a significant interaction between AF and total brain volume with respect to age (p = 0.02), with associations between AF and smaller brain volumes being stronger for older individuals. In conclusion, AF was associated with smaller brain volumes, and the association was stronger among older individuals. This finding may be related to the longer exposure period of the older population to AF or the possibility that older people are more susceptible to the effects of AF on brain volume.
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http://dx.doi.org/10.1016/j.amjcard.2019.10.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942172PMC
January 2020

Association of Transient Endothelial Dysfunction Induced by Mental Stress With Major Adverse Cardiovascular Events in Men and Women With Coronary Artery Disease.

JAMA Cardiol 2019 10;4(10):988-996

Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Importance: Acute mental stress can result in transient endothelial dysfunction, but the prognostic relevance of this phenomenon is unknown.

Objective: To determine the association between mental stress-induced impairment in endothelium-dependent relaxation as assessed by brachial artery flow-mediated vasodilation and adverse cardiovascular outcomes among individuals with stable coronary artery disease.

Design, Setting, And Participants: This cohort study was conducted at a university-affiliated hospital network between June 2011 and August 2014. A cohort of individuals with stable coronary artery disease were included. Data analysis took place from November 2018 to May 2019.

Exposures: Study participants were subjected to a laboratory mental stress task (public speaking).

Main Outcomes And Measures: Flow-mediated vasodilation was measured before and 30 minutes after a public-speaking mental stress task. We examined the association of the rest (prestress), poststress, and δ flow-mediated vasodilation (poststress minus prestress levels) with an adjudicated composite end point of adverse events, including cardiovascular death, myocardial infarction, unstable angina leading to revascularization, and heart failure hospitalization, after adjusting for sociodemographic factors, medical history, and depression.

Results: A total of 569 patients were included (mean [SD] age, 62.6 [9.3] years; 420 men [73.8%]). Flow-mediated vasodilation decreased from a mean (SD) of 4.8% (3.7%) before mental stress to 3.9% (3.6%) after mental stress (a 23% reduction; P < .001), and 360 participants (63.3%) developed transient endothelial dysfunction (a decrease in flow-mediated vasodilation). During a median (interquartile range) follow-up period of 3.0 (2.9-3.1) years, 74 patients experienced a major adverse cardiovascular event. The presence of transient endothelial dysfunction with mental stress was associated with a 78% increase (subdistribution hazard ratio [sHR], 1.78 [95% CI, 1.15-2.76]) in the incidence of major adverse cardiovascular event. Both the δ flow-mediated vasodilation (sHR, 1.15 [95% CI, 1.03-1.27] for each 1% decline) and poststress flow-mediated vasodilation (sHR, 1.14 [95% CI, 1.04-1.24] for each 1% decline) were associated with major adverse cardiovascular event. Risk discrimination statistics demonstrated a significant model improvement after addition of either poststress flow-mediated vasodilation (change in the area under the curve, 0.05 [95% CI, 0.01-0.09]) or prestress plus δ flow-mediated vasodilation (change in the area under the curve, 0.04 [95% CI, 0.00-0.08]) compared with conventional risk factors.

Conclusions And Relevance: In this study, transient endothelial dysfunction with mental stress was associated with adverse cardiovascular outcomes in patients with coronary artery disease. Endothelial responses to stress represent a possible mechanism through which psychological stress may affect outcomes in patients with coronary artery disease.
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http://dx.doi.org/10.1001/jamacardio.2019.3252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739728PMC
October 2019

Independent and joint association of obesity and metabolic syndrome with depression and inflammation.

Health Psychol 2019 Jul 23;38(7):586-595. Epub 2019 May 23.

Department of Epidemiology, Rollins School of Public Health, Emory University.

Objective: To investigate the separate and combined associations of obesity and metabolic syndrome (MetS) with depression and the role of inflammation.

Method: Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9) and was defined with a cutpoint of ≥10. Obesity was defined as body mass index (BMI) ≥30 kg/m2 from measured height and weight. MetS was defined based on the American Heart Association consensus definition. Participants were divided into four groups: healthy normal weight (MHN), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUN), and metabolic unhealthy obese (MUO). C-Reactive protein was assessed in a subsample.

Results: A total of 18,025 subjects were included in the analysis. Participants with MUO had the highest prevalence of depression compared with the MHN group (14.8% vs. 6.8, p < .001). While both obesity and MetS were independently associated with depression, there was a significant interaction between the two (p < .001), indicating that the associations of obesity and MetS with depression were synergistic. After adjusting for baseline characteristics, compared with the MHN group, the MUO group had the highest odds of depression (odds ratio [OR] = 2.30, 95% CI [2.03, 2.61]), followed by MHO group (OR = 1.51, 95% CI [1.30, 1.74]) and the MUN group (OR = 1.39, 95% CI [1.18, 1.64]). The MUO group also showed the highest level of C-reactive protein, and the latter partially mediated the effect between MUO and depressive symptoms (20.5% of the total effect).

Conclusion: Both obesity and MetS are associated with depression independent of each other, but when present together, these conditions have a synergistic association with depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626601PMC
July 2019

Early childhood trauma alters neurological responses to mental stress in patients with coronary artery disease.

J Affect Disord 2019 07 11;254:49-58. Epub 2019 May 11.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology, Emory University School of Medicine, United States; Atlanta VA Medical Center, Decatur, GA, United States.

Background: Early childhood trauma is known to independently increase adverse outcome risk in coronary artery disease (CAD) patients, although the neurological correlates are not well understood. The purpose of this study was to examine whether early childhood trauma alters neural responses to acute mental stress in CAD patients.

Methods: Participants (n = 152) with CAD underwent brain imaging with High Resolution Positron Emission Tomography and radiolabeled water during control (verbal counting, neutral speaking) and mental stress (mental arithmetic, public speaking). Traumatic events in childhood were assessed with the Early Trauma Inventory (ETI-SR-SF) and participants were separated by presence (ETI+) or absence (ETI-) of early childhood trauma. Brain activity during mental stress was compared between ETI+ and ETI-.

Results: Compared to ETI-, ETI+ experienced greater (p < 0.005) activations during mental stress within the left anterior cingulate, bilateral frontal lobe and deactivations (p < 0.005) within the left insula, left parahippocampal gyrus, right dorsal anterior cingulate, bilateral cerebellum, bilateral fusiform gyrus, left inferior temporal gyrus, and right parietal lobe. Significant (p < 0.005) positive correlations between brain activation and ETI-SR-SF scores were observed within the left hippocampus, bilateral frontal lobe, left occipital cuneus, and bilateral temporal lobe.

Limitations: Results in non-CAD samples may differ and ETI may be subject to recall bias.

Conclusion: Early childhood trauma exacerbated activations in stress-responsive limbic and cognitive brain areas with direct and indirect connections to the heart, potentially contributing to adverse outcomes in CAD patients.
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http://dx.doi.org/10.1016/j.jad.2019.05.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592739PMC
July 2019

Higher in-hospital mortality of percutaneous ventricular assist devices versus intra-aortic balloon pumps in cardiogenic shock: A propensity-matched study.

Heart Lung 2018 11 28;47(6):646-647. Epub 2018 Sep 28.

Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ, USA.

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http://dx.doi.org/10.1016/j.hrtlng.2018.08.014DOI Listing
November 2018

Catheter Ablation for Cardiac Arrhythmias: Utilization and In-Hospital Complications, 2000 to 2013.

JACC Clin Electrophysiol 2017 11 2;3(11):1240-1248. Epub 2017 Aug 2.

Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts. Electronic address:

Objectives: This study sought to investigate the utilization of and in-hospital complications in patients undergoing catheter ablation in the United States from 2000 to 2013 by using the National Inpatient Sample and Nationwide Inpatient Sample.

Background: Catheter ablation has become a mainstay in the treatment of a wide range of cardiac arrhythmias.

Methods: This study identified patients 18 years of age and older who underwent inpatient catheter ablation from 2000 to 2013 and had 1 primary diagnosis of any of the following arrhythmias: atrial fibrillation, atrial flutter, supraventricular tachycardia, or ventricular tachycardia.

Results: An estimated total of 519,951 (95% confidence interval: 475,702 to 564,200) inpatient ablations were performed in the United States between 2000 and 2013. The median age was 62 years (interquartile range: 51 to 72 years), and 59.3% of the patients were male. The following parameters showed increasing trends during the study period: annual volume of ablations, number of hospitals performing ablations, mean age and comorbidity index of patients, rate of ≥1 complication, and length of stay (p < 0.001 for each). Substantial proportions (27.5%) of inpatient ablation procedures were performed in low-volume hospitals and were associated with an increased risk for complications (odds ratio: 1.26; 95% confidence interval: 1.12 to 1.42; p < 0.001). Older age, greater numbers of comorbidities, and complex ablations for atrial fibrillation and ventricular tachycardia were independent predictors of in-hospital complications and in-hospital mortality. In addition, female sex and lower hospital volumes were independent predictors of complications.

Conclusions: From 2000 to 2013, there was a substantial increase in the annual number of in-hospital catheter ablation procedures, as well as the rate of periprocedural complications nationwide. Low-volume centers had a significantly higher rate of complications.
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http://dx.doi.org/10.1016/j.jacep.2017.05.005DOI Listing
November 2017

Left Ventricular Hypertrophy and Remodeling and Risk of Cognitive Impairment and Dementia: MESA (Multi-Ethnic Study of Atherosclerosis).

Hypertension 2018 03 29;71(3):429-436. Epub 2018 Jan 29.

From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.).

Limited information exists on the longitudinal association between the left ventricular (LV) structure and function and future cognitive impairment and dementia in a large population without clinically recognized cardiovascular disease at baseline. The aim of the present study was to investigate the association between cardiac structure and function and risk of dementia and cognitive impairment in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. Measures of LV structure and function were determined using magnetic resonance imaging at baseline in 4999 participants free of clinically diagnosed cardiovascular disease and dementia. Probable incident clinical dementia was ascertained from hospitalization discharge records. Cognitive function was evaluated using tests addressing global cognitive function, processing speed, and memory. Associations of measures of LV structure and function with the incidence of clinically diagnosed dementia and cognitive performance were evaluated using Cox proportional hazard regression models adjusted for demographics, cardiovascular risk factors, and cardiovascular events. During a median follow-up of 12 years, 130 probable incident dementia cases were documented. Higher LV mass index (hazard ratio, 1.01; 95% confidence interval, 1.00-1.02) and LV mass-to-volume ratio (hazard ratio, 2.37; 95% confidence interval, 1.25-4.43) were independently associated with incident dementia and impaired cognitive function. Measures of LV function were not associated with risk of dementia or cognitive impairment. In conclusion, in a multiethnic cohort of participants without clinically detected cardiovascular disease and dementia at baseline, LV hypertrophy and concentric remodeling were independently associated with incident dementia and cognitive impairment.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.117.10289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812794PMC
March 2018

Left Ventricular Hypertrophy and Remodeling and Risk of Cognitive Impairment and Dementia: MESA (Multi-Ethnic Study of Atherosclerosis).

Hypertension 2018 03 29;71(3):429-436. Epub 2018 Jan 29.

From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.).

Limited information exists on the longitudinal association between the left ventricular (LV) structure and function and future cognitive impairment and dementia in a large population without clinically recognized cardiovascular disease at baseline. The aim of the present study was to investigate the association between cardiac structure and function and risk of dementia and cognitive impairment in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. Measures of LV structure and function were determined using magnetic resonance imaging at baseline in 4999 participants free of clinically diagnosed cardiovascular disease and dementia. Probable incident clinical dementia was ascertained from hospitalization discharge records. Cognitive function was evaluated using tests addressing global cognitive function, processing speed, and memory. Associations of measures of LV structure and function with the incidence of clinically diagnosed dementia and cognitive performance were evaluated using Cox proportional hazard regression models adjusted for demographics, cardiovascular risk factors, and cardiovascular events. During a median follow-up of 12 years, 130 probable incident dementia cases were documented. Higher LV mass index (hazard ratio, 1.01; 95% confidence interval, 1.00-1.02) and LV mass-to-volume ratio (hazard ratio, 2.37; 95% confidence interval, 1.25-4.43) were independently associated with incident dementia and impaired cognitive function. Measures of LV function were not associated with risk of dementia or cognitive impairment. In conclusion, in a multiethnic cohort of participants without clinically detected cardiovascular disease and dementia at baseline, LV hypertrophy and concentric remodeling were independently associated with incident dementia and cognitive impairment.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.117.10289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812794PMC
March 2018

Dietary sodium intake among US adults with hypertension, 1999-2012.

J Hypertens 2018 02;36(2):237-242

Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Objective: Excess sodium consumption has strong links with hypertension and cardiovascular disease with Food and Drug Association calling to limit sodium intake. However, little is known regarding the trends of sodium intake among hypertensive patients in the United States.

Methods: Data from The National Health and Nutrition Examination Survey (1999-2012) were used to identify adults older than 20 years with self-reported hypertension. Sodium intake was measured through 24-h dietary recall. Linear regression was used to assess the time trends of sodium intake.

Results: Between the years of 1999 and 2012, sodium consumption increased 14.2% among all adults with hypertension (P = 0.012). The increase was seen in both sexes (by 13.3%, P = 0.023 for male, and by 12.1%, P = 0.015 for female). A significant increase was seen in the amount of sodium consumption among Hispanic (by 26.2%, P = 0.021) and African-American (by 20%, P = 0.031) participants, but not among non-Hispanic whites (by 2%, P = 0.096) during the study period. Participants with higher level of education (3487 ± 1678 vs. 3230 ± 1785 mg, P = 0.002) and household income (3527 ± 1770 vs. 3301 ± 1726 mg, P = 0.009) were found to consume more sodium, which remained significant after adjustment for age.

Conclusion: Sodium intake has increased over the last two decades among individuals with hypertension. The increase was especially marked for Hispanics and African-Americans. Improved population-based interventions, including more effective strategies and aggressive approaches to reduce the sodium consumption among hypertensive adults, are needed.
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http://dx.doi.org/10.1097/HJH.0000000000001558DOI Listing
February 2018