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Coronary Artery Disease: HELP
Articles by Laura Kristin Newby
Based on 22 articles published since 2008
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Between 2008 and 2019, L. Kristin Newby wrote the following 22 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C / Halperin, Jonathan L / Levine, Glenn N / Al-Khatib, Sana M / Birtcher, Kim K / Bozkurt, Biykem / Brindis, Ralph G / Cigarroa, Joaquin E / Curtis, Lesley H / Fleisher, Lee A / Gentile, Federico / Gidding, Samuel / Hlatky, Mark A / Ikonomidis, John S / Joglar, José A / Pressler, Susan J / Wijeysundera, Duminda N. · ·J Thorac Cardiovasc Surg · Pubmed #27751237.

ABSTRACT: -- No abstract --

2 Guideline 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C. · ·J Am Coll Cardiol · Pubmed #27036918.

ABSTRACT: -- No abstract --

3 Editorial Sex, Region, and Outcomes After Revascularization. 2017

Newby, L Kristin. ·From the Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC. kristin.newby@duke.edu. ·Circ Cardiovasc Interv · Pubmed #28495900.

ABSTRACT: -- No abstract --

4 Editorial Applying the evidence in coronary disease secondary prevention: a call to action. 2014

Newby, L Kristin. ·Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: kristin.newby@duke.edu. ·J Am Coll Cardiol · Pubmed #24184241.

ABSTRACT: -- No abstract --

5 Review 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C. ·Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative. Society for Cardiovascular Angiography and Interventions Representative. ·Circulation · Pubmed #27026020.

ABSTRACT: -- No abstract --

6 Clinical Trial Multicenter validation of the diagnostic accuracy of a blood-based gene expression test for assessing obstructive coronary artery disease in nondiabetic patients. 2010

Rosenberg, Steven / Elashoff, Michael R / Beineke, Philip / Daniels, Susan E / Wingrove, James A / Tingley, Whittemore G / Sager, Philip T / Sehnert, Amy J / Yau, May / Kraus, William E / Newby, L Kristin / Schwartz, Robert S / Voros, Szilard / Ellis, Stephen G / Tahirkheli, Naeem / Waksman, Ron / McPherson, John / Lansky, Alexandra / Winn, Mary E / Schork, Nicholas J / Topol, Eric J / Anonymous15630674. ·CardioDx, Palo Alto, California, USA. ·Ann Intern Med · Pubmed #20921541.

ABSTRACT: BACKGROUND: Diagnosing obstructive coronary artery disease (CAD) in at-risk patients can be challenging and typically requires both noninvasive imaging methods and coronary angiography, the gold standard. Previous studies have suggested that peripheral blood gene expression can indicate the presence of CAD. OBJECTIVE: To validate a previously developed 23-gene, expression-based classification test for diagnosis of obstructive CAD in nondiabetic patients. DESIGN: Multicenter prospective trial with blood samples obtained before coronary angiography. (ClinicalTrials.gov registration number: NCT00500617) SETTING: 39 centers in the United States. PATIENTS: An independent validation cohort of 526 nondiabetic patients with a clinical indication for coronary angiography. MEASUREMENTS: Receiver-operating characteristic (ROC) analysis of classifier score measured by real-time polymerase chain reaction, additivity to clinical factors, and reclassification of patient disease likelihood versus disease status defined by quantitative coronary angiography. Obstructive CAD was defined as 50% or greater stenosis in 1 or more major coronary arteries by quantitative coronary angiography. RESULTS: The area under the ROC curve (AUC) was 0.70 ± 0.02 (P < 0.001); the test added to clinical variables (Diamond-Forrester method) (AUC, 0.72 with the test vs. 0.66 without; P = 0.003) and added somewhat to an expanded clinical model (AUC, 0.745 with the test vs. 0.732 without; P = 0.089). The test improved net reclassification over both the Diamond-Forrester method and the expanded clinical model (P < 0.001). At a score threshold that corresponded to a 20% likelihood of obstructive CAD (14.75), the sensitivity and specificity were 85% and 43% (yielding a negative predictive value of 83% and a positive predictive value of 46%), with 33% of patient scores below this threshold. LIMITATION: Patients with chronic inflammatory disorders, elevated levels of leukocytes or cardiac protein markers, or diabetes were excluded. CONCLUSION: A noninvasive whole-blood test based on gene expression and demographic characteristics may be useful for assessing obstructive CAD in nondiabetic patients without known CAD. PRIMARY FUNDING SOURCE: CardioDx.

7 Article Pooled RCTs: CABG reduces mortality more than PCI with DES in nondiabetic patients with multivessel CAD. 2016

Rymer, Jennifer A / Newby, L Kristin. ·Duke University Medical CenterDurham, North Carolina, USA. ·Ann Intern Med · Pubmed #27842388.

ABSTRACT: -- No abstract --

8 Article A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial. 2014

Rao, Sunil V / Hess, Connie N / Barham, Britt / Aberle, Laura H / Anstrom, Kevin J / Patel, Tejan B / Jorgensen, Jesse P / Mazzaferri, Ernest L / Jolly, Sanjit S / Jacobs, Alice / Newby, L Kristin / Gibson, C Michael / Kong, David F / Mehran, Roxana / Waksman, Ron / Gilchrist, Ian C / McCourt, Brian J / Messenger, John C / Peterson, Eric D / Harrington, Robert A / Krucoff, Mitchell W. ·The Duke Clinical Research Institute, Durham, North Carolina. Electronic address: sunil.rao@duke.edu. · The Duke Clinical Research Institute, Durham, North Carolina. · Unity Health System, Rochester, New York. · University of South Carolina School of Medicine-Greenville, Greenville, South Carolina. · The Ohio State University Medical Center, Columbus, Ohio. · McMaster University, Hamilton, Ontario, Canada. · Boston University School of Medicine, Boston, Massachusetts. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Mount Sinai Hospital, New York, New York. · Washington Hospital Center, Washington, DC. · Penn State Hershey Medical Center, Hershey, Pennsylvania. · The American College of Cardiology, Washington, DC. · Stanford University Medical Center, Palo Alto, California. ·JACC Cardiovasc Interv · Pubmed #25147030.

ABSTRACT: OBJECTIVES: This study sought to determine the effect of radial access on outcomes in women undergoing percutaneous coronary intervention (PCI) using a registry-based randomized trial. BACKGROUND: Women are at increased risk of bleeding and vascular complications after PCI. The role of radial access in women is unclear. METHODS: Women undergoing cardiac catheterization or PCI were randomized to radial or femoral arterial access. Data from the CathPCI Registry and trial-specific data were merged into a final study database. The primary efficacy endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding or vascular complications requiring intervention. The primary feasibility endpoint was access site crossover. The primary analysis cohort was the subgroup undergoing PCI; sensitivity analyses were conducted in the total randomized population. RESULTS: The trial was stopped early for a lower than expected event rate. A total of 1,787 women (691 undergoing PCI) were randomized at 60 sites. There was no significant difference in the primary efficacy endpoint between radial or femoral access among women undergoing PCI (radial 1.2% vs. 2.9% femoral, odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.12 to 1.27); among women undergoing cardiac catheterization or PCI, radial access significantly reduced bleeding and vascular complications (0.6% vs. 1.7%; OR: 0.32; 95% CI: 0.12 to 0.90). Access site crossover was significantly higher among women assigned to radial access (PCI cohort: 6.1% vs. 1.7%; OR: 3.65; 95% CI: 1.45 to 9.17); total randomized cohort: (6.7% vs. 1.9%; OR: 3.70; 95% CI: 2.14 to 6.40). More women preferred radial access. CONCLUSIONS: In this pragmatic trial, which was terminated early, the radial approach did not significantly reduce bleeding or vascular complications in women undergoing PCI. Access site crossover occurred more often in women assigned to radial access. (SAFE-PCI for Women; NCT01406236).

9 Article ACP Journal Club. Review: CABG reduces long-term mortality and morbidity more than PCI in multivessel coronary disease. 2014

Harskamp, Ralf E / Newby, L Kristin. · ·Ann Intern Med · Pubmed #24733226.

ABSTRACT: -- No abstract --

10 Article Validation of the association between a branched chain amino acid metabolite profile and extremes of coronary artery disease in patients referred for cardiac catheterization. 2014

Bhattacharya, Sayanti / Granger, Christopher B / Craig, Damian / Haynes, Carol / Bain, James / Stevens, Robert D / Hauser, Elizabeth R / Newgard, Christopher B / Kraus, William E / Newby, L Kristin / Shah, Svati H. ·Duke Global Health Institute, Durham, NC, USA; Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: sayanti.bhattacharya@duke.edu. · Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA. Electronic address: christopher.granger@duke.edu. · Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: damian.craig@duke.edu. · Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: carol.haynes@duke.edu. · Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: james.bain@duke.edu. · Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: rdjestev@duke.edu. · Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: elizabeth.hauser@duke.edu. · Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: newga002@mc.duke.edu. · Duke Institute of Molecular Physiology, Durham, NC, USA. Electronic address: william.kraus@duke.edu. · Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA. Electronic address: kristin.newby@duke.edu. · Duke Global Health Institute, Durham, NC, USA; Duke Institute of Molecular Physiology, Durham, NC, USA; Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA. Electronic address: svati.shah@duke.edu. ·Atherosclerosis · Pubmed #24401236.

ABSTRACT: OBJECTIVE: To validate independent associations between branched-chain amino acids (BCAA) and other metabolites with coronary artery disease (CAD). METHODS: We conducted mass-spectrometry-based profiling of 63 metabolites in fasting plasma from 1983 sequential patients undergoing cardiac catheterization. Significant CAD was defined as CADindex ≥ 32 (at least one vessel with ≥ 95% stenosis; N = 995) and no CAD as CADindex ≤ 23 and no previous cardiac events (N = 610). Individuals (N = 378) with CAD severity between these extremes were excluded. Principal components analysis (PCA) reduced large numbers of correlated metabolites into uncorrelated factors. Association between metabolite factors and significant CAD vs. no CAD was tested using logistic regression; and between metabolite factors and severity of CAD was tested using linear regression. RESULTS: Of twelve PCA-derived metabolite factors, two were associated with CAD in multivariable models: factor 10, composed of BCAA (adjusted odds ratio, OR, 1.20; 95% CI 1.05-1.35, p = 0.005) and factor 7, composed of short-chain acylcarnitines, which include byproducts of BCAA metabolism (adjusted OR 1.30; 95% CI 1.14-1.48, p = 0.001). After adjustment for glycated albumin (marker of insulin resistance [IR]) both factors 7 (p = 0.0001) and 10 (p = 0.004) remained associated with CAD. Severity of CAD as a continuous variable (including patients with non-obstructive disease) was associated with metabolite factors 2, 3, 6, 7, 8 and 9; only factors 7 and 10 were associated in multivariable models. CONCLUSIONS: We validated the independent association of metabolites involved in BCAA metabolism with CAD extremes. These metabolites may be reporting on novel mechanisms of CAD pathogenesis that are independent of IR and diabetes.

11 Article Antithrombotic therapy for atrial fibrillation and coronary artery disease in older patients. 2012

Hess, Connie N / Broderick, Samuel / Piccini, Jonathan P / Alexander, Karen P / Newby, L Kristin / Shaw, Linda K / Mahaffey, Kenneth W / Alexander, John H / Peterson, Eric D / Granger, Christopher B / Lopes, Renato D. ·Duke Clinical Research Institute, Durham, NC 27705, USA. ·Am Heart J · Pubmed #23067921.

ABSTRACT: BACKGROUND: Older patients with atrial fibrillation (AF) and coronary artery disease (CAD) face high risk of stroke and bleeding with antithrombotic therapy. Balancing safe and effective use of aspirin, clopidogrel, and warfarin in this population is important. METHODS: From the Duke Databank for Cardiovascular Disease, we identified patients with AF ≥65 years old with angiographically confirmed CAD from 2000 to 2010. Antithrombotic use was described across age and Congestive heart failure, Hypertension, Age >75 years, Diabetes, prior Stroke/transient ischemic attack (CHADS(2)) stroke risk and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding scores. Death and the composite of death, myocardial infarction, and stroke by antithrombotic strategy were reported. RESULTS: Of 2,122 patients ≥65 years old with AF and CAD, 477 (22.5%) were ≥80 years old; 1,133 (53.4%) had acute coronary syndromes. Overall rates of aspirin, clopidogrel, and warfarin use were 83.4%, 34.6%, and 38.9%, respectively. Compared with patients 65 to 79 years old, more patients ≥80 years old were at high stroke risk (CHADS(2) ≥2, 84.7% vs 57.8%) and high bleeding risk (ATRIA 5-10, 55.8% vs 23.3%). Warfarin use in both age groups increased with higher CHADS(2) scores and decreased with higher ATRIA scores. Of patients ≥80 years old with CHADS(2) ≥2, 150 (38.2%) received warfarin. Antithrombotic strategy was not associated with improved 1-year adjusted outcomes. CONCLUSIONS: Among older patients with AF and CAD, overall warfarin use was low. Patients ≥80 years old at highest stroke risk received warfarin in similar proportions to the overall cohort. Further investigation into optimizing antithrombotic strategies in this population is warranted.

12 Article Nighttime blood pressure dipping in postmenopausal women with coronary heart disease. 2012

Sherwood, Andrew / Bower, Julie K / Routledge, Faye S / Blumenthal, James A / McFetridge-Durdle, Judith A / Newby, L Kristin / Hinderliter, Alan L. ·Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. sherw002@mc.duke.edu ·Am J Hypertens · Pubmed #22785406.

ABSTRACT: BACKGROUND: Blunted nighttime blood pressure (BP) dipping is prognostic of cardiovascular morbidity and mortality. This relationship may be stronger among women than men. The present study hypothesized that coronary artery disease (CAD) and advancing age would be associated with reduced BP dipping in postmenopausal women. The effects of daytime physical activity and nighttime sleep quality on BP dipping were also examined. METHODS: 54 postmenopausal women with CAD (≥50% occlusion of at least one major coronary vessel) and 48 age-matched (range 50-80 years) postmenopausal women without CAD (non-CAD) underwent 24-h ambulatory BP monitoring and actigraphic evaluations of daytime physical activity and nighttime sleep efficiency. RESULTS: Women with CAD evidenced higher nighttime systolic BP (SBP) (P = 0.05) and blunted SBP dipping (P = 0.017), blunted diastolic BP (DBP) dipping (P = 0.047), and blunted pulse pressure dipping (P = 0.01), compared to non-CAD women. Multivariable regression models showed that the presence of CAD, age, daytime physical activity, and nighttime sleep efficiency were independently related to the magnitude of SBP dipping, together accounting for 25% of its variability. DBP dipping showed similar associations. CONCLUSIONS: For postmenopausal women, the presence of CAD and advancing age are accompanied by blunted nighttime BP dipping, which may increase the risk of adverse cardiovascular events. Lifestyle changes that increase daytime physical activity and improve nighttime sleep quality may help improve cardiovascular risk by enhancing nighttime BP dipping.

13 Article Baseline metabolomic profiles predict cardiovascular events in patients at risk for coronary artery disease. 2012

Shah, Svati H / Sun, Jie-Lena / Stevens, Robert D / Bain, James R / Muehlbauer, Michael J / Pieper, Karen S / Haynes, Carol / Hauser, Elizabeth R / Kraus, William E / Granger, Christopher B / Newgard, Christopher B / Califf, Robert M / Newby, L Kristin. ·Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. svati.shah@duke.edu ·Am Heart J · Pubmed #22607863.

ABSTRACT: BACKGROUND: Cardiovascular risk models remain incomplete. Small-molecule metabolites may reflect underlying disease and, as such, serve as novel biomarkers of cardiovascular risk. METHODS: We studied 2,023 consecutive patients undergoing cardiac catheterization. Mass spectrometry profiling of 69 metabolites and lipid assessments were performed in fasting plasma. Principal component analysis reduced metabolites to a smaller number of uncorrelated factors. Independent relationships between factors and time-to-clinical events were assessed using Cox modeling. Clinical and metabolomic models were compared using log-likelihood and reclassification analyses. RESULTS: At median follow-up of 3.1 years, there were 232 deaths and 294 death/myocardial infarction (MI) events. Five of 13 metabolite factors were independently associated with mortality: factor 1 (medium-chain acylcarnitines: hazard ratio [HR] 1.12 [95% CI, 1.04-1.21], P = .005), factor 2 (short-chain dicarboxylacylcarnitines: HR 1.17 [1.05-1.31], P = .005), factor 3 (long-chain dicarboxylacylcarnitines: HR 1.14 [1.05-1.25], P = .002); factor 6 (branched-chain amino acids: HR 0.86 [0.75-0.99], P = .03), and factor 12 (fatty acids: HR 1.19 [1.06-1.35], P = .004). Three factors independently predicted death/MI: factor 2 (HR 1.11 [1.01-1.23], P = .04), factor 3 (HR 1.13 [1.04-1.22], P = .005), and factor 12 (HR 1.18 [1.05-1.32], P = .004). For mortality, 27% of intermediate-risk patients were correctly reclassified (net reclassification improvement 8.8%, integrated discrimination index 0.017); for death/MI model, 11% were correctly reclassified (net reclassification improvement 3.9%, integrated discrimination index 0.012). CONCLUSIONS: Metabolic profiles predict cardiovascular events independently of standard predictors.

14 Article Metabolic profiles predict adverse events after coronary artery bypass grafting. 2012

Shah, Asad A / Craig, Damian M / Sebek, Jacqueline K / Haynes, Carol / Stevens, Robert C / Muehlbauer, Michael J / Granger, Christopher B / Hauser, Elizabeth R / Newby, L Kristin / Newgard, Christopher B / Kraus, William E / Hughes, G Chad / Shah, Svati H. ·Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. ·J Thorac Cardiovasc Surg · Pubmed #22306227.

ABSTRACT: OBJECTIVE: Clinical models incompletely predict the outcomes after coronary artery bypass grafting. Novel molecular technologies can identify biomarkers to improve risk stratification. We examined whether metabolic profiles can predict adverse events in patients undergoing coronary artery bypass grafting. METHODS: The study population comprised 478 subjects from the CATHGEN biorepository of patients referred for cardiac catheterization who underwent coronary artery bypass grafting after enrollment. Targeted mass spectrometry-based profiling of 69 metabolites was performed in frozen, fasting plasma samples collected before surgery. Principal components analysis and Cox proportional hazards regression modeling were used to assess the relation between the metabolite factor levels and a composite outcome of postcoronary artery bypass grafting myocardial infarction, the need for percutaneous coronary intervention, repeat coronary artery bypass grafting, and death. RESULTS: During a mean follow-up period of 4.3 ± 2.4 years, 126 subjects (26.4%) experienced an adverse event. Three principal components analysis-derived factors were significantly associated with an adverse outcome on univariate analysis: short-chain dicarboxylacylcarnitines (factor 2, P = .001); ketone-related metabolites (factor 5, P = .02); and short-chain acylcarnitines (factor 6, P = .004). These 3 factors remained independently predictive of an adverse outcome after multivariate adjustment: factor 2 (adjusted hazard ratio, 1.23; 95% confidence interval, 1.10-1.38; P < .001), factor 5 (odds ratio, 1.17; 95% confidence interval, 1.01-1.37; P = .04), and factor 6 (odds ratio, 1.14; 95% confidence interval, 1.02-1.27; P = .03). CONCLUSIONS: Metabolic profiles are independently associated with adverse outcomes after coronary artery bypass grafting. These profiles might represent novel biomarkers of risk that can augment existing tools for risk stratification of coronary artery bypass grafting patients and might elucidate novel biochemical pathways that mediate risk.

15 Article Effect of heparin administration on metabolomic profiles in samples obtained during cardiac catheterization. 2011

Brunner, Michael P / Shah, Svati H / Craig, Damian M / Stevens, Robert D / Muehlbauer, Michael J / Bain, James R / Newgard, Christopher B / Kraus, William E / Granger, Christopher B / Sketch, Michael H / Newby, L Kristin. ·Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. ·Circ Cardiovasc Genet · Pubmed #22010138.

ABSTRACT: BACKGROUND: Metabolic profiling holds promise for early detection of coronary artery disease and assessing risk for ischemic events. Heparin is frequently administered (1) to treat acute coronary syndromes; and (2) during routine cardiac catheterization procedures. Because it stimulates lipolysis, heparin is a potential confounder of metabolic profiling in these populations. METHODS AND RESULTS: Using mass spectrometry and conventional immunoassays, we evaluated how unfractionated heparin administration affected 69 peripheral blood metabolites (acylcarnitines, amino acids, nonesterified fatty acids and their oxidation byproducts, conventional lipids, glucose, and C-reactive protein) in samples obtained pre- and postcardiac catheterization from 19 patients who received heparin and 10 patients who did not. Using unpaired t tests, we compared the changes in mean metabolite levels before and after the procedure between the nonheparin and heparin groups. Clinical characteristics of the nonheparin and heparin groups, indication for cardiac catheterization, procedure performed, and other periprocedural variables were similar. The mean change between pre- and postprocedure β-hydroxybutyrate (5.43 versus 66.84 μmol/L; P=0.009), ketones (21.17 versus 98.49 μmol/L; P=0.009), nonesterified fatty acids (0.37 versus 1.20 mmol/L; P=0.017), and triglycerides (-9.33 versus -36.50 mg/dL; P=0.007) was significantly different between the nonheparin and heparin groups, respectively. There were no significant differences between groups in the other metabolites measured. CONCLUSIONS: Heparin administration during cardiac catheterization induced changes in peripheral blood metabolites that were consistent with known lipolytic effects of heparin and define a metabolite signature associated with heparin administration. These findings are important for accurate interpretation of future metabolic profiling studies in populations exposed to heparin.

16 Article Polymorphisms associated with in vitro aspirin resistance are not associated with clinical outcomes in patients with coronary artery disease who report regular aspirin use. 2011

Voora, Deepak / Horton, John / Shah, Svati H / Shaw, Linda K / Newby, L Kristin. ·Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, NC 27710, USA. deepak.voora@duke.edu ·Am Heart J · Pubmed #21742104.

ABSTRACT: BACKGROUND: We hypothesized that single-nucleotide polymorphisms (SNPs) associated with heightened in vitro platelet function during aspirin exposure (which we define as "laboratory aspirin resistance") would be associated with greater risk for death, myocardial infarction (MI) or stroke among patients with coronary artery disease regularly using aspirin. METHODS: Duke Databank for Cardiovascular Disease patients with (n = 3,449, CATHeterization GENetics cohort) or without (n = 11,754, nongenetic cohort) banked DNA with ≥1 coronary stenosis >75% were followed up at 6 months, then annually for death, MI, or stroke occurring during periods of reported aspirin use. We evaluated associations of candidate SNPs from GNB3, PEAR1, ITGB3, VAV3, ITGA2, GPVI, PTGS1, F2R, THBS1, A2AR, and GP1BA with events during follow-up using Cox proportional hazards modeling adjusted for clinical characteristics associated with outcomes in the nongenetic cohort. RESULTS: Over a median of 3.5 years, 2,762 (24%) nongenetic cohort patients and 648 (19%) CATHeterization GENetics cohort patients had the composite outcome during reported aspirin use. No candidate SNPs were significantly associated with death, MI, or stroke in either univariable or multivariable analyses. A prospective analysis demonstrated 80% to 88% power to detect a hazard ratio of ≥1.3 for minor allele carriers. CONCLUSION: Patients with angiographically significant coronary artery disease regularly using aspirin and carrying SNPs associated with laboratory aspirin resistance were not at higher risk for death, MI, or stroke. Using these SNPs to guide more aggressive antiplatelet therapy is not justified by these results. Direct extrapolation from in vitro findings to the clinical setting should be avoided.

17 Article Association of a peripheral blood metabolic profile with coronary artery disease and risk of subsequent cardiovascular events. 2010

Shah, Svati H / Bain, James R / Muehlbauer, Michael J / Stevens, Robert D / Crosslin, David R / Haynes, Carol / Dungan, Jennifer / Newby, L Kristin / Hauser, Elizabeth R / Ginsburg, Geoffrey S / Newgard, Christopher B / Kraus, William E. ·Department of Medicine, Duke University, Durham, NC, USA. svati.shah@duke.edu ·Circ Cardiovasc Genet · Pubmed #20173117.

ABSTRACT: BACKGROUND: Molecular tools may provide insight into cardiovascular risk. We assessed whether metabolites discriminate coronary artery disease (CAD) and predict risk of cardiovascular events. METHODS AND RESULTS: We performed mass-spectrometry-based profiling of 69 metabolites in subjects from the CATHGEN biorepository. To evaluate discriminative capabilities of metabolites for CAD, 2 groups were profiled: 174 CAD cases and 174 sex/race-matched controls ("initial"), and 140 CAD cases and 140 controls ("replication"). To evaluate the capability of metabolites to predict cardiovascular events, cases were combined ("event" group); of these, 74 experienced death/myocardial infarction during follow-up. A third independent group was profiled ("event-replication" group; n=63 cases with cardiovascular events, 66 controls). Analysis included principal-components analysis, linear regression, and Cox proportional hazards. Two principal components analysis-derived factors were associated with CAD: 1 comprising branched-chain amino acid metabolites (factor 4, initial P=0.002, replication P=0.01), and 1 comprising urea cycle metabolites (factor 9, initial P=0.0004, replication P=0.01). In multivariable regression, these factors were independently associated with CAD in initial (factor 4, odds ratio [OR], 1.36; 95% CI, 1.06 to 1.74; P=0.02; factor 9, OR, 0.67; 95% CI, 0.52 to 0.87; P=0.003) and replication (factor 4, OR, 1.43; 95% CI, 1.07 to 1.91; P=0.02; factor 9, OR, 0.66; 95% CI, 0.48 to 0.91; P=0.01) groups. A factor composed of dicarboxylacylcarnitines predicted death/myocardial infarction (event group hazard ratio 2.17; 95% CI, 1.23 to 3.84; P=0.007) and was associated with cardiovascular events in the event-replication group (OR, 1.52; 95% CI, 1.08 to 2.14; P=0.01). CONCLUSIONS: Metabolite profiles are associated with CAD and subsequent cardiovascular events.

18 Article Patterns and prognostic implications of low high-density lipoprotein levels in patients with non-ST-segment elevation acute coronary syndromes. 2008

Roe, Matthew T / Ou, Fang-Shu / Alexander, Karen P / Newby, Laura Kristin / Foody, Joanne M / Gibler, W Brian / Boden, William E / Ohman, Erik Magnus / Smith, Sidney C / Peterson, Eric D. ·Department of Medicine, Division of Cardiovascular Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. matthew.roe@duke.edu ·Eur Heart J · Pubmed #18716006.

ABSTRACT: AIMS: The patterns and prognostic significance of low high-density lipoprotein (HDL) cholesterol levels have not been well characterized. We sought to determine the prevalence and prognostic significance of low HDL cholesterol levels in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). METHODS AND RESULTS: We evaluated HDL levels among NSTE ACS patients [ischaemic ECG (electrocardiogram) changes and/or positive cardiac markers] from the CRUSADE [Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC(American College of Cardiology)/AHA(American Heart Association) Guidelines] initiative treated at 555 US hospitals from January 2001 through June 2006. Clinical and angiographic characteristics, treatments, and in-hospital outcomes were analysed by categories of HDL levels measured during hospitalization. Among 93 263 NSTE ACS patients with HDL measurements, 16 854 (18.1%) had very low HDL levels (10-29 mg/dL), 32 185 (34.5%) had low HDL levels (30-39 mg/dL), 35 875 (38.5%) had normal HDL levels (40-59 mg/dL), and 8349 (9.0%) had high HDL levels (60-100 mg/dL). Patients with very low HDL levels were younger, more often male, and more commonly obese and diabetic. Patients with very low HDL levels had the greatest risk of multi-vessel coronary disease on angiography and in-hospital mortality compared with patients with normal and high HDL levels. CONCLUSION: Almost one-fifth of patients with NSTE ACS have very low HDL levels--a finding that adds incrementally to a greater burden of atherosclerosis and a higher risk of mortality. Consequently, strategies for mitigating the adverse prognosis associated with very low HDL levels warrant further exploration in patients with ACS.

19 Article ALOX5AP variants are associated with in-stent restenosis after percutaneous coronary intervention. 2008

Shah, Svati H / Hauser, Elizabeth R / Crosslin, David / Wang, Liyong / Haynes, Carol / Connelly, Jessica / Nelson, Sarah / Johnson, Jessica / Gadson, Shera / Nelson, Charlotte L / Seo, David / Gregory, Simon / Kraus, William E / Granger, Christopher B / Goldschmidt-Clermont, Pascal / Newby, L Kristin. ·Department of Medicine, Duke University Medical Center, Durham, NC 27710, United States. svati.shah@duke.edu ·Atherosclerosis · Pubmed #18374923.

ABSTRACT: BACKGROUND: Use of drug-eluting stents (DES) has reduced in-stent restenosis after percutaneous coronary intervention (PCI); however, DES are associated with late stent thrombosis. There is no accurate way to predict in-stent restenosis, although risk factors for atherosclerosis overlap those for in-stent restenosis. Therefore, we evaluated atherosclerosis candidate genes for association with in-stent restenosis. METHODS: We identified 46 consecutive cases that had undergone PCI with bare-metal stents who subsequently developed symptomatic in-stent restenosis of the target lesion (>/=75% luminal narrowing) within 6 months. Forty-six age-, race-, vessel-diameter- and sex-matched controls without in-stent restenosis after PCI with bare-metal stent were also identified. Single-nucleotide polymorphisms (SNPs, N=82) from 39 candidate atherosclerosis genes were genotyped. Multivariable logistic regression models were used to test for association. RESULTS: Five SNPs were associated with in-stent restenosis. Three ALOX5AP SNPs were most strongly associated, two with increased risk (OR 3.74, p=0.01; OR 3.46, p=0.02), and the third with decreased risk of in-stent restenosis (OR 0.09, p=0.004). Two ALOX5AP haplotypes were associated with in-stent restenosis (HapB: OR 3.13, p=0.03); and a haplotype similar to HapA: OR 0.14, p=0.0009). CONCLUSIONS: ALOX5AP, a gene within the inflammatory leukotriene pathway linked to and associated with coronary atherosclerosis, is also associated with in-stent restenosis. Genotyping these variants may help identify those at risk for in-stent restenosis who would benefit most from use of DES.

20 Minor Anger control and cardiovascular outcomes. 2013

Schmidt, Márcia M / Lopes, Renato D / Newby, L Kristin / Moura, Mauro R / Stochero, Luciele / Gottschall, Carlos M / Quadros, Alexandre S. ·Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil. ·Int J Cardiol · Pubmed #23735336.

ABSTRACT: -- No abstract --

21 Unspecified TransRadial Education and Therapeutics (TREAT): shifting the balance of safety and efficacy of antithrombotic agents in percutaneous coronary intervention: a report from the Cardiac Safety Research Consortium. 2013

Hess, Connie N / Rao, Sunil V / Kong, David F / Miller, Julie M / Anstrom, Kevin J / Bertrand, Olivier F / Collet, Jean-Philippe / Effron, Mark B / Eloff, Benjamin C / Fadiran, Emmanuel O / Farb, Andrew / Gilchrist, Ian C / Holmes, David R / Jacobs, Alice K / Kaul, Prashant / Newby, L Kristin / Rutledge, David R / Tavris, Dale R / Tsai, Thomas T / White, Roseann M / Peterson, Eric D / Krucoff, Mitchell W. ·Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. ·Am Heart J · Pubmed #23453103.

ABSTRACT: Percutaneous coronary intervention (PCI) is an integral part of the treatment of coronary artery disease. The most common complication of PCI, bleeding, typically occurs at the vascular access site and is associated with short-term and long-term morbidity and mortality. Periprocedural bleeding also represents the primary safety concern of concomitant antithrombotic therapies essential for PCI success. Use of radial access for PCI reduces procedural bleeding and hence may change the risk profile and net clinical benefit of these drugs. This new drug-device safety interaction creates opportunities to advance the safe and effective use of antithrombotic agents during PCI. In June 2010 and March 2011, leaders from government, academia, professional societies, device manufacturing, and pharmaceutical industries convened for 2 think tank meetings. Titled TREAT I and II, these forums examined approaches to improve the overall safety of PCI by optimizing strategies for antithrombotic drug use and radial artery access. This article summarizes the content and proceedings of these sessions.

22 Minor In response to "is non-dipping status related to coronary heart disease in postmenopausal women?". 2013

Sherwood, Andrew / Hinderliter, Alan L / Newby, L Kristin. · ·Am J Hypertens · Pubmed #23382397.

ABSTRACT: -- No abstract --