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Coronary Artery Disease: HELP
Articles by Steven J. Shea
Based on 17 articles published since 2010
(Why 17 articles?)
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Between 2010 and 2020, Steven Shea wrote the following 17 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Clinical Trial Basic vs More Complex Definitions of Family History in the Prediction of Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis. 2018

Patel, Jaideep / Al Rifai, Mahmoud / Scheuner, Maren T / Shea, Steven / Blumenthal, Roger S / Nasir, Khurram / Blaha, Michael J / McEvoy, John W. ·Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Department of Internal Medicine, University of Kansas, Wichita. · Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. · Department of Medicine and Epidemiology, Columbia University, New York, NY. · Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL. · Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD. Electronic address: jmcevoy1@jhmi.edu. ·Mayo Clin Proc · Pubmed #29555305.

ABSTRACT: OBJECTIVE: To determine whether family history of coronary heart disease (FH) definitions differ in their association with atherosclerotic cardiovascular disease (ASCVD) events. PATIENTS AND METHODS: Participants who provided FH data from July 17, 2000, through February 24, 2004, were identified. Definitions of FH were any, premature, and Familial Risk Assessment (FRA). Outcomes included coronary heart disease (CHD), stroke, peripheral artery disease, angina, and congestive heart failure. Multivariable-adjusted Cox models examined the association of FH definitions with events. C statistics and the net reclassification index examined the incremental prognostic contribution of each definition. RESULTS: In 6200 participants, the proportions of any FH and premature FH were 36% and 16%, respectively, and of weak, moderate, and strong familial risk were 20%, 16%, and 20%, respectively. Over median follow-up of 10.1 years (range, 0.02-11.5 years), 741 participants experienced a composite event. Compared with no FH, any FH was associated with incident CHD, angina, and composite ASCVD (hazard ratios [95% CIs]: 1.4 [1.1-1.8], 1.6 [1.2-2.1], and 1.3 [1.1-1.5], respectively). Similar results were obtained for premature FH compared with no FH and for strong compared with weak FRA for these 3 outcomes. There was no association between the FH definitions and noncoronary cardiovascular events. Compared with traditional risk factors (C statistic = 0.740), any FH, premature FH, and FRA all improved discrimination of composite ASCVD (all P < .01); however, the differences in C statistics among any FH (0.743), premature FH (0.742), and FRA (0.744) were numerically small, as were differences in the net reclassification index. CONCLUSION: A single question regarding the presence of FH in any first-degree relative performs just as well as more complicated assessments in predicting CHD. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00005487.

2 Article The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol <70 mg/dL: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). 2018

Al Rifai, Mahmoud / Martin, Seth S / McEvoy, John W / Nasir, Khurram / Blankstein, Ron / Yeboah, Joseph / Miedema, Michael / Shea, Steven J / Polak, Joseph F / Ouyang, Pamela / Blumenthal, Roger S / Bittencourt, Marcio / Bensenor, Isabela / Santos, Raul D / Duncan, Bruce B / Santos, Itamar S / Lotufo, Paulo A / Blaha, Michael J. ·The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; Department of Internal Medicine, Kansas University School of Medicine, Wichita, KS, USA. · The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA. · The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA. · Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA. · Department of Cardiology, Wake Forest Baptist Health, Winston-Salem, NC, USA. · Minneapolis Heart Institute Foundation, Minneapolis, MS, USA. · Departments of Medicine and Epidemiology, Columbia University, New York, NY, USA. · Department of Radiology, Tufts University School of Medicine, Boston, MA, USA. · Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil. · Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil. · Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil. · Faculty of Medicine, Federal University of Rio Grande do Sul, Brazil. · The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA. Electronic address: mblaha1@jhmi.edu. ·Atherosclerosis · Pubmed #29751286.

ABSTRACT: BACKGROUND AND AIMS: The prevalence and correlates of subclinical atherosclerosis when low-density lipoprotein cholesterol (LDL-C) levels are low remain unclear. Therefore, we examined the association of cardiovascular risk factors and subclinical atherosclerosis among individuals with untreated LDL-C <70 mg/dL. METHODS: We included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohorts. To optimize accuracy, LDL-C was calculated by the validated Martin/Hopkins equation that uses an adjustable factor for the ratio of triglycerides to very low-density lipoprotein cholesterol. We defined subclinical atherosclerosis as a coronary artery calcium (CAC) score >0 in the combined cohort or common carotid intima media thickness (cIMT) in the 4 RESULTS: Among 9411 participants not on lipid lowering therapy, 263 (3%) had LDL-C <70 mg/dL (MESA: 206, ELSA: 57). Mean age in this population was 58 (SD 12) years, with 43% men, and 41% Black. The prevalence of CAC >0 in those with untreated LDL-C<70 mg/dL was 30%, and 18% were in 4th quartile of cIMT. In demographically adjusted models, only ever smoking was significantly associated with both CAC and cIMT. Similar results were obtained in risk factor-adjusted models (smoking: OR, 2.29; 95% CI, 1.10-4.80 and OR, 3.44; 95% CI, 1.41-8.37 for CAC and cIMT, respectively). CONCLUSIONS: Among middle-aged to older individuals with untreated LDL-C <70 mg/dL, subclinical atherosclerosis remains moderately common and is associated with cigarette smoking.

3 Article Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). 2018

Budoff, Matthew J / Young, Rebekah / Burke, Gregory / Jeffrey Carr, J / Detrano, Robert C / Folsom, Aaron R / Kronmal, Richard / Lima, Joao A C / Liu, Kiang J / McClelland, Robyn L / Michos, Erin / Post, Wendy S / Shea, Steven / Watson, Karol E / Wong, Nathan D. ·Los Angeles Biomedical Research Institute, 1124 W Carson Street, CDCRC, Torrance, CA, USA. · Department of Biostatistics, University of Washington, Bldg. 29, Suite 310, 6200 NE 74th Street, Seattle, WA, USA. · Department of Public Health Sciences, Wake Forest University Health Sciences, 475 Vine St, Winston-Salem, NC, USA. · Department of Radiological Sciences, Vanderbilt University, 2525 West End, Nashville, TN, USA. · Departments of Radiological Sciences and Public Health, University of California, Irvine, Irvine, CA, USA. · Department of Public Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA. · Department of Internal Medicine, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD, USA. · Department of Preventive Medicine, Northwestern University, 600 N Lake Shore Drive, Chicago, IL, USA. · Department of Medicine, Vagelos College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, 630 W. 168th Street, New York, NY, USA. · Department of Internal Medicine, UCLA, 200 UCLA Medical Plaza, Los Angeles, CA, USA. ·Eur Heart J · Pubmed #29688297.

ABSTRACT: Aims: While coronary artery calcium (CAC) has been extensively validated for predicting clinical events, most outcome studies of CAC have evaluated coronary heart disease (CHD) rather than atherosclerotic cardiovascular disease (ASCVD) events (including stroke). Also, virtually all CAC studies are of short- or intermediate-term follow-up, so studies across multi-ethnic cohorts with long-term follow-up are warranted prior to widespread clinical use. We sought to evaluate the contribution of CAC using the population-based MESA cohort with over 10 years of follow-up for ASCVD events, and whether the association of CAC with events varied by sex, race/ethnicity, or age category. Methods and results: We utilized MESA, a prospective multi-ethnic cohort study of 6814 participants (51% women), aged 45-84 years, free of clinical CVD at baseline. We evaluated the relationship between CAC and incident ASCVD using Cox regression models adjusted for age, race/ethnicity, sex, education, income, cigarette smoking status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes, lipid-lowering medication, systolic blood pressure, antihypertensive medication, intentional physical exercise, and body mass index. Only the first event for each individual was used in the analysis. Overall, 500 incident ASCVD (7.4%) events were observed in the total study population over a median of 11.1 years. Hard ASCVD included 217 myocardial infarction, 188 strokes (not transient ischaemic attack), 13 resuscitated cardiac arrest, and 82 CHD deaths. Event rates in those with CAC = 0 Agatston units ranged from 1.3% to 5.6%, while for those with CAC > 300, the 10-year event rates ranged from 13.1% to 25.6% across different age, gender, and racial subgroups. At 10 years of follow-up, all participants with CAC > 100 were estimated to have >7.5% risk regardless of demographic subset. Ten-year ASCVD event rates increased steadily across CAC categories regardless of age, sex, or race/ethnicity. For each doubling of CAC, we estimated a 14% relative increment in ASCVD risk, holding all other risk factors constant. This association was not significantly modified by age, sex, race/ethnicity, or baseline lipid-lowering use. Conclusions: Coronary artery calcium is associated strongly and in a graded fashion with 10-year risk of incident ASCVD as it is for CHD, independent of standard risk factors, and similarly by age, gender, and ethnicity. While 10-year event rates in those with CAC = 0 were almost exclusively below 5%, those with CAC ≥ 100 were consistently above 7.5%, making these potentially valuable cutpoints for the consideration of preventive therapies. Coronary artery calcium strongly predicts risk with the same magnitude of effect in all races, age groups, and both sexes, which makes it among the most useful markers for predicting ASCVD risk.

4 Article Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis. 2018

Al Rifai, Mahmoud / Greenland, Philip / Blaha, Michael J / Michos, Erin D / Nasir, Khurram / Miedema, Michael D / Yeboah, Joseph / Sandfort, Veit / Frazier-Wood, Alexis C / Shea, Steven / Lima, Joao Ac / Szklo, Moyses / Post, Wendy S / Blumenthal, Roger S / McEvoy, John W. ·Department of Medicine, University of Kansas School of Medicine, Wichita, KS; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD. · Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. · Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD. · Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL. · Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN. · Department of Cardiology, Wake Forest Baptist Health, Winston-Salem, NC. · National Institutes of Health, Bethesda, MD. · ARS/USDA Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX. · Departments of Medicine and Epidemiology, Columbia University, New York, NY. · Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. · Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jmcevoy1@jhmi.edu. ·Am Heart J · Pubmed #29653643.

ABSTRACT: BACKGROUND: Although cardiovascular disease (CVD) prevention traditionally emphasizes risk factor control, recent evidence also supports the promotion of "health factors" associated with cardiovascular wellness. However, whether such health factors exist among adults with advanced subclinical atherosclerosis is unknown. We aimed to study the association between health factors and events among persons with elevated coronary artery calcium (CAC). METHODS: Self-reported health-factors studied included nonsmoking, physical activity, Mediterranean-style diet, sleep quality, emotional support, low stress burden, and absence of depression. Measured health-factors included optimal weight, blood pressure, lipids, and glucose. Multivariable-adjusted Cox models examined the association between health factors and incident CVD or mortality, independent of risk factor treatment. Accelerated failure time models assessed whether health factors were associated with relative time delays in disease onset. RESULTS: Among 1,601 Multi-Ethnic Study of Atherosclerosis participants with CAC >100 without baseline clinical atherosclerotic CVD, mean age was 69 (±9) years, 64% were male, and median CAC score was 332 Agatston units. Over 12 years of follow-up, nonsmoking, high-density lipoprotein cholesterol levels >40 mg/dL for men and >50 mg/dL for women, and low stress burden were inversely associated with ASCVD (hazard ratios ranging from 0.58 to 0.71, all P<.05). Nonsmoking, glucose levels <100 mg/dL, regular physical activity, and low stress burden were inversely associated with mortality (hazard ratios ranging from 0.40 to 0.77, all P<.05). Each of these factors was also associated with delays in onset of clinical disease, as was absence of depression. CONCLUSIONS: Adults with elevated CAC appear to have healthy lifestyle options to lower risk and delay onset of CVD, over and above standard preventive therapies.

5 Article Incident Cardiovascular Disease Among Adults With Blood Pressure <140/90 mm Hg. 2017

Tajeu, Gabriel S / Booth, John N / Colantonio, Lisandro D / Gottesman, Rebecca F / Howard, George / Lackland, Daniel T / O'Brien, Emily C / Oparil, Suzanne / Ravenell, Joseph / Safford, Monika M / Seals, Samantha R / Shimbo, Daichi / Shea, Steven / Spruill, Tanya M / Tanner, Rikki M / Muntner, Paul. ·From Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.) · Department of Epidemiology (J.N.B., L.D.C., R.M.T., P.M.), Department of Biostatistics (G.H.), Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program (S.O.), Department of Medicine (M.M.S.), University of Alabama at Birmingham · Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.) · Department of Neurology, Medical University of South Carolina, Charleston (D.T.L.) · Duke Clinical Research Institute, Duke University, Durham, NC (E.C.O.) · Department of Population Health, New York University School of Medicine (J.R., T.S.) · Department of Medicine, Weill Cornell Medical College, New York (M.M.S.) · Department of Mathematics and Statistics, University of West Florida, Pensacola, FL (S.R.S.) · Department of Medicine (D.S.), Departments of Medicine and Epidemiology (S.S.), Columbia University, New York. ·Circulation · Pubmed #28634217.

ABSTRACT: BACKGROUND: Data from before the 2000s indicate that the majority of incident cardiovascular disease (CVD) events occur among US adults with systolic and diastolic blood pressure (SBP/DBP) ≥140/90 mm Hg. Over the past several decades, BP has declined and hypertension control has improved. METHODS: We estimated the percentage of incident CVD events that occur at SBP/DBP <140/90 mm Hg in a pooled analysis of 3 contemporary US cohorts: the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), the MESA (Multi-Ethnic Study of Atherosclerosis), and the JHS (Jackson Heart Study) (n=31 856; REGARDS=21 208; MESA=6779; JHS=3869). Baseline study visits were conducted in 2003 to 2007 for REGARDS, 2000 to 2002 for MESA, and 2000 to 2004 for JHS. BP was measured by trained staff using standardized methods. Antihypertensive medication use was self-reported. The primary outcome was incident CVD, defined by the first occurrence of fatal or nonfatal stroke, nonfatal myocardial infarction, fatal coronary heart disease, or heart failure. Events were adjudicated in each study. RESULTS: Over a mean follow-up of 7.7 years, 2584 participants had incident CVD events. Overall, 63.0% (95% confidence interval [CI], 54.9-71.1) of events occurred in participants with SBP/DBP <140/90 mm Hg; 58.4% (95% CI, 47.7-69.2) and 68.1% (95% CI, 60.1-76.0) among those taking and not taking antihypertensive medication, respectively. The majority of events occurred in participants with SBP/DBP <140/90 mm Hg among those <65 years of age (66.7%; 95% CI, 60.5-73.0) and ≥65 years of age (60.3%; 95% CI, 51.0-69.5), women (61.4%; 95% CI, 49.9-72.9) and men (63.8%; 95% CI, 58.4-69.1), and for whites (68.7%; 95% CI, 66.1-71.3), blacks (59.0%; 95% CI, 49.5-68.6), Hispanics (52.7%; 95% CI, 45.1-60.4), and Chinese-Americans (58.5%; 95% CI, 45.2-71.8). Among participants taking antihypertensive medication with SBP/DBP <140/90 mm Hg, 76.6% (95% CI, 75.8-77.5) were eligible for statin treatment, but only 33.2% (95% CI, 32.1-34.3) were taking one, and 19.5% (95% CI, 18.5-20.5) met the SPRINT (Systolic Blood Pressure Intervention Trial) eligibility criteria and may benefit from a SBP target goal of 120 mm Hg. CONCLUSIONS: Although higher BP levels are associated with increased CVD risk, in the modern era, the majority of incident CVD events occur in US adults with SBP/DBP <140/90 mm Hg. While absolute risk and cost-effectiveness should be considered, additional CVD risk-reduction measures for adults with SBP/DBP <140/90 mm Hg at high risk for CVD may be warranted.

6 Article Albuminuria in Rheumatoid Arthritis: Associations With Rheumatoid Arthritis Characteristics and Subclinical Atherosclerosis. 2017

Sammut, Amanda / Shea, Steven / Blumenthal, Roger S / Szklo, Moyses / Bathon, Joan M / Polak, Joseph F / Tracy, Russell / Giles, Jon T. ·Columbia University College of Physicians & Surgeons, New York, New York. · Johns Hopkins University, Baltimore, Maryland. · Tufts University School of Medicine, Boston, Massachusetts. · University of Vermont College of Medicine, Burlington, Vermont. ·Arthritis Care Res (Hoboken) · Pubmed #28257609.

ABSTRACT: OBJECTIVE: Albuminuria is a marker for subclinical cardiovascular disease (CVD) in the general population. It is uncertain whether this association is present in patients with rheumatoid arthritis (RA), a population with increased atherosclerosis and CVD events. METHODS: Urine albumin from a spot morning collection was measured, and the urine albumin-to-creatinine ratio (uACR) was calculated for RA patients and a population-based sample of demographically matched non-RA controls. Associations of elevated uACR (≥25 mg/gm for women and ≥17 mg/gm for men) with CVD risk factors and measures of atherosclerosis (coronary artery calcification, ultrasound-determined maximal intima-media thickness of the common carotid artery and internal carotid artery [ICA], and the presence of focal plaque in the ICA) were compared cross-sectionally according to RA status. RESULTS: We compared 196 RA patients with 271 non-RA controls. Elevated uACR was found in 18% of the RA patients compared with 17% of the controls (P = 0.89). After adjustment, RA was associated with 57% lower odds of elevated uACR (P = 0.016). Higher serum creatinine levels and hypertension were both strongly and significantly associated with elevated uACR in the control group but not in the RA group (both P for interaction < 0.05). Among RA characteristics, the adjusted prevalence of elevated uACR among those treated with tumor necrosis factor inhibitors was less than half that among those not so treated (9% versus 20%, respectively; P = 0.047). CONCLUSION: There was no association in the RA group of elevated uACR with measures of atherosclerosis or with several key cardiometabolic risk factors, which suggests a lower usefulness of elevated uACR as an indicator of subclinical CVD in RA.

7 Article Cholesterol, lipoproteins and subclinical interstitial lung disease: the MESA study. 2017

Podolanczuk, Anna J / Raghu, Ganesh / Tsai, Michael Y / Kawut, Steven M / Peterson, Eric / Sonti, Rajiv / Rabinowitz, Daniel / Johnson, Craig / Barr, R Graham / Hinckley Stukovsky, Karen / Hoffman, Eric A / Carr, J Jeffrey / Ahmed, Firas S / Jacobs, David R / Watson, Karol / Shea, Steven J / Lederer, David J. ·Department of Medicine, Columbia University Medical Center, New York, New York, USA. · Department of Medicine, University of Washington, Seattle, Washington, USA. · Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA. · Department of Medicine, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Statistics, Columbia University, New York, New York, USA. · Department of Biostatistics, University of Washington, Seattle, Washington, USA. · Department of Epidemiology, Columbia University Medical Center, New York, New York, USA. · Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. · Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. · Department of Radiology, Columbia University Medical Center, New York, New York, USA. · Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis Minnesota, USA. · Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA. ·Thorax · Pubmed #28130491.

ABSTRACT: We investigated associations of plasma lipoproteins with subclinical interstitial lung disease (ILD) by measuring high attenuation areas (HAA: lung voxels between -600 and -250 Hounsfield units) in 6700 adults and serum MMP-7 and SP-A in 1216 adults age 45-84 without clinical cardiovascular disease in Multi-Ethnic Study of Atherosclerosis. In cross-sectional analyses, each SD decrement in high density lipoprotein cholesterol (HDL-C) was associated with a 2.12% HAA increment (95% CI 1.44% to 2.79%), a 3.53% MMP-7 increment (95% CI 0.93% to 6.07%) and a 6.37% SP-A increment (95% CI 1.35% to 11.13%), independent of demographics, smoking and inflammatory biomarkers. These findings support a novel hypothesis that HDL-C might influence subclinical lung injury and extracellular matrix remodelling.

8 Article Prevalence and Correlates of Myocardial Scar in a US Cohort. 2015

Turkbey, Evrim B / Nacif, Marcelo S / Guo, Mengye / McClelland, Robyn L / Teixeira, Patricia B R P / Bild, Diane E / Barr, R Graham / Shea, Steven / Post, Wendy / Burke, Gregory / Budoff, Matthew J / Folsom, Aaron R / Liu, Chia-Ying / Lima, João A / Bluemke, David A. ·Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland2Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland. · Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland. · Department of Biostatistics, University of Washington, Seattle. · Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Patient-Centered Outcomes Research Institute, Washington, DC. · Departments of Medicine and Epidemiology, Columbia University, New York, New York. · Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina. · Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California. · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis. · Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland4Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. ·JAMA · Pubmed #26547466.

ABSTRACT: IMPORTANCE: Myocardial scarring leads to cardiac dysfunction and poor prognosis. The prevalence of and factors associated with unrecognized myocardial infarction and scar have not been previously defined using contemporary methods in a multiethnic US population. OBJECTIVE: To determine prevalence of and factors associated with myocardial scar in middle- and older-aged individuals in the United States. DESIGN, SETTING, AND PARTICIPANTS: The Multi-Ethnic Study of Atherosclerosis (MESA) study is a population-based cohort in the United States. Participants were aged 45 through 84 years and free of clinical cardiovascular disease (CVD) at baseline in 2000-2002. In the 10th year examination (2010-2012), 1840 participants underwent cardiac magnetic resonance (CMR) imaging with gadolinium to detect myocardial scar. Cardiovascular disease risk factors and coronary artery calcium (CAC) scores were measured at baseline and year 10. Logistic regression models were used to estimate adjusted odds ratios (ORs) for myocardial scar. EXPOSURES: Cardiovascular risk factors, CAC scores, left ventricle size and function, and carotid intima-media thickness. MAIN OUTCOMES AND MEASURES: Myocardial scar detected by CMR imaging. RESULTS: Of 1840 participants (mean [SD] age, 68 [9] years, 52% men), 146 (7.9%) had myocardial scars, of which 114 (78%) were undetected by electrocardiogram or by clinical adjudication. In adjusted models, age, male sex, body mass index, hypertension, and current smoking at baseline were associated with myocardial scar at year 10. The OR per 8.9-year increment was 1.61 (95% CI, 1.36-1.91; P < .001); for men vs women: OR, 5.76 (95% CI, 3.61-9.17; P < .001); per 4.8-SD body mass index: OR, 1.32 (95% CI, 1.09-1.61, P = .005); for hypertension: OR, 1.61 (95% CI, 1.12-2.30; P = .009); and for current vs never smokers: 2.00 (95% CI, 1.22-3.28; P = .006). Age-, sex-, and ethnicity-adjusted CAC scores at baseline were also associated with myocardial scar at year 10. Compared with a CAC score of 0, the OR for scores from 1 through 99 was 2.4 (95% CI, 1.5-3.9); from 100 through 399, 3.0 (95% CI, 1.7-5.1), and 400 or higher, 3.3 (95% CI, 1.7-6.1) (P ≤ .001). The CAC score significantly added to the association of myocardial scar with age, sex, race/ethnicity, and traditional CVD risk factors (C statistic, 0.81 with CAC vs 0.79 without CAC, P = .01). CONCLUSIONS AND RELEVANCE: The prevalence of myocardial scars in a US community-based multiethnic cohort was 7.9%, of which 78% were unrecognized by electrocardiography or clinical evaluation. Further studies are needed to understand the clinical consequences of these undetected scars.

9 Article 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). 2015

McClelland, Robyn L / Jorgensen, Neal W / Budoff, Matthew / Blaha, Michael J / Post, Wendy S / Kronmal, Richard A / Bild, Diane E / Shea, Steven / Liu, Kiang / Watson, Karol E / Folsom, Aaron R / Khera, Amit / Ayers, Colby / Mahabadi, Amir-Abbas / Lehmann, Nils / Jöckel, Karl-Heinz / Moebus, Susanne / Carr, J Jeffrey / Erbel, Raimund / Burke, Gregory L. ·Department of Biostatistics, University of Washington, Seattle, Washington. Electronic address: rmcclell@u.washington.edu. · Department of Biostatistics, University of Washington, Seattle, Washington. · Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. · Patient-Centered Outcomes Research Institute, Washington, DC. · Departments of Medicine and Epidemiology, Columbia University, New York, New York. · Department of Preventive Medicine, Northwestern University Medical School, Chicago, Illinois. · Division of Cardiology, UCLA School of Medicine, Los Angeles, California. · Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota. · Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas. · Division of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas. · University Clinic Essen, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Essen, Germany. · Institute of Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, University of Duisburg, Essen, Germany. · Department of Radiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee. · Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. ·J Am Coll Cardiol · Pubmed #26449133.

ABSTRACT: BACKGROUND: Several studies have demonstrated the tremendous potential of using coronary artery calcium (CAC) in addition to traditional risk factors for coronary heart disease (CHD) risk prediction. However, to date, no risk score incorporating CAC has been developed. OBJECTIVES: The goal of this study was to derive and validate a novel risk score to estimate 10-year CHD risk using CAC and traditional risk factors. METHODS: Algorithm development was conducted in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective community-based cohort study of 6,814 participants age 45 to 84 years, who were free of clinical heart disease at baseline and followed for 10 years. MESA is sex balanced and included 39% non-Hispanic whites, 12% Chinese Americans, 28% African Americans, and 22% Hispanic Americans. External validation was conducted in the HNR (Heinz Nixdorf Recall Study) and the DHS (Dallas Heart Study). RESULTS: Inclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 vs. 0.75; p < 0.0001). External validation in both the HNR and DHS studies provided evidence of very good discrimination and calibration. Harrell's C-statistic was 0.779 in HNR and 0.816 in DHS. Additionally, the difference in estimated 10-year risk between events and nonevents was approximately 8% to 9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within one-half of a percent of the observed event rate. CONCLUSIONS: An accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. The MESA risk score, which is available online on the MESA web site for easy use, can be used to aid clinicians when communicating risk to patients and when determining risk-based treatment strategies.

10 Article Objectively measured sleep characteristics and prevalence of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis Sleep study. 2015

Lutsey, Pamela L / McClelland, Robyn L / Duprez, Daniel / Shea, Steven / Shahar, Eyal / Nagayoshi, Mako / Budoff, Matthew / Kaufman, Joel D / Redline, Susan. ·Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA. · Department of Biostatistics, University of Washington, Seattle, Washington, USA. · Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA. · Departments of Medicine and Epidemiology, Columbia University, New York, New York, USA. · Division of Epidemiology & Biostatistics, University of Arizona, Tucson, Arizona, USA. · Department of Community Medicine, Nagasaki University, Nagasaki, Japan. · Department of Medicine, University of California-Los Angeles, Torrance, California, USA. · Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA. · Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ·Thorax · Pubmed #26156526.

ABSTRACT: BACKGROUND: We tested whether objectively measured indices of obstructive sleep apnoea (OSA) and sleep quality are associated with coronary artery calcification (CAC) prevalence independent of obesity, a classic confounder. METHODS: 1465 Multi-Ethnic Study of Atherosclerosis participants (mean age 68 years), who were free of clinical cardiovascular disease, had both coronary CT and in-home polysomnography and actigraphy performed. OSA categories were defined by the Apnea-Hypopnea Index (AHI). Prevalence ratios (PRs) for CAC >0 and >400 (high burden) were calculated. RESULTS: Participants with severe OSA (AHI ≥30; 14.6%) were more likely to have prevalent CAC, relative to those with no evidence of OSA, after adjustment for demographics and smoking status (PR 1.16; 95% CI 1.06 to 1.26), body mass index (1.11; 1.02 to 1.21) and traditional cardiovascular risk factors (1.10; 1.01 to 1.19). Other markers of hypoxaemia tended to be associated with a higher prevalence of CAC >0. For CAC >400, a higher prevalence was observed with both a higher arousal index and less slow-wave sleep. Overall, associations were somewhat stronger among younger participants, but did not vary by sex or race/ethnicity. CONCLUSIONS: In this population-based multi-ethnic sample, severe OSA was associated with subclinical coronary artery disease (CAC >0), independent of obesity and traditional cardiovascular risk factors. Furthermore, the associations of the arousal index and slow-wave sleep with high CAC burden suggest that higher nightly sympathetic nervous system activation is also a risk factor. These findings highlight the potential importance of measuring disturbances in OSA as well as sleep fragmentation as possible risk factors for coronary artery disease.

11 Article Obstructive sleep apnea and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis study. 2014

Kwon, Younghoon / Duprez, Daniel A / Jacobs, David R / Nagayoshi, Mako / McClelland, Robyn L / Shahar, Eyal / Budoff, Matthew / Redline, Susan / Shea, Steven / Carr, J Jeffrey / Lutsey, Pamela L. ·Department of Medicine, University of Minnesota, Minneapolis, MN (Y.K., D.A.D.). · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (D.R.J., P.L.L.). · Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.). · Department of Biostatistics, University of Washington, Seattle, WA (R.L.M.C.). · College of Public Health, University of Arizona, Tuscan, AZ (E.S.). · Harbor-UCLA Los Angeles Biomedical Research Institute, Torrance, CA (M.B.). · Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.). · Department of Medicine, Columbia University, New York, NY (S.S.). · Department of Radiology, Vanderbilt University, Nashville, TN (J.C.). ·J Am Heart Assoc · Pubmed #25261530.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is a common condition associated with cardiovascular disease. Its potential effect on progression of subclinical atherosclerosis is not well understood. We tested the hypothesis that self-reported OSA is associated with progression of coronary artery calcium (CAC). We also evaluated whether traditional cardiovascular risk factors accounted for the association. METHODS AND RESULTS: In the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort, we studied 2603 participants who at baseline (2002-2004) completed a sleep questionnaire and underwent coronary computed tomography (CT) and, then 8 years later (2010-2011), a repeat coronary CT. Participants were categorized by symptoms of habitual snoring or reported physician diagnosis of OSA. At baseline, 102 (3.9%) reported diagnosed OSA; 666 (25.6%) reported diagnosed habitual snoring; and 1835 (70.5%) reported neither habitual snoring nor OSA ("normal"). At baseline, CAC prevalence was highest among those with OSA but similar for those with and without habitual snoring. During 8 years of follow-up, greater progression of CAC was observed among those with OSA versus normal (mean increase of 204.2 versus 135.5 Agatston units; P=0.01), after accounting for demographics, behaviors, and body habitus. Modest attenuation was observed after adjustment for cardiovascular risk factors (188.7 versus 138.8; P=0.06). CAC progression among habitual snorers was similar to that observed in the normal group. CONCLUSIONS: OSA was associated with CAC score progression after adjustment for demographics, behaviors, and body mass index. However, the association was not significant after accounting for cardiovascular risk factors, which may mediate the association between OSA and CAC.

12 Article Electrocardiographic abnormalities and coronary artery calcium for coronary heart disease prediction and reclassification: the Multi-Ethnic Study of Atherosclerosis (MESA). 2014

Desai, Chintan S / Ning, Hongyan / Soliman, Elsayed Z / Burke, Gregory L / Shea, Steven / Nazarian, Saman / Lloyd-Jones, Donald M / Greenland, Philip. ·Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. · Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC. · Columbia University Mailman School of Public Health, New York, NY. · Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: p-greenland@northwestern.edu. ·Am Heart J · Pubmed #25173552.

ABSTRACT: BACKGROUND: Electrocardiographic (ECG) abnormalities and coronary artery calcium (CAC) identify different aspects of subclinical coronary heart disease (CHD). We sought to determine whether ECG abnormalities improve risk prediction for all CHD and fatal CHD events jointly with CAC measures. METHODS: We included 6,406 men and women from the MESA aged 45 to 84 years who were free of cardiovascular disease at the time of enrollment (2000-2002). We stratified participants by presence of ST-T and Q wave abnormalities: any major, any minor/no major, and no major/minor using the Minnesota Code classifications. CAC score was defined into one of the following strata: 0, 1 to 100, 101 to 300, greater than 300. We created risk prediction models using MESA-specific coefficients for traditional risk factors (RFs) and calculated categorical net reclassification improvement (NRI) for all and fatal CHD. RESULTS: Over a median follow-up of 10 years, we observed that the addition of ECG abnormalities to a risk prediction model for all CHD resulted in a categorical NRI of 0.05 (P = .04). For fatal CHD alone, the addition of ECG abnormalities resulted in categorical NRI of 0.09 (P = .02). Addition of ECG abnormalities to a model containing RFs and CAC resulted in categorical NRI of 0.02 (P = .11) for all CHD events. We also observed differences in the association between ECG abnormalities and CHD when stratifying by CAC presence. CONCLUSION: Electrocardiographic abnormalities improved risk prediction for CHD when added to RFs but not when added to CAC. Electrocardiographic abnormalities particularly improved risk prediction for fatal CHD.

13 Article Ten-year trends in coronary calcification in individuals without clinical cardiovascular disease in the multi-ethnic study of atherosclerosis. 2014

Bild, Diane E / McClelland, Robyn / Kaufman, Joel D / Blumenthal, Roger / Burke, Gregory L / Carr, J Jeffrey / Post, Wendy S / Register, Thomas C / Shea, Steven / Szklo, Moyses. ·Division of Cardiovascular Sciences, NHLBI, Bethesda, Maryland, United States of America. · Department of Biostatistics, University of Washington, Seattle, Washington, United States of America. · Department of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America. · Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America. · Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America. · Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America. · Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America. · Columbia University, New York, New York, United States of America. · Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America. ·PLoS One · Pubmed #24743658.

ABSTRACT: BACKGROUND: Coronary heart disease (CHD) incidence has declined significantly in the US, as have levels of major coronary risk factors, including LDL-cholesterol, hypertension and smoking, but whether trends in subclinical atherosclerosis mirror these trends is not known. METHODS AND FINDINGS: To describe recent secular trends in subclinical atherosclerosis as measured by serial evaluations of coronary artery calcification (CAC) prevalence in a population over 10 years, we measured CAC using computed tomography (CT) and CHD risk factors in five serial cross-sectional samples of men and women from four race/ethnic groups, aged 55-84 and without clinical cardiovascular disease, who were members of Multi-Ethnic Study of Atherosclerosis (MESA) cohort from 2000 to 2012. Sample sizes ranged from 1062 to 4837. After adjusting for age, gender, and CT scanner, the prevalence of CAC increased across exams among African Americans, whose prevalence of CAC was 52.4% in 2000-02, 50.4% in 2003-04, 60.0% is 2005-06, 57.4% in 2007-08, and 61.3% in 2010-12 (p for trend <0.001). The trend was strongest among African Americans aged 55-64 [prevalence ratio for 2010-12 vs. 2000-02, 1.59 (95% confidence interval 1.06, 2.39); p = 0.005 for trend across exams]. There were no consistent trends in any other ethnic group. Risk factors generally improved in the cohort, and adjustment for risk factors did not change trends in CAC prevalence. CONCLUSIONS: There was a significant secular trend towards increased prevalence of CAC over 10 years among African Americans and no change in three other ethnic groups. Trends did not reflect concurrent general improvement in risk factors. The trend towards a higher prevalence of CAC in African Americans suggests that CHD risk in this population is not improving relative to other groups.

14 Article Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis). 2013

Budoff, Matthew J / Young, Rebekah / Lopez, Victor A / Kronmal, Richard A / Nasir, Khurram / Blumenthal, Roger S / Detrano, Robert C / Bild, Diane E / Guerci, Alan D / Liu, Kiang / Shea, Steven / Szklo, Moyses / Post, Wendy / Lima, Joao / Bertoni, Alain / Wong, Nathan D. ·Division of Cardiology, LA Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, California, USA. ·J Am Coll Cardiol · Pubmed #23500326.

ABSTRACT: OBJECTIVES: The study examined whether progression of coronary artery calcium (CAC) is a predictor of future coronary heart disease (CHD) events. BACKGROUND: CAC predicts CHD events and serial measurement of CAC has been proposed to evaluate atherosclerosis progression. METHODS: We studied 6,778 persons (52.8% female) aged 45 to 84 years from the MESA (Multi-Ethnic Study of Atherosclerosis) study. A total of 5,682 persons had baseline and follow-up CAC scans approximately 2.5 ± 0.8 years apart; multiple imputation was used to account for the remainder (n = 1,096) missing follow-up scans. Median follow-up duration from the baseline was 7.6 (max = 9.0) years. CAC change was assessed by absolute change between baseline and follow-up CAC. Cox proportional hazards regression providing hazard ratios (HRs) examined the relation of change in CAC with CHD events, adjusting for age, gender, ethnicity, baseline calcium score, and other risk factors. RESULTS: A total of 343 and 206 hard CHD events occurred. The annual change in CAC averaged 24.9 ± 65.3 Agatston units. Among persons without CAC at baseline (n = 3,396), a 5-unit annual change in CAC was associated with an adjusted HR (95% Confidence Interval) of 1.4 (1.0 to 1.9) for total and 1.5 (1.1 to 2.1) for hard CHD. Among those with CAC >0 at baseline, HRs (per 100 unit annual change) were 1.2 (1.1 to 1.4) and 1.3 (1.1 to 1.5), respectively. Among participants with baseline CAC, those with annual progression of ≥300 units had adjusted HRs of 3.8 (1.5 to 9.6) for total and 6.3 (1.9 to 21.5) for hard CHD compared to those without progression. CONCLUSIONS: Progression of CAC is associated with an increased risk for future hard and total CHD events.

15 Article Correlates of coronary artery calcified plaque in blacks and whites with type 2 diabetes. 2011

Wagenknecht, Lynne E / Divers, Jasmin / Bertoni, Alain G / Langefeld, Carl D / Carr, J Jeffrey / Bowden, Donald W / Elbein, Steven C / Shea, Steven / Lewis, Cora E / Freedman, Barry I. ·Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA. lwgnkcht@wfubmc.edu ·Ann Epidemiol · Pubmed #21130367.

ABSTRACT: PURPOSE: To examine whether the relationship between cardiovascular disease risk factors and coronary artery calcification (CAC) is modified by race among those with diabetes. METHODS: Data were pooled data from three studies (Multi-Ethnic Study of Atherosclerosis, Family Heart Study, Diabetes Heart Study) for a total of 835 blacks and 1122 whites with diabetes. CAC was quantified by cardiac computed tomography and risk factors were obtained using standard methods. Regression models examined the relationship between risk factors and presence and quantity of CAC. RESULTS: The average age of the cohort was 60 years; 57% were women. Presence of CAC was lower in blacks compared to whites (odds ratio = 0.22 for men, 0.57 for women, p <0.01). Hemoglobin A1c, duration of diabetes, low-density lipoprotein, smoking, and body mass index were independently associated with presence of CAC; high-density lipoprotein, triglycerides, and C-reactive protein were not. Race did not modify these associations. Adjustment for multiple risk factors did not explain the race disparity in CAC. CONCLUSIONS: CAC was reduced in blacks compared to whites in persons with diabetes. This effect was most pronounced in men. The relationship between risk factors and CAC did not differ between races. Racial differences in CAC are likely due to unmeasured risk factors and/or genetic susceptibility.

16 Article Cardiovascular imaging for assessing cardiovascular risk in asymptomatic men versus women: the multi-ethnic study of atherosclerosis (MESA). 2011

Jain, Aditya / McClelland, Robyn L / Polak, Joseph F / Shea, Steven / Burke, Gregory L / Bild, Diane E / Watson, Karol E / Budoff, Matthew J / Liu, Kiang / Post, Wendy S / Folsom, Aaron R / Lima, João A C / Bluemke, David A. ·Department of Radiology, Johns Hopkins University, Baltimore, MD, USA. ·Circ Cardiovasc Imaging · Pubmed #21068189.

ABSTRACT: BACKGROUND: Coronary artery calcium (CAC), carotid intima-media thickness, and left ventricular (LV) mass and geometry offer the potential to characterize incident cardiovascular disease (CVD) risk in clinically asymptomatic individuals. The objective of the study was to compare these cardiovascular imaging measures for their overall and sex-specific ability to predict CVD. METHODS AND RESULTS: The study sample consisted of 4965 Multi-Ethnic Study of Atherosclerosis participants (48% men; mean age, 62±10 years). They were free of CVD at baseline and were followed for a median of 5.8 years. There were 297 CVD events, including 187 coronary heart disease (CHD) events, 65 strokes, and 91 heart failure (HF) events. CAC was most strongly associated with CHD (hazard ratio [HR], 2.3 per 1 SD; 95% CI, 1.9 to 2.8) and all CVD events (HR, 1.7; 95% CI, 1.5 to 1.9). Most strongly associated with stroke were LV mass (HR, 1.3; 95% CI, 1.1 to 1.7) and LV mass/volume ratio (HR, 1.3; 95% CI, 1.1 to 1.6). LV mass showed the strongest association with HF (HR, 1.8; 95% CI, 1.6 to 2.1). There were no significant interactions for imaging measures with sex and ethnicity for any CVD outcome. Compared with traditional risk factors alone, overall risk prediction (C statistic) for future CHD, HF, and all CVD was significantly improved by adding CAC, LV mass, and CAC, respectively (all P<0.05). CONCLUSIONS: There was no evidence that imaging measures differed in association with incident CVD by sex. CAC was most strongly associated with CHD and CVD; LV mass and LV concentric remodeling best predicted stroke; and LV mass best predicted HF.

17 Article The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis). 2010

Criqui, Michael H / McClelland, Robyn L / McDermott, Mary M / Allison, Matthew A / Blumenthal, Roger S / Aboyans, Victor / Ix, Joachim H / Burke, Gregory L / Liu, Kaing / Shea, Steven. ·Department of Family & Preventive Medicine, University of California, San Diego, La Jolla, California 92093-0607, USA. mcriqui@ucsd.edu ·J Am Coll Cardiol · Pubmed #20951328.

ABSTRACT: OBJECTIVES: The purpose of this study was to examine the association of both a low and a high ankle-brachial index (ABI) with incident cardiovascular events in a multiethnic cohort. BACKGROUND: Abnormal ABIs, both low and high, are associated with elevated cardiovascular disease (CVD) risk. However, it is unknown whether this association is consistent across different ethnic groups, and whether it is independent of both newer biomarkers and other measures of subclinical atherosclerotic CVD. METHODS: A total of 6,647 non-Hispanic white, African-American, Hispanic, and Chinese men and women age 45 to 84 years from free-living populations in 6 U.S. field centers and free of clinical CVD at baseline had extensive measures of traditional and newer biomarker risk factors, and measures of subclinical CVD, including the ABI. Incident CVD, defined as coronary disease, stroke, or other atherosclerotic CVD death, was determined over a mean follow-up of 5.3 years. RESULTS: Both a low (<1.00) and a high (≥1.40) ABI were associated with incident CVD events. Sex- and ethnic-specific analyses showed consistent results. Hazard ratios were 1.77 (p<0.001) for a low and 1.85 (p=0.050) for a high ABI after adjustment for both traditional and newer biomarker CVD risk factors, and the ABI significantly improved risk discrimination. Further adjustment for coronary artery calcium score, common and internal carotid intimal medial thickness, and major electrocardiographic abnormalities only modestly attenuated these hazard ratios. CONCLUSIONS: In this study, both a low and a high ABI were associated with elevated CVD risk in persons free of known CVD, independent of standard and novel risk factors, and independent of other measures of subclinical CVD. Further research should address the cost effectiveness of measuring the ABI in targeted population groups.