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1.
J Diabetes Metab Disord ; 21(2): 1249-1254, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36404812

RESUMO

Purpose-: This study aimed to examine the association between periodontitis and diabetes mellitus. Methods: Participants with natural teeth in one jaw from the Third United States National Health and Nutrition Examination Survey (1988-1994) were included in this analysis. Participants with moderate (> 4mm attachment loss in ≥ 2 mesial sites or 5mm pocket depth in ≥ 2 mesial sites) or severe (> 6mm attachment loss in ≥ 2 mesial sites and > 5mm pocket depth in ≥ 1 mesial site) periodontitis were classified as having periodontal disease. The rest of the participants were considered without periodontal disease. Diabetes mellitus was defined as fasting glucose ≥ 126mg/dL, hemoglobin A1c ≥ 6.5% or the use of antihyperglycemic medications. Multivariable logistic regression was used to examine the association between periodontitis and diabetes mellitus in all study population and subgroups stratified by demographics and comorbidities. Results: This analysis included 13,000 participants [mean age 43.8 ± 19.1 years, 47.5% male, 30% whites]. About 12.7% (n = 1,656) of the study population had periodontitis, and 9.2% (n = 1,200) had diabetes. In a multivariable-adjusted model, presence (vs. absence) of periodontitis was associated with 66% increased odds of diabetes (OR (95% CI):1.66 (1.43-1.94); p < 0.001). Compared to those without periodontitis, the odds of diabetes among those with severe periodontitis was much higher (OR (95% CI): 2.31(1.72-3.11); p < 0.001) than in those with moderate periodontitis (OR (95% CI): 1.54(1.30-1.82); p < 0.001). Conclusions: Periodontitis is associated with prevalent diabetes in a dose-response fashion, suggesting a bidirectional relationship between those two diseases. Patients with periodontal disease should be counseled regarding their elevated risk of diabetes. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01010-6.

2.
J Am Coll Cardiol ; 80(16): 1516-1525, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36229087

RESUMO

BACKGROUND: Left ventricular hypertrophy (LVH) combined with elevations in cardiac biomarkers reflecting myocardial injury and neurohormonal stress (malignant LVH) is associated with a high risk for heart failure and death. OBJECTIVES: The aim of this study was to determine the impact of intensive systolic blood pressure (SBP) control on the prevention of malignant LVH and its consequences. METHODS: A total of 8,820 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were classified into groups based on the presence or absence of LVH assessed by 12-lead ECG, and elevations in biomarker levels (high-sensitivity cardiac troponin T ≥14 ng/L or N-terminal pro-B-type natriuretic peptide ≥125 pg/mL) at baseline. The effects of intensive vs standard SBP lowering on rates of acute decompensated heart failure (ADHF) events and death and on the incidence and regression of malignant LVH were determined. RESULTS: Randomization to intensive SBP lowering led to similar relative reductions in ADHF events and death across the combined LVH/biomarker groups (P for interaction = 0.68). The absolute risk reduction over 4 years in ADHF events and death was 4.4% (95% CI: -5.2% to 13.9%) among participants with baseline malignant LVH (n = 449) and 1.2% (95% CI: 0.0%-2.5%) for those without LVH and nonelevated biomarkers (n = 4,361). Intensive SBP lowering also reduced the incidence of malignant LVH over 2 years (2.5% vs 1.1%; OR: 0.44; 95% CI: 0.30-0.63). CONCLUSIONS: Intensive SBP lowering prevented malignant LVH and may provide substantial absolute risk reduction in the composite of ADHF events and death among SPRINT participants with baseline malignant LVH.


Assuntos
Insuficiência Cardíaca , Hipertensão , Anti-Hipertensivos/uso terapêutico , Biomarcadores , Pressão Sanguínea , Humanos , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/epidemiologia , Peptídeo Natriurético Encefálico , Fatores de Risco , Troponina T
3.
iScience ; 25(10): 105210, 2022 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-36267918

RESUMO

Premature atrial contractions (PACs) are frequently observed on electrocardiograms and are associated with increased risks of atrial fibrillation (AF), stroke, and mortality. In this study, we aimed to identify genetic susceptibility loci for PAC frequency. We performed a genome-wide association study meta-analysis with PAC frequency obtained from ambulatory cardiac monitoring in 4,831 individuals of European ancestry. We identified a genome-wide significant locus at the SCN5A gene. The lead variant, rs7373862, located in an intron of SCN5A, was associated with an increase of 0.12 [95% CI 0.08-0.16] standard deviations of the normalized PAC frequency per risk allele. Among genetic variants previously associated with AF, there was a significant enrichment in concordance of effect for PAC frequency (n = 73/106, p = 5.1 × 10-5). However, several AF risk loci, including PITX2, were not associated with PAC frequency. These findings suggest the existence of both shared and distinct genetic mechanisms for PAC frequency and AF.

5.
J Stroke Cerebrovasc Dis ; 31(11): 106662, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36115108

RESUMO

OBJECTIVES: Cardiac rhythm monitoring is increasingly used after stroke. We studied feasibility of telephone guided, mail-in ambulatory long-term cardiac rhythm monitoring in Black and White stroke survivors. MATERIALS AND METHODS;: We contacted 28 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had an ischemic stroke during follow-up. After obtaining informed consent by telephone, a noninvasive 14-day cardiac rhythm monitoring device (ZIO® XT patch; iRhythm Technologies, San Francisco, CA) was mailed to each participant. We evaluated the results of telephone consent, follow-up calls, compliance and wear time as the primary objective. Secondarily, we reported prevalence of atrial and ventricular arrhythmias. RESULTS: The majority of those contacted (20/28 = 71%) agreed to enroll in the monitoring study. Non-participation was nominally more common in Black than White participants; 6/16 (37.5%) vs. 2/12 (17%). Of those who agreed, 15 participants (75%, 6 Black, 9 White) completed ambulatory monitoring with mean wear time 12.9 ± 2.5 days. Arrhythmias were observed in two-thirds of the 15 participants: AF in 2, brief atrial tachycardia in 12, NSVT in 2, premature ventricular contractions in 3, and pause or atrioventricular block in 2. CONCLUSIONS: Non-invasive rhythm monitoring was feasible in this pilot from a large, national cohort study of stroke survivors that employed a telephone guided, mail-in monitoring system, and these preliminary results suggest a high prevalence of arrhythmias. Increased emphasis on recruitment strategies for Black stroke survivors may be required. We demonstrated a high yield of significant cardiac arrhythmias among post-stroke participants who completed monitoring.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Humanos , Eletrocardiografia Ambulatorial , Estudos de Viabilidade , Estudos de Coortes , Arritmias Cardíacas/diagnóstico , Acidente Vascular Cerebral/diagnóstico
6.
Nat Commun ; 13(1): 5106, 2022 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-36042188

RESUMO

Accurate and efficient classification of variant pathogenicity is critical for research and clinical care. Using data from three large studies, we demonstrate that population-based associations between rare variants and quantitative endophenotypes for three monogenic diseases (low-density-lipoprotein cholesterol for familial hypercholesterolemia, electrocardiographic QTc interval for long QT syndrome, and glycosylated hemoglobin for maturity-onset diabetes of the young) provide evidence for variant pathogenicity. Effect sizes are associated with pathogenic ClinVar assertions (P < 0.001 for each trait) and discriminate pathogenic from non-pathogenic variants (area under the curve 0.82-0.84 across endophenotypes). An effect size threshold of ≥ 0.5 times the endophenotype standard deviation nominates up to 35% of rare variants of uncertain significance or not in ClinVar in disease susceptibility genes with pathogenic potential. We propose that variant associations with quantitative endophenotypes for monogenic diseases can provide evidence supporting pathogenicity.


Assuntos
Endofenótipos , Síndrome do QT Longo , Suscetibilidade a Doenças , Humanos , Virulência
7.
Eur J Clin Nutr ; 2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-35986210

RESUMO

BACKGROUND: Recent evidence has shown associations between cardiovascular disease and a proinflammatory diet. We hypothesized that a proinflammatory diet, assessed using the Empirical Dietary Inflammatory Index (EDII), is associated with increased risk of prevalent heart failure (HF). METHODS: This analysis included 13,687 participants (44.8 ± 19.4 years; 45.7% male, 67.8% whites) from the Third National Health and Nutrition Examination Survey. EDII score was calculated from the Food Frequency Questionnaire. Prevalent HF was determined by physician-diagnosed self-report. Multivariable logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between EDII score and prevalent HF across tertiles (reference group first tertile) and per 1-unit standard deviation (1-SD) increase. RESULTS: About 1.4% (n = 190) of the participants reported a history of HF. Each 1-SD increase in EDII score (0.276) conferred 25% increased odds of prevalent HF (OR (95% CI): 1.25 (1.07-1.46); p value = 0.006). Odds of HF increased as EDII tertile increased, indicating a dose-response relationship (OR (95% CI) for 2nd and 3rd tertiles compared to 1st tertile: 1.42 (0.99-2.04), 1.68 (1.15-2.46), respectively). These results were consistent in subgroups of the participants stratified by demographics and comorbidities. CONCLUSIONS: Proinflammatory dietary patterns are associated with an increased risk of HF. The risk of HF could potentially be reduced by avoiding proinflammatory dietary patterns.

8.
Am J Cardiol ; 180: 59-64, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35945040

RESUMO

The link between abnormal P-wave axis (aPWA) and incident ischemic stroke is well established. However, studies examining the association between aPWA and fatal stroke are rare. We hypothesized that aPWA is associated with fatal stroke. We examined the association of abnormal aPWA with stroke mortality in 7,359 participants (60.0 ± 13.4 years, 51.9% women, 49.8% White) without cardiovascular (CV) disease (CVD) from the Third National Health and Nutrition Examination Survey. aPWA was defined as any value <0 or >75°. The National Death Index was used to identify the date and cause of death. Cox proportional hazard analysis was used to examine the association between baseline aPWA with stroke mortality. Over a median follow-up of 14 years, 189 stroke deaths occurred. During follow-up, stroke mortality was more common in those with aPWA than those without aPWA (3.5% vs 2.2%, respectively; p = 0.002). In a multivariable-adjusted model, aPWA was associated with a 44% increased risk of stroke mortality (hazard ratio [HR] 95% confidence interval [CI] 1.44 [1.05 to 1.99]). This association was stronger in men than in women (HR 95% CI 2.29 [1.42 to 3.67] vs 1.00 [0.64 to 1.55]), respectively; p-interaction = 0.04) and among non-Whites than Whites (HR 95% CI 2.20 [1.39 to 3.46] vs. 1.07 [0.68 to 1.69], respectively; p-interaction = 0.09). The annualized stroke death rates/1,000 participants across levels of CHA2DS2-VASc scores were higher in those with than without aPWA. In conclusion, aPWA, a marker of atrial cardiopathy, is associated with an increased risk of stroke mortality, especially among men and non-Whites. Whether intensive risk factor modifications in those with aPWA would reduce the risk of stroke and thus, stroke mortality needs further investigation.


Assuntos
Fibrilação Atrial , Doenças Cardiovasculares , Acidente Vascular Cerebral , Fibrilação Atrial/epidemiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco
9.
Am J Hypertens ; 2022 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-35861252

RESUMO

BACKGROUND: Atrial cardiopathy is associated with increased risk of mortality. However, it is unclear whether this association is modified by hypertension, a risk factor for both atrial cardiopathy and mortality. METHODS: This analysis included 8,023 participants from the Third National Health and Nutrition Examination Survey. Electrocardiographic deep terminal negativity of P-wave in V1 ≥100 µv defined atrial cardiopathy. National Death Index was used to identify date and cause of death. Cox proportional hazard analysis was used to examine the association of atrial cardiopathy with mortality among participants stratified by hypertension status. RESULTS: 2.7% of the participants had atrial cardiopathy. Over a median follow-up of 14 years, 2,922 all-cause deaths occurred, of which 1,058 were CVD. All-cause death rates were almost double among participants with concomitant atrial cardiopathy and elevated blood pressure (BP) (120-129/<80), stage 1(130-139/80-89) or stage 2 hypertension (≥140/≥90) compared to their counterparts in the same hypertension stages without atrial cardiopathy (47.8, 61.3, and 80.2 vs. 23, 24.7, and 44.8 per 1000 PY, respectively). In multivariable-adjusted models, stronger association between atrial cardiopathy and all-cause mortality was observed in the presence compared to the absence of hypertension (HR 95% CI):1.59(1.25-2.01) vs. 0.67(0.41-1.10), respectively, interaction p-value=0.009). Similarly, an association between atrial cardiopathy and cardiovascular disease (CVD) mortality was observed in the presence compared to the absence of hypertension (HR 95% (CI): 1.64 (1.08-2.47) vs. 0.63 (0.20-2.00), respectively, interaction p-value=0.20). CONCLUSIONS: Concomitant presence of high BP and atrial cardiopathy carries higher risk of mortality, and the risk increases with higher BP levels.

10.
Artigo em Inglês | MEDLINE | ID: mdl-35767774

RESUMO

Introduction: Observational studies have reported associations between cannabis use and coronary heart disease. Since diabetes is a coronary heart disease equivalent, we hypothesized that cannabis use would be associated with prevalent angina among individuals with diabetes. Methods: This analysis included 1314 participants with diabetes (age 47.4±9.0 years, 49.5% male, 28.3% Caucasians) from the National Health and Nutrition Examination Survey years 2011-2018. Cannabis use was self-reported. Prevalent angina was defined by self-reported physician diagnosis. Multivariable logistic regression models were used to examine the association between prevalent angina and cannabis use. Results: Approximately 3.3% (n=43) of participants had prevalent angina and 45.7% (n=601) were ever cannabis users. After adjustment, ever cannabis users did not have significantly increased odds of prevalent angina compared with never users (odds ratio: 3.29, 95% confidence interval [95% CI]: 0.88-12.22, p=0.08). However, those who had used cannabis at least once per month for at least 1 year had greater than fivefold increased odds of prevalent angina (odds ratio: 5.73, 95% CI: 1.26-26.04, p=0.03). Current cannabis users had greater than fivefold increased odds of prevalent angina (odds ratio: 5.35, 95% CI: 1.26-22.70, p=0.03), with a dose-response increase based on level of use. Effect modification was present among those with history of cocaine use (interaction p-value <0.001). Conclusion: Among individuals with diabetes, cannabis use is associated with prevalent angina with apparent dose response. This finding supports emerging evidence that cannabis may have negative cardiovascular (CV) health effects, and an individualized CV risk assessment should be pursued among those with diabetes.

11.
J Am Heart Assoc ; 11(9): e024292, 2022 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-35491988

RESUMO

Background Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. Methods and Results We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardiographic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging-detectable infarcts (n=315), magnetic resonance imaging-diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain-a 3-dimensional echocardiographic index of LA reservoir function-and E/e' divided by LA global longitudinal strain-an index of LA stiffness-worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e' divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. Conclusions In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Remodelamento Atrial , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Infarto Cerebral , Estudos de Coortes , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem
12.
Kidney Int Rep ; 7(4): 708-719, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35497796

RESUMO

Introduction: Heart failure (HF) is common in chronic kidney disease (CKD); identifying patients with CKD at high risk for HF may guide clinical care. We assessed the prognostic value of cardiac biomarkers and echocardiographic variables for 10-year HF prediction compared with a published clinical HF prediction equation in a cohort of participants with CKD. Methods: We studied 2147 Chronic Renal Insufficiency Cohort (CRIC) participants without prior HF with complete clinical, cardiac biomarker (N-terminal brain natriuretic peptide [NT-proBNP] and high sensitivity troponin-T [hsTnT]), and echocardiographic data (left ventricular mass [LVM] and left ventricular ejection fraction [LVEF] data). We compared the discrimination of the 11-variable Atherosclerosis Risk in Communities (ARIC) HF prediction equation with LVM, LVEF, hsTnT, and NT-proBNP to predict 10-year risk of hospitalization for HF using a Fine and Gray modeling approach. We separately evaluated prediction of HF with preserved and reduced LVEF (LVEF ≥50% and <50%, respectively). We assessed discrimination with internally valid C-indices using 10-fold cross-validation. Results: Participants' mean (SD) age was 59 (11) years, 53% were men, 43% were Black, and mean (SD) estimated glomerular filtration rate (eGFR) was 44 (16) ml/min per 1.73 m2. A total of 324 incident HF hospitalizations occurred during median (interquartile range) 10.0 (5.7-10.0) years of follow-up. The ARIC HF model with clinical variables had a C-index of 0.68. Echocardiographic variables predicted HF (C-index 0.70) comparably to the published ARIC HF model, while NT-proBNP and hsTnT together (C-index 0.73) had significantly better discrimination (P = 0.004). A model including cardiac biomarkers, echocardiographic variables, and clinical variables had a C-index of 0.77. Discrimination of HF with preserved LVEF was lower than for HF with reduced LVEF for most models. Conclusion: The ARIC HF prediction model for 10-year HF risk had modest discrimination among adults with CKD. NT-proBNP and hsTnT discriminated better than the ARIC HF model and at least as well as a model with echocardiographic variables. HF clinical prediction models tailored to adults with CKD are needed. Until then, measurement of NT-proBNP and hsTnT may be a low-burden approach to predicting HF in this population, as they offer moderate discrimination.

13.
BMC Cardiovasc Disord ; 22(1): 196, 2022 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-35473497

RESUMO

AIMS: To evaluate the association of physical activity (PA) with atrial fibrillation (AF) incidence in an elderly population. METHODS: We studied 5166 participants of the Atherosclerosis Risk in Communities cohort examined in 2011-2013 free of AF. Self-reported PA was evaluated with a validated questionnaire. Weekly minutes of leisure-time moderate to vigorous physical activity (MVPA) were calculated and categorized using the 2018 Physical Activity Guidelines for Americans (no activity [0 min/week], low [> 0- < 150 min/week], adequate [150- < 300 min/week], high [≥ 300 min/week]). Incident AF through 2019 was ascertained from hospital discharges and death certificates. Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for AF by levels of physical activity adjusting for potential confounders. RESULTS: The mean (SD) age for the sample was 75 (5) years (59% female, 22% Black). During a mean (SD) follow-up time of 6.3 (2.0) years, 703 AF events were identified. The association of MVPA with AF incidence showed a U-shaped relationship. Compared to those not engaging in MVPA, individuals with low MVPA had a 23% lower hazard of AF (HR = 0.77; 95% CI 0.61, 0.96), while those with adequate MVPA had a 14% lower hazard (HR 0.86; 95% CI 0.69, 1.06). High levels of MVPA were not associated with AF risk (HR 0.97; 95% CI 0.78, 1.20). CONCLUSION: This study suggests that being involved in low to moderate levels of MVPA is associated with lower AF risk, with no evidence of increased risk of AF in those with higher levels of MVPA.


Assuntos
Aterosclerose , Fibrilação Atrial , Idoso , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Exercício Físico , Feminino , Humanos , Incidência , Masculino , Fatores de Risco , Estados Unidos/epidemiologia
14.
J Am Heart Assoc ; 11(8): e023583, 2022 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-35414195

RESUMO

Background Long-term data to study recent trends in the incidence of atrial fibrillation (AF), overall and among sex and race groups, are scarce. We evaluated the 30-year trends in the incidence of AF in the ARIC (Atherosclerosis Risk in Communities) study cohort and explored race and sex differences in these trends. Methods and Results We included 15 343 men and women aged 45 to 64 years in 1987 to 1989 without AF from 4 US communities in the ARIC cohort. Incident AF was identified based on study ECGs, hospital discharge codes, and death certificates through 2017. We calculated age and period-specific incidence rates (IRs) of AF. We used Poisson regression to calculate IR ratios of AF over time adjusting for age, sex, and race. A total of 3241 AF cases were identified during a mean (SD) follow-up of 22 years (8.4 years) (599 in Black participants, 2642 in White participants, 1582 in women, and 1659 in men). Overall, the IR of AF in the ARIC cohort was 9.6 per 1000 person-years (6.9 in Black participants, 10.5 in White participants, 8.1 in women, and 11.6 in men). Age-specific IR by time period did not show significant changes over time. In a model adjusted for sex, race, and age group, the rate of AF did not change significantly from 1987 to 1991 compared with 2012 to 2017 (IR ratio, 1.10 [95% CI, 0.88-1.36] comparing 2012-2017 with 1987-1991). Similarly, no evidence of changes over time in AF rates were identified in men and women or White and Black participants separately. Conclusions Even though IRs of AF increase as age increases, our analysis provided evidence suggesting that the overall IRs of AF have not changed over time in a multicenter cohort of Black and White individuals in the United States from 1987 to 2017.


Assuntos
Fibrilação Atrial , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Estudos Prospectivos , Grupos Raciais , Fatores de Risco , Estados Unidos/epidemiologia
15.
Am J Med Sci ; 364(3): 327-332, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35405138

RESUMO

BACKGROUND: Periodontal disease (PD) has been linked to a range of cardiometabolic disorders. However, the association between PD and composite cardiovascular risk has not been studied. We hypothesized that PD would be associated with an elevated atherosclerotic cardiovascular risk (ASCVD) score. METHODS: This analysis included 12,402 participants (age 42.7 ± 18.6 years, 46.8% male, 69.6% Caucasian) from the Third National Health and Nutrition Examination Survey. Participants with a history of myocardial infarction or stroke were excluded. PD was defined as moderate (≥4mm attachment loss or ≥5 mm pocket depth in ≥2 mesial sites) or severe (≥6 mm attachment loss in ≥2 mesial sites and ≥5 mm pocket depth in ≥1 mesial site). ASCVD scores were classified categorically: low (<5.0%), borderline (5.0-7.4%), intermediate (7.5-19.9%), and high (≥20.0%). Linear and multinomial logistic regression were used to examine the association between PD and ASCVD score. RESULTS: Approximately 12.1% (n = 1499) of participants had PD. Moderate periodontitis was associated with a greater than five-fold increased odds of high-risk ASCVD score [OR (95% CI): 5.40 (4.63-6.31), p-value <0.001]. Severe periodontitis was associated with a greater than seven-fold increased odds of high-risk ASCVD score [OR (95% CI): 7.15 (5.14-9.96), p-value <0.001]. Composite periodontitis (moderate or severe) was associated with a 7.0% increase in ASCVD score [ß (95% CI): 7.01 (6.53-7.50)] when modeled linearly. CONCLUSIONS: PD is associated with elevated ASCVD score. Patients with PD should be counseled regarding their elevated cardiovascular risk and risk reduction strategies should be implemented with an emphasis on routine dental care.


Assuntos
Aterosclerose , Doenças Cardiovasculares , Doenças Periodontais , Periodontite , Adulto , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Fatores de Risco , Adulto Jovem
16.
Am J Med Sci ; 364(3): 304-308, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35427587

RESUMO

BACKGROUND: Cannabis is associated with risk of acute coronary syndrome in observational studies. However, its association with prevalent coronary artery disease (CAD) remains unclear. We hypothesized that cannabis use is associated with prevalent CAD. METHODS: This analysis included 12,543 participants (age 39.3 ± 11.6 years, 48.8% male, 35.3% Caucasians) from The National Health and Nutrition Examination Survey (NHANES). Cannabis use was self-reported. Prevalent CAD was defined by physician diagnosis. The association between cannabis use and CAD was tested for using multivariable logistic regression. RESULTS: About 53.1% (n = 6,650) of participants were ever cannabis users and 1.1% (n = 137) had prevalent CAD. Ever (versus never) cannabis users had 90% increased odds of CAD [OR (95% CI): 1.90 (1.24 - 2.93), p = 0.003]. Those who had used cannabis at least once per month for at least one year had 68% increased odds of CAD [OR (95% CI): 1.68 (1.02-2.77), p = 0.04]. Current cannabis users had near 98% increased odds of CAD [OR (95% CI): 1.98 (1.11 - 3.54), p = 0.02]. Similar results were seen with heavy cannabis users [OR (95% CI): 1.99 (1.02 - 3.89), p = 0.045]. These results were consistent in subgroups stratified by race, gender, hypertension, obesity, COPD, hyperlipidemia, tobacco smoking status, and diabetes. CONCLUSIONS: Cannabis use is associated with prevalent CAD. This finding emphasizes the potential harmful effects of cannabis use on cardiovascular health and highlights the need for further research as it becomes more accepted at both a national and global level.


Assuntos
Cannabis , Doença da Artéria Coronariana , Adulto , Cannabis/efeitos adversos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fatores de Risco
17.
Circulation ; 145(20): 1524-1533, 2022 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-35389749

RESUMO

BACKGROUND: Rare sequence variation in genes underlying cardiac repolarization and common polygenic variation influence QT interval duration. However, current clinical genetic testing of individuals with unexplained QT prolongation is restricted to examination of monogenic rare variants. The recent emergence of large-scale biorepositories with sequence data enables examination of the joint contribution of rare and common variations to the QT interval in the population. METHODS: We performed a genome-wide association study of the QTc in 84 630 UK Biobank participants and created a polygenic risk score (PRS). Among 26 976 participants with whole-genome sequencing and ECG data in the TOPMed (Trans-Omics for Precision Medicine) program, we identified 160 carriers of putative pathogenic rare variants in 10 genes known to be associated with the QT interval. We examined QTc associations with the PRS and with rare variants in TOPMed. RESULTS: Fifty-four independent loci were identified by genome-wide association study in the UK Biobank. Twenty-one loci were novel, of which 12 were replicated in TOPMed. The PRS composed of 1 110 494 common variants was significantly associated with the QTc in TOPMed (ΔQTc/decile of PRS=1.4 ms [95% CI, 1.3 to 1.5]; P=1.1×10-196). Carriers of putative pathogenic rare variants had longer QTc than noncarriers (ΔQTc=10.9 ms [95% CI, 7.4 to 14.4]). Of individuals with QTc>480 ms, 23.7% carried either a monogenic rare variant or had a PRS in the top decile (3.4% monogenic, 21% top decile of PRS). CONCLUSIONS: QTc duration in the population is influenced by both rare variants in genes underlying cardiac repolarization and polygenic risk, with a sizeable contribution from polygenic risk. Comprehensive assessment of the genetic determinants of QTc prolongation includes incorporation of both polygenic and monogenic risk.


Assuntos
Estudo de Associação Genômica Ampla , Síndrome do QT Longo , Eletrocardiografia , Heterozigoto , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/genética , Herança Multifatorial , Sequenciamento Completo do Genoma
18.
JAMA ; 327(12): 1138-1148, 2022 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-35315884

RESUMO

Importance: Atrial myopathy-characterized by alterations in left atrial (LA) function and size-is associated with ischemic stroke, independent of atrial fibrillation (AF). Electrocardiographic markers of atrial myopathy are associated with dementia, but it is unclear whether 2-dimensional echocardiographic (2DE)-defined LA function and size are associated with dementia. Objective: To examine the association of LA function and size with incident dementia. Design, Setting, and Participants: The Atherosclerosis Risk in Communities (ARIC) study is a community-based prospective cohort. An exploratory, retrospective analysis was conducted. ARIC centers are located in Forsyth County, North Carolina; Jackson, Mississippi; Washington County, Maryland; and suburban Minneapolis, Minnesota. For this analysis, visit 5 (2011-2013) served as the baseline. Participants without prevalent AF and stroke and who had 2DEs in 2011-2013 were included and surveilled through December 31, 2019. Exposures: LA function (reservoir strain, conduit strain, contractile strain, emptying fraction, passive emptying fraction, and active emptying fraction), and LA size (maximal and minimal volume index) as evaluated by 2DE. Main Outcomes and Measures: Dementia cases were identified using in-person and phone cognitive assessments, hospitalization codes, and death certificates. Cox proportional hazards models were used. Results: Among 4096 participants (mean [SD] age, 75 [5] years; 60% women; 22% Black individuals), 531 dementia cases were ascertained over a median follow-up of 6 years. Dementia incidence for the lowest LA quintile was 4.80 for reservoir strain, 3.94 for conduit strain, 3.29 for contractile strain, 4.20 for emptying fraction, 3.67 for passive emptying fraction, and 3.27 for active emptying fraction per 100 person-years. After full-model adjustments, there were statistically significant associations between measures of LA function and dementia; the hazard ratios (HRs) from the lowest vs highest quintile for reservoir strain were 1.98 (95% CI, 1.42-2.75); for conduit strain, 1.50 (95% CI, 1.09-2.06); for contractile strain, 1.57 (95% CI, 1.16-2.14); for emptying fraction, 1.87 (95% CI, 1.31-2.65); and for active emptying fraction, 1.43 (95% CI, 1.04-1.96). LA passive emptying fraction was not significantly associated with dementia (HR, 1.26 [95% CI, 0.93-1.71]). Dementia incidence for the highest LA maximal volume index quintile was 3.18 per 100 person-years (HR for highest vs lowest quintile, 0.77 [95% CI, 0.58-1.02]) and for the highest minimal volume index quintile was 3.50 per 100 person-years (HR for the highest vs lowest quintile, 0.95 [95% CI, 0.71-1.28]). Both measures were not significantly associated with dementia. These findings were robust to sensitivity analyses that excluded participants with incident AF or stroke. Conclusions and Relevance: In this exploratory analysis of a US community-based cohort, several echocardiographic measures of lower LA function were significantly associated with an increased risk of subsequent dementia. Measures of LA size were not significantly associated with dementia risk. These findings suggest that impaired LA function may be a risk factor associated with dementia.


Assuntos
Função do Átrio Esquerdo , Demência/diagnóstico por imagem , Demência/fisiopatologia , Ecocardiografia , Átrios do Coração/anatomia & histologia , Átrios do Coração/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Demência/epidemiologia , Feminino , Humanos , Incidência , Masculino , Tamanho do Órgão , Estudos Retrospectivos
19.
Circ Arrhythm Electrophysiol ; 15(4): e010435, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35333097

RESUMO

Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V1, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.


Assuntos
Fibrilação Atrial , Demência , AVC Isquêmico , Fibrilação Atrial/diagnóstico , Consenso , Eletrocardiografia , Humanos , Reprodutibilidade dos Testes
20.
J Am Heart Assoc ; 11(2): e022921, 2022 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-35023350

RESUMO

Background It is unknown if stroke symptoms in the absence of a stroke diagnosis are a sign of subtle cardioembolic phenomena. The objective of this study was to examine associations between atrial fibrillation (AF) and stroke symptoms among adults with no clinical history of stroke or transient ischemic attack (TIA). Methods and Results We evaluated associations between AF and self-reported stroke symptoms in the national, prospective REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort. We conducted cross-sectional (n=27 135) and longitudinal (n=21 932) analyses over 8 years of follow-up of REGARDS participants without stroke/transient ischemic attack and stratified by anticoagulant or antiplatelet agent use. The mean age was 64.4 (SD±9.4) years, 55.3% were women, and 40.8% were Black participants; 28.6% of participants with AF reported stroke symptoms. In the cross-sectional analysis, comparing participants with and without AF, the risk of stroke symptoms was elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (odds ratio [OR], 2.22; 95% CI, 1.89-2.59) or antiplatelet agents only (OR, 1.92; 95% CI, 1.61-2.29) but not for adults with AF taking anticoagulants (OR, 1.08; 95% CI, 0.71-1.65). In the longitudinal analysis, the risk of stroke symptoms was also elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (hazard ratio [HR], 1.41; 95% CI, 1.21-1.66) or antiplatelet agents only (HR, 1.23; 95% CI, 1.04-1.46) but not for adults with AF taking anticoagulants (HR, 0.86; 95% CI, 0.62-1.18). Conclusions Stroke symptoms in the absence of a stroke diagnosis may represent subclinical cardioembolic phenomena or "whispering strokes." Future studies examining the benefit of stroke symptom screening may be warranted.


Assuntos
Fibrilação Atrial , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Adulto , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos Transversais , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
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