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Ciccarone Center Research

All Ciccarone Research Articles

Associations of common carotid intima-media thickness with coronary heart disease risk factors and events vary with distance from the carotid bulb.
By: Polak JF, Post WS, Carr JJ, Szklo M, O’Leary DH.
Common carotid artery intima-media thickness (IMT) measurements made below the carotid bulb are smaller but have more consistent associations with CHD risk factors and outcomes compared with IMT measured near the bulb.
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Associations of Pentraxin 3 with cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis.
By: Jenny NS, Blumenthal RS, Kronmal RA, Rotter JI, Siscovick DS, Psaty BM.
In a study of apparently healthy adults, Pentraxin 3 was associated with CVD risk factors, subclinical CVD, CAC and incident coronary heart disease events independent of C-reactive protein (CRP) and CVD risk factors. These results support the hypothesis that PTX3 reflects different aspects of inflammation than CRP and may provide additional insight into the development and progression of atherosclerosis.
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CPAP versus oxygen in obstructive sleep apnea.
By: Gottlieb DJ, Punjabi NM, Mehra R, Patel SR, Quan SF, Babineau DC, Tracy RP, Rueschman M, Blumenthal RS, Lewis EF, Bhatt DL, Redline S.
In patients with cardiovascular disease or multiple CVD risk factors, the treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP), but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure.
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Fibroblast growth factor-23 and incident coronary heart disease, heart failure, and cardiovascular mortality: the atherosclerosis risk in communities study.
By: Lutsey PL, Alonso A, Selvin E, Pankow JS, Michos ED, Agarwal SK, Loehr LR, Eckfeldt JH, Coresh J.
High levels of serum FGF-23 were associated with increased risk of coronary heart disease, heart failure, and cardiovascular mortality in this large, biracial, population-based cohort.
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Two classic hemodynamic findings for hypertrophic cardiomyopathy.
By: Barth AS, Abraham T, Ndumele C, Zakaria S.
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Letter regarding article, “Taking a longer term view of cardiovascular risk: the causal exposure paradigm.”
By: Joshi PH, Blaha MJ, Martin SS, Blumenthal RS.
Understanding the high prevalence of diabetes in U.S. South Asians compared with four racial/ethnic groups: The MASALA and MESA Studies.
By: Kanaya AM, Herrington D, Vittinghoff E, Ewing SK, Liu K, Blaha MJ, Dave SS, Qureshi F, Kandula NR.
This study compared South Asians with four other racial/ethnic groups in the U.S. to determine whether socio-demographic, lifestyle, or metabolic factors could explain the higher diabetes prevalence and whether insulin resistance and beta-cell dysfunction occurred at younger ages and/or lower adiposity levels compared with other groups.
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Invited commentary: the association of low vitamin D with cardiovascular disease — getting at the “heart and soul” of the relationship.
By: Schneider AL, Michos ED.
The authors place the results from the Heart and Soul study in context with the existing literature and propose future directions for vitamin D research.
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Vascular disease patient information page: Peripheral artery disease.
By: Ratchford EV, Evans NS.

Peripheral artery disease is common, and the symptoms typically include leg discomfort with exercise. Patients with PAD can also have other symptoms such as non-healing wounds on the feet. A simple ABI test with a blood pressure cuff can diagnose PAD. Treatment for PAD includes smoking cessation, medications aimed at preventing heart attack and stroke, and exercise to alleviate the discomfort. Patients with more severe PAD, such as those with wounds that are not healing or those with symptoms that do not respond to medication and exercise, may need to undergo a procedure to restore blood flow to the leg (angioplasty or bypass surgery).

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Vulnerability of the developing heart to oxygen deprivation as a cause of congenital heart defects.
By: Kenchegowda D, Liu H, Thompson K, Luo L, Martin SS, Fisher SA.
Low oxygen concentrations and lack of oxygen reserve during a critical phase of heart organogenesis may provide a basis for vulnerability to the development of common septation and conotruncal heart defects.
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Does hormone therapy affect blood pressure changes in the Diabetes Prevention Program?
By: Kim C, Golden SH, Kong S, Nan B, Mather KJ, Barrett-Connor, Diabetes Prevention Program Research Group.

Among overweight women with dysglycemia, the magnitude of blood pressure reductions after intensive lifestyle change is unrelated to postmenopausal estrogen use.

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Vitamin D and cognitive function and dementia risk in a biracial cohort: the ARIC Brain MRI Study.
By: Schneider AL, Lutsey PL, Alonso A, Gottesman RF, Sharrett AR, Carson KA, Gross M, Post WS, Knopman DS, Mosley TH, Michos ED.
This study of late middle age white and black participants did not find significant associations between lower levels of 25-hydroxy vitamin D with lower cognitive test scores at baseline, change in scores over time or dementia risk.
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The fascinating story of PCSK9 Inhibition: Insights and perspective from ACC.14.
By: Joshi PH, Martin SS, Blumenthal RS.

The development of PCSK9 inhibitors is coming along at a unique point in the realm of preventive cardiology from multiple perspectives.

Coronary artery calcium and physical fitness — the two best predictors of long-term survival.
By: Blaha MJ, Feldman DI, Nasir K.
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Risk factors for fatty liver in the Multicenter AIDS Cohort Study.
By: Price JC, Seaberg EC, Latanich R, Budoff MJ, Kingsley LA, Palella FJ Jr, Witt MD, Post WS, Thio CL.
Though treated HIV infection was associated with a lower prevalence of fatty liver, prolonged exposure to dideoxynucleoside analogs is associated with higher prevalence.
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Comparison of the relation between left ventricular anatomy and QRS duration in patients with cardiomyopathy with versus without left bundle branch block.
By: Chan DD, Wu KC, Loring Z, Galeotti L, Gerstenblith G, Tomaselli G, Weiss RG, Wagner GS, Strauss DG.
Increasing left ventricular (LV) anatomical measurements were associated with increasing QRS duration in patients with cardiomyopathy.
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Diabetes and depression.
By: Holt RI, de Groot M, Golden SH.
Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control.
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Vascular disease patient information page: Venous Thromboembolism (deep vein thrombosis and pulmonary embolism).
By: Evans NS, Ratchford EV.

Venous thromboembolism is common, occurring in about one to two per 1000 people each year. DVT is typically diagnosed using ultrasound. PE is usually diagnosed using a CT scan. Anticoagulant medications are the mainstay of treatment; most patients take anticoagulants for a minimum of 3 months. Several important measures can help prevent venous thromboembolism.

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Comparing coronary artery calcium among U.S. South Asians with four racial/ethnic groups: the MASALA and MESA studies.
By: Kanaya AM, Kandula NR, Ewing SK, Herrington D, Liu K, Blaha MJ, Srivastava S, Dave SS, Budoff MJ.
A high burden of subclinical coronary atherosclerosis in South Asians may partly explain higher rates of cardiovascular disease in South Asians.
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Nonfatal outcomes in the primary prevention of atherosclerotic cardiovascular disease: is all-cause mortality really all that matters?
By: Czarny MJ, Martin SS, Kohli P, Metkus T, Blumenthal RS.
This article clearly shows that major nonfatal cardiovascular outcomes are very important to take into account when designing primary prevention guidelines.
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Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis.
By: Brener M, Ketlogetswe K, Budoff M, Jacobson LP, Li X, Rezaeian P, Razipour A, Palella FJ Jr, Kingsley L, Witt MD, George RT, Post WS.
Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV.
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Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis.
By: Miedema MD, Duprez DA, Misialek JR, Blaha MJ, Nasir K, Silverman MG, Blankstein R, Budoff MJ, Greenland P, Folsom AR.
For the primary prevention of coronary heart disease (CHD), MESA participants with coronary artery calcium (CAC) ?100 were shown to have favorable risk/benefit estimations for aspirin use, while participants with zero CAC were estimated to receive net harm from aspirin.
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Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization: multi-ethnic study of atherosclerosis.
By: Silverman MG, Harkness JR, Blankstein R, Budoff MJ, Agatston AS, Carr JJ, Lima JA, Blumenthal RS, Nasir K, Blaha MJ.
There was a strong association between the baseline burden and regional distribution of CAC and the risk and type of future coronary revascularization among asymptomatic subjects.
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Genetically low triglycerides and mortality: further support for “the earlier the better”?
By: Martin SS, Blaha MJ.
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Incident stroke is associated with common carotid artery diameter and not common carotid artery intima-media thickness.
By: Polak JF, Sacco RL, Post WS, Vaidya D, Arnan MK, O’Leary DH.
Though common carotid IMT is not associated with stroke, inter-adventitial diameter of the common carotid artery is independently associated with first-time incident ischemic stroke even after adjusting for IMT.
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Does hormone therapy affect blood pressure in the Diabetes Prevention Program?
By: Kim C, Golden SH, Kong S, Nan B, Mather K, Barrett-Connor E; for the Diabetes Prevention Program Research Group.

This study aims to examine whether blood pressure reductions differ by estrogen use among overweight glucose-intolerant women. Among overweight women with dysglycemia, the magnitude of blood pressure reductions after ILS is unrelated to postmenopausal estrogen use.

Read on Pubmed
ABI and stroke: action at a distance and a call to action.
By: McEvoy JW, Nasir K.
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Usefulness of coronary and carotid imaging rather than traditional atherosclerotic risk factors to identify firefighters at increased risk for cardiovascular disease.
By: Ratchford EV, Carson KA, Jones SR, Ashen MD.
Early detection and integration of imaging with traditional risk assessment will be important in preventing premature death and disability among firefighters.
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Delayed heart rate recovery is strongly associated with early and late stage prehypertension during exercise stress testing.
By: Aneni E, Roberson LL, Shaharyar S, Blaha MJ, Agatston A, Blumenthal RS, Meneghelo RS, Conceiçao RD, Nasir K, Santos RD.
Among asymptomatic patients undergoing stress testing delayed HRR was independently associated with early and late stages of prehypertension. Further studies are needed to determine the usefulness of HRR measure in the prevention and management of hypertension.
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2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.
By: Abd TT, Misra S, Ojeifo O, Martin SS, Blumenthal RS, Foody J, Wong ND.
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Extensive bilateral lower extremity deep venous thrombosis in a patient on dimethyl fumarate.
By: Ratchford EV, Baldanza JT, Pardo CA.

We report a case of extensive bilateral lower extremity deep vein thrombosis (DVTs) in a patient recently started on dimethyl fumarate.

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Insulin requirements in non-critically ill hospitalized diabetic patients with steroid-induced hyperglycemia.
By: Spanakis E, Shah N, Malhotra K, Yeh HC, Golden SH.

Noncritically ill patients with hyperglycemia receiving steroids require a higher percentage of TDD insulin therapy as nutritional insulin to achieve normoglycemia.

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Narrowing sex differences in lipoprotein cholesterol subclasses following mid-life: the very large database of lipids (VLDL-10B).
By: Swiger KJ, Martin SS, Blaha MJ, Toth PP, Nasir K, Michos ED, Gerstenblith G, Blumenthal RS, Jones SR.
The narrowing sex differential in CVD risk after midlife is mirrored by a higher total atherogenic lipoprotein cholesterol burden in women and a closer approximation of the less favorable density phenotype characteristic of men.
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2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults.
By: Abd TT, Misra S, Ojeifo O, Martin SS, Blumenthal RS, Foody J, Wong ND.
The authors sought to answer five critical questions, addressing 1) expected health benefits of weight loss; 2) cut points for body mass index (BMI) and waist circumference; 3) dietary interventions most effective for weight loss; 4) the efficacy of a comprehensive lifestyle intervention programs; and 5) bariatric surgery.
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Type 2 diabetes and cardiovascular disease: what next?
By: Joseph JJ, Golden SH.

CVD in Type 2 diabetes is multifactorial and requires a multifaceted approach in reducing known cardiovascular risks, at both the individual patient and societal levels.

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Screening low-risk individuals for coronary artery disease.
By: Desai CS, Blumenthal RS, Greenland P.
Data regarding the role of additional testing in low-risk populations to improve early detection or to enhance risk assessment indicate that CAC and the ankle-brachial index (ABI) may be helpful for improving risk classification and detecting the higher-risk people from among those at lower risk.
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Fatty acids and TxA2 generation, in the absence of platelet-COX-1 activity.
By: DeFilippis AP, Rai SN, Cambon A, Miles R, Saenger AK, Blumenthal RS, Jaffe AS, Moser AB, Jones RO, Bolli R, Schulman SP.
This study shows that baseline omega-3 fatty acid levels do not influence TxA(2) generation in patients with or at high risk for CVD receiving adequate aspirin therapy.
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Ethnic and sex differences in fatty liver on cardiac computed tomography: the multi-ethnic study of atherosclerosis.
By: Tota-Maharaj R, Blaha MJ, Zeb I, Katz R, Blankstein R, Blumenthal RS, Budoff MJ, Nasir K.
African-Americans have a lower prevalence, and Hispanics have a higher prevalence, of fatty liver than do other ethnicities. There are distinct ethnic variations in the prevalence of fatty liver even in patients with the metabolic syndrome or obesity, suggesting that genetic factors may play a substantial role in the phenotypic expression of fatty liver.
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Ten-year trends in coronary calcification in individuals without clinical cardiovascular disease in the multi-ethnic study of atherosclerosis.
By: Bild DE, McClelland R, Kaufman JD, Blumenthal R, Burke GL, Carr JJ, Post WS, Register TC, Shea S, Szklo M.

Researchers reported a significant secular trend toward increased prevalence of CAC over 10 years among African-Americans and no change in three other ethnic groups..

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Risk and the physics of clinical prediction.
By: McEvoy JW, Diamond GA, Detrano RC, Kaul S, Blaha MJ, Blumenthal RS, Jones SR.
This study shifts the focus from prediction of events to detection of disease in the effort to improve personalized decision-making and outcomes. It also discusses innovative future strategies for risk estimation and treatment allocation in preventive cardiology.
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2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk.
By: Abd TT, Misra S, Ojeifo O, Martin SS, Blumenthal RS, Foody J, Wong ND.
The 2013 lifestyle guidelines provide guidance in three narrowly focused areas: 1) the effect of dietary patterns and macronutrient composition on CVD risk factors; 2) the effect of sodium and potassium on CVD risk factors; and 3) the effect of physical activity on blood pressure and lipids.
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Autologous mesenchymal stem cells produce concordant improvements in regional function, tissue perfusion, and fibrotic burden when administered to patients undergoing coronary artery bypass grafting: The Prospective Randomized Study of Mesenchymal Stem...
By: Karantalis V, DiFede DL, Gerstenblith G, et al.

Intramyocardial injection of autologous mesenchymal stem cells into akinetic yet nonrevascularized segments produces comprehensive regional functional restitution, which in turn drives improvement in global LV function.

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Does transendocardial injection of mesenchymal stem cells improve myocardial function locally or globally? An analysis from the Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis (POSEIDON) randomized trial.
By: Suncion VY, Ghersin E, Fishman JE, Zambrano JP, Karantalis V, Mandel N, Nelson KH, Gerstenblith G, DiFede Velazquez DL, et al.

Scar-size reduction and ventricular functional responses preferentially occurred at the sites of transendocardial stem cell injection, compared to nontransendocardial stem cell injection sites.

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Delayed heart rate recovery is strongly associated with early and late-stage prehypertension during exercise stress testing.
By: Aneni E, Roberson LL, Shaharyar S, Blaha MJ, Agatston AA, Blumenthal RS, Meneghelo RS, Conceiçao RD, Nasir K, Santos RD.
Among asymptomatic patients undergoing stress testing, delayed heart rate recovery was independently associated with early and late stages of prehypertension.
Read on Pubmed
Insulin requirements in non-critically ill hospitalized patients with diabetes and steroid-induced hyperglycemia.
By: Spanakis EK, Shah N, Malhotra K, Kemmerer T, Yeh HC, Golden SH.

Noncritically ill patients with hyperglycemia receiving steroids require a higher percentage of total daily dose insulin therapy as nutritional insulin to achieve normoglycemia.

Read on Pubmed
Resting heart rate as predictor for left ventricular dysfunction and heart failure: MESA (Multi-Ethnic Study of Atherosclerosis).
By: Opdahl A, Ambale Venkatesh B, Fernandes VR, Wu CO, Nasir K, Choi EY, Almeida AL, Rosen B, Carvalho B, Edvardsen T, Bluemke DA, Lima JA.
Elevated resting heart rate was associated with increased risk for incident HF in asymptomatic participants in the MESA trial; higher heart rate was related to development of regional and global LV dysfunction independent of subclinical atherosclerosis and coronary heart disease.
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Serum phosphate is associated with aortic valve calcification in the Multi-ethnic Study of Atherosclerosis (MESA).
By: Linefsky JP, O’Brien KD, Sachs M, Katz R, Eng J, Michos ED, Budoff MJ, de Boer I, Kestenbaum B.
Data indicate that serum phosphate levels are significantly associated with aortic valve calcification prevalence.
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Physical environment may modify the association between depressive symptoms and change in waist circumference: the multi-ethnic study of atherosclerosis.
By: Remigio-Baker RA, Diez Roux AV, Szklo M, Crum RM, Leoutsakos JM, Franco M, Schreiner PJ, Carnethon MR, Nettleton JA, Mujahid MS, Michos ED, Gary-Webb TL, Golden SH.

Elevated depressive symptoms were associated with greater increase in waist circumference among individuals living in poorly rated physical environments than in those in better-rated physical environments.

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Associations between HIV infection and subclinical coronary atherosclerosis.
By: Post WS, Budoff M, Kingsley L, Palella FJ Jr, Witt MD, Li X, George RT, Brown TT, Jacobson LP.
Coronary artery plaque, especially noncalcified plaque, is more prevalent and extensive in HIV-infected men, independent of CAD risk factors.
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Focused update on the 2013-2014 cardiovascular disease prevention guidelines.
By: Abd TT, Misra S, Ojeifo O, Martin SS, Blumenthal RS, Foody J, Wong ND.