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2010

Ciccarone Center Research

All Ciccarone Research Articles

Diurnal salivary is associated with body mass index and waist circumference: the multi-ethnic study of atherosclerosis.
By: Champaneri S, Carnethon MR, Bertoni AG, Seeman T, DeSantis AS, Diez Roux A, Shrager S, Golden SH.

Neuroendocrine abnormalities, such as activation of the hypothalamic-pituitary-adrenal (HPA) axis, are associated with obesity; however, few large-scale population-based studies have examined HPA axis and markers of obesity. We examined the cross-sectional association of the cortisol awakening response (CAR) and diurnal salivary cortisol curve with obesity. Higher BMI and WC are associated with neuroendocrine dysregulation, which is present in a large population sample, and only partially explained by other covariates

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Diurnal salivary cortisol is associated with body mass index and waist circumference: the multiethnic study of atherosclerosis.
By: Champaneri S, Xu X, Carnethon MR, Bertoni AG, Seeman T, DeSantis AS, Diez Roux A, Shrager S, Golden SH.
Researchers showed that higher body mass index and waistline circumference are associated with neuroendocrine dysregulation, which is present in a large population sample, and only partially explained by other covariates.
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C-reactive protein level and the incidence of eligibility for statin therapy: the multi-ethnic study of atherosclerosis.
By: Mann DM, Shimbo D, Cushman M, Lakoski S, Greenland P, Blumenthal RS, Michos ED, Lloyd-Jones DM, Muntner P.
Findings from this study suggest that many patients with an elevated hsCRP level may not receive the benefits of statins if hsCRP is not incorporated into the NCEP screening strategy.
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Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study.
By: Orchard TJ, Temprosa M, Barrett-Connor E, Fowler SE, Goldberg RB, Golden SH, Mather KJ, Marcovina SM, Montez M, Ratner RE, Saudek CD, Sherif H, Watson KE; and the Diabetes Prevention Program Outcomes Study Research Group.
This study investigated the long-term differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group.
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Associations between NOS1AP single nucleotide polymorphisms (SNPs) and QT interval duration in four racial/ethnic grops in the Multi-Ethnic Study of Atherosclerosis (MESA).
By: Shah SA, Herrington DM, Howard TD, Divers J, Arnett DK, Burke GL, Kao WH, Guo X, Siscovick DS, Chakravarti A, Lima JA, Psaty BM, Tomaselli GF, Rich SS, Bowden DW, Post W.

QT is a risk factor for sudden cardiac death. This study used the Multi-Ethnic Study of Atherosclerosis to examine association of QT with NOS1AP variants in an ethnically diverse cohort.

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Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction.
By: Martin SS, Gosch K, Kulkarni KR, Spertus JA, Mathews R, Ho PM, Maddox TM, Newby LK, Alexander KP, Wang TY.
Findings from this study support targeted interventions in the transition of acute myocardial infarction care to promote affordable statin prescription at discharge, medication persistence and adherence, and cardiac rehabilitation participation.
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Statin therapy: impact on dyslipidemia and cardiovascular events in diabetic patients.
By: Martin SS, Joshi PH, Jones SP.

Diabetes mellitus is associated with high rates of atherosclerosis-related cardiovascular events. Rigorous randomized controlled trials have shown consistently beneficial effects with statin treatment in diabetic patients, reducing event rates. The beneficial effects are seen consistently regardless of pretreatment low-density lipoprotein cholesterol levels. Further reduction of risk with statins may be achieved with more aggressive treatment targeting metrics of atherogenic burden such as apolipoprotein B or LDL particle concentration, more accurately quantifying atherogenic and atherosclerosis-related event risk.

Metabolic Syndrome: understanding the epidemic in India and South Asia.
By: Blaha MJ, Tota-Maharaj R, McEvoy JW.
Impact of ancestry and common genetic variants on QT interval in African Americans.
By: Smith JG, Avery CL, Evans DS, Nalls MA, Meng YA, Smith EN, Palmer C, Tanaka T, Mehra R, Butler AM, Young T, Buxbaum SG, Kerr KF, Berenson GS, Schnabel RB, Li G, Ellinor PT, Magnani JW, Chen W, Bis JC, Curb JD, Hsueh WC, Rotter JI, Liu Y, Newman AB, Limacher MC, North KE, Reiner AP, Quibrera PM, Schork NJ, Singleton AB, Psaty BM, Soliman EZ, Solomon AJ, Srinivasan SR, Alonso A, Wallace R, Redline S, Zhang ZM, Post WS, Zonderman AB, Taylor HA, Murray SS, Ferrucci L, Arking DE, Newton-Cheh C, et al.; CARe and COGENT consortia.
This study tested the hypotheses that African ancestry and common genetic variants are associated with prolonged duration of cardiac repolarization, a central pathophysiological determinant of arrhythmia. However, no difference in duration of cardiac repolarization with global genetic indices of African-American ancestry was noted.
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Epidemiology and natural history of peripheral artery disease.
By: Ratchford EV, Salameh MJ.
What is the role of calcium scoring in the age of coronary computed tomographic angiography?
By: Joshi PH, Blaha MJ, Blumenthal RS, Blankstein R, Nasir K.

Available data suggest that in low-to-intermediate risk symptomatic patients, CAC scanning may serve as an appropriate gatekeeper to further testing with either coronary computed tomographic angiography, functional imaging, or invasive coronary angiography.

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Relation of uric acid to serum levels of high-sensitivity C-reactive protein, triglycerides, and high-density lipoprotein cholesterol and to hepatic steatosis.
By: Keenan T, Blaha MJ, Nasir K, Silverman MG, Tota-Maharaj R, Carvalho JA, Conceição RD, Blumenthal RS, Santos RD.
High uric acid levels were associated with increased triglycerides, high-density lipoprotein cholesterol, and hepatic steatosis, independent of metabolic syndrome and obesity, and with increased hsCRP independently of metabolic syndrome.
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Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension.
By: Graham G, Blaha MJ, Budoff MJ, Rivera JJ, Agatston A, Raggi P, Shaw LJ, Berman D, Rana JS, Callister T, Rumberger JA, Min J, Blumenthal RS, Nasir K.
This study found that the addition of CAC scores contributed significantly in predicting mortality, in addition to traditional risk factors alone, among those with and without hypertension.
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Comparison of allogeneic vs autologous bone marrow–derived mesenchymal stem cells delivered by transendocardial injection in patients with ischemic cardiomyopathy: the POSEIDON randomized trial.
By: Hare JM, Fishman JE, Gerstenblith G, et al.
This study showed that, in aggregate, an injection of mesenchymal stem cells as a therapy for patients with ischemic cardiomyopathy favorably affected their functional capacity, quality of life, and ventricular remodeling.
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Gene-centric meta-analysis of lipid traits in African, East Asian and Hispanic populations.
By: Elbers CC, Guo Y, Tragante V, van Iperen EP, Lanktree MB, Castillo BA, Chen F, Yanek LR, Wojczynski MK, Li YR, Ferwerda B, Ballantyne CM, Buxbaum SG, Chen YD, Chen WM, Cupples LA, Cushman M, Duan Y, Duggan D, Evans MK, Fernandes JK, Fornage M, Garcia M, Garvey WT, Glazer N, Gomez F, Harris TB, Halder I, Howard VJ, Keller MF, Kamboh MI, Kooperberg C, Kritchevsky SB, LaCroix A, Liu K, Liu Y, Musunuru K, Newman AB, Onland-Moret NC, Ordovas J, Peter I, Post W, Redline S, Reis SE, Saxena R, Schreiner PJ, Volcik KA, Wang X, Yusuf S, Zonderland AB, Anand SS, Becker DM, Psaty B, Rader DJ, Reiner AP, Rich SS, Rotter JI, Wilson JG, Keating BJ, et al.
Meta-analyses of European populations has successfully identified genetic variants in over 100 loci associated with lipid levels. This study seeks to expand our knowledge in other ethnicities, which remains limited.
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Coronary artery disease is under-diagnosed and under-treated in advanced lung disease.
By: Reed RM, Eberlein M, Girgis RE, Hashmi S, Iacono A, Jones SP, Netzer G, Scharf S.

Coronary artery disease is a potentially treatable comorbidity observed frequently in both chronic obstructive pulmonary disease and interstitial lung disease. The prevalence of angiographically proven coronary artery disease in advanced lung disease is not well described. We sought to characterize the treatment patterns of coronary artery disease complicating advanced lung disease and to describe the frequency of occult coronary artery disease in this population. Coronary artery disease is common in patients with advanced lung disease attributable to chronic obstructive pulmonary disease or interstitial lung disease and is under-diagnosed. Guideline-recommended cardioprotective medications are suboptimally utilized in this population.

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Racial/ethnic differences in sex hormone levels among postmenopausal women in the diabetes prevention program.
By: Kim C, Golden SH, Mather KJ, Laughlin GA, Kong S, Nan B, Barrett-Connor E, Randolph JF Jr; Diabetes Prevention Program Research Group.

This study found that, among postmenopausal women, there were significant race/ethnicity differences in baseline sex hormones and changes in sex hormones.

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Reductions in glucose among postmenopausal women who use and do not use estrogen therapy.
By: Kim C, Kong S, Laughlin GA, Golden SH, Mather KJ, Nan B, Randolph JF Jr, Edelstein SL, Labrie F, Buschur E, Barrett-Connor E; for The Diabetes Prevention Program Research Group.
Among postmenopausal women who do not use estrogen therapy (ET), we have previously reported that intensive lifestyle modification (ILS) leads to increases in sex hormone-binding globulin (SHBG) and that such increases are associated with reductions in fasting plasma glucose (FPG) and 2-hour postchallenge glucose (2HG). Oral ET decreases FPG and increases 2HG while increasing both SHBG and estradiol (E2). It is unknown if ILS reduces glucose among ET users, if changes in SHBG and E2 might mediate any glucose decreases in ET users, and if these patterns differ from those in non-ET users. We conclude that among glucose-intolerant ET users, interventions to reduce glucose are effective but possibly mediated through different pathways than among women who do not use ET.
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Cardiovascular effects of noninsulin, glucose-lowering agents: Need for more outcomes data.
By: Joshi PH, Kalyani RR, Blumenthal RS, Donner TW.
This comprehensive review article provides recommendations, based on current data, for a therapeutic approach with noninsulin, glucose-lowering agents for the prevention of cardiovascular events in patients with type 2 diabetes.
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Large-scale gene-centric meta-analysis across 32 studies identifies multiple lipid loci.
By: Asselbergs FW, Guo Y, van Iperen EP, Sivapalaratnam S, Tragante V, Lanktree MB, Lange LA, Almoguera B, Appelman YE, Barnard J, Baumert J, Beitelshees AL, Bhangale TR, Chen YD, Gaunt TR, Gong Y, Hopewell JC, Johnson T, Kleber ME, Langaee TY, Li M, Li YR, Liu K, McDonough CW, Meijs MF, Middelberg RP, Musunuru K, Post WS, et al.
This large meta-analysis of lipid phenotypes with the use of a dense gene-centric approach identified multiple single nucleotide polymorphisms not previously described in established lipid genes and several previously unknown loci, suggesting that a focused genotyping approach can further increase the understanding of heritability of plasma lipids.
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Let’s not be so quick to stop statins: Expert opinion on the importance of awareness of reporting bias and outstanding questions in studies.
By: Martin SS, Blaha MJ, Blumenthal RS.
Researchers examined a study linking statins to fatigue and found that it lacked several elements expected of a high-quality randomized controlled trial and suffered from multiple potential sources of bias.
Apolipoproteins do not add prognostic information beyond lipoprotein cholesterol measures among individuals with obesity and insulin resistance syndromes: The ARIC Study.
By: Ndumele CE, Matsushita K, Astor B, Virani SS, Mora S, Williams EK, Hoogeveen RC, Blumenthal RS, Sharrett AR, Ballantyne CM, Coresh J.
Among individuals with obesity and insulin resistance syndromes, apolipoproteins did not provide prognostic information regarding CHD risk beyond that provided by non-HDL-C and HDL-C.
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Dyslipidemia management for secondary prevention in women with cardiovascular disease: What can we expect from non-pharmacologic strategies?
By: Whelton S, Chow GV, Ashen MD, Blumenthal RS.

In this review, we examine the effect of non-pharmacologic therapy (i.e., diet and lifestyle modification) on lipids as part of the secondary prevention strategy of cardiovascular disease in women.

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Cigarette smoking is associated with increased mortality in both the presence and absence of coronary artery calcification.
By: McEvoy JW, Blaha MJ, Rivera JJ, Budoff MJ, Khan AN, Shaw LJ, Berman DS, Raggi P, Min JK, Rumberger JA, Callister TQ, Blumenthal RS, Nasir K.

The aim of this study was to further explore the interplay between smoking status, coronary artery calcium (CAC), and all-cause mortality. Smoking is a risk factor for death across the entire spectrum of subclinical coronary atherosclerosis. Smokers with any CAC had significantly higher mortality than smokers without CAC, a finding with implications for smokers undergoing lung cancer CT-based screening. However, the absence of CAC might not be as useful a "negative risk factor" in active smokers, because this group has mortality rates similar to nonsmokers with mild-to-moderate atherosclerosis.

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Mitochondrial performance in heat acclimation—a lesson from ischemia/reperfusion and calcium overload insults in the heart.
By: Assayag M, Saada A, Gerstenblith G, Canaana H, Shlomai R, Horowitz M.

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Mortality rates in smokers and nonsmokers in the presence or absence of coronary artery calcification.
By: McEvoy JW, Blaha MJ, Rivera JJ, Budoff MJ, Khan AN, Shaw LJ, Berman DS, Raggi P, Min JK, Rumberger JA, Callister TQ, Blumenthal RS, Nasir K.

The aim of this study was to further explore the interplay between smoking status, coronary artery calcium (CAC), and all-cause mortality. Smoking is a risk factor for death across the entire spectrum of subclinical coronary atherosclerosis. Smokers with any CAC had significantly higher mortality than smokers without CAC, a finding with implications for smokers undergoing lung cancer CT-based screening. However, the absence of CAC might not be as useful a "negative risk factor" in active smokers, because this group has mortality rates similar to nonsmokers with mild-to-moderate atherosclerosis.

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Response to catecholamine stimulation of polymorphisms of the beta-1 and beta-2 adrenergic receptors.
By: McLean RC, Baird SW, Becker LC, Townsend SN, Gerstenblith G, Kass DA, Tomaselli GF, Schulman SP.
This study concludes that beta receptor gene variants significantly influence inotropic and chronotropic responses to beta-agonist exposure in patients on beta blocker therapy.
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Use of high-sensitivity C-reactive protein for risk assessment.
By: Graham G, Ketlogetswe KS, Campbell CY, Musunuru K, Mora S, Blumenthal RS.
Utility of coronary artery calcium scoring in the evaluation of patients with chest pain.
By: Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS.
Although further research is needed, carefully selected patients presenting to the emergency department with a normal electrocardiogram, normal cardiac biomarkers, and no CAC may be considered for early discharge without further testing.
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Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals.
By: Nasir K, Clouse M.

Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper" for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.

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Utility of coronary artery calcium scoring in the evaluation of patients with chest pain.
By: Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS.
Although further research is needed, carefully selected patients presenting to the emergency department with chest pain and with a normal electrocardiogram, normal cardiac biomarkers, and CAC = 0 may be considered for early discharge without further testing.
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Endogenous sex hormone changes in postmenopausal women in the diabetes prevention program.
By: Kim C, Kong S, Laughlin GA, Golden SH, Mather KJ, Nan B, Edelstein SL, Randolph JF Jr, Labrie F, Buschur E, Barrett-Connor E.
Among postmenopausal glucose-intolerant women not using estrogen, intensive lifestyle modification increased SHBG levels and lower DHEA levels. These changes are associated with lower glucose independent of adiposity and insulin. Metformin effects upon endogenous sex hormones are not significant.
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Association of SRB1 variants with subclinical atherosclerosis and incident cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis.
By: Manichaikul A, Naj AC, Herrington D, Post W, Rich SS, Rodriguez A.

We previously reported a statistically significant association of SCARB1 intronic single nucleotide polymorphism (SNP) rs10846744 with common carotid intimal-medial artery thickness in each of the 4 Multi-Ethnic Study of Atherosclerosis racial/ethnic groups (white, Chinese, black, and Hispanic). The SCARB1 SNP, rs10846744, exerts a major effect on subclinical atherosclerosis and incident cardiovascular disease in humans.

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Lipoprotein(a) particle concentration and lipoprotein(a) cholesterol assays yield discordant classification of patients defining four physiologically discrete groups.
By: Konerman M, Kulkarni K, Toth PP, Jones SR.

There is little known about the relative predictive value of different lipoprotein(a) [Lp(a)] assays in clinical use, although each has been shown to predict similar incremental risk over conventional clinical and lipid risk factors. Thus, we examined the classification behavior of two commonly used Lp(a) assays and their associations with other lipid parameters. Serum lipid and Lp(a) concentrations were measured in 144 primary and secondary prevention patients. Lp(a) cholesterol [Lp(a)-C] was measured with the Vertical Auto Profile (upper limit of normal, 10 mg/dL). Lp(a) particle concentrations [Lp(a)-P] were measured with an isoform-independent molar assay (upper limit of normal, 70 nmol/L). The subjects were divided into the following four groups on the basis of their Lp(a)-C and Lp(a)-P levels: normal Lp(a)-P and Lp(a)-C; high Lp(a)-P and normal Lp(a)-C; normal Lp(a)-P and high Lp(a)-C; and high Lp(a)-P and Lp(a)-C. The proportion of subjects with values above the upper limit of normal was similar with both assays (P = .15). However, the Lp(a)-C and Lp(a)-P assays discordantly classified 23% of the study's subjects. In addition, the four Lp(a)-defined groups displayed differences in their relationships with other lipoproteins. The two groups with elevated Lp(a)-C showed significant associations with higher high-density lipoprotein cholesterol, apolipoprotein AI, and high-density lipoprotein cholesterol/apolipoprotein AI ratios. Triglycerides were also noted to be above normal in discordant and normal within concordant Lp(a) groups. Finally, the amount of cholesterol per Lp(a) particle [Lp(a)-C/Lp(a)-P] varied widely across the four groups. These findings suggest that the four Lp(a)-defined groups are physiologically discrete. Further investigation is warranted to assess which parameters among Lp(a)-P, Lp(a)-C, and Lp(a)-C/Lp(a)-P can be used to more accurately characterize Lp(a)-associated cardiovascular risk.

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Herpes simplex virus type 2 (HSV-2) as a coronary atherosclerosis risk factor in HIV-infected men: Multicenter AIDS Cohort Study.
By: Hechter RC, Budoff M, Hodis HN, Rinaldo CR, Jenkins FJ, Jacobson LP, Kingsley LA, Taiwo B, Post WS, Margolick JB, Detels R.

We assessed associations of herpes simplex virus types 1 and 2 (HSV-1 and -2), cytomegalovirus (CMV), and human herpesvirus 8 (HHV-8) infection with subclinical coronary atherosclerosis in 291 HIV-infected men in the Multicenter AIDS Cohort Study. Coronary artery calcium (CAC) was measured by non-contrast coronary CT imaging. Markers for herpesviruses infection were measured in frozen specimens collected 10-12 years prior to case identification. Multivariable logistic regression models and ordinal logistic regression models were performed. HSV-2 seropositivity was associated with coronary atherosclerosis (adjusted odds ratio [AOR]=4.12, 95% confidence interval [CI]=1.58-10.85) after adjustment for age, race/ethnicity, cardiovascular risk factors, and HIV infection related factors. Infection with a greater number of herpesviruses was associated with elevated CAC levels (AOR=1.58, 95% CI=1.06-2.36). Our findings suggest HSV-2 may be a risk factor for subclinical coronary atherosclerosis in HIV-infected men. Infection with multiple herpesviruses may contribute to the increased burden of atherosclerosis.

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Association of sex hormones and sex hormone-binding globulin with depressive symptoms in postmenopausal women: the Multi-ethnic Study of Atherosclerosis.
By: Colangelo LA, Craft LL, Ouyang P, Liu K, Schreiner PJ, Michos ED, Gapstur SM.
In early postmenopausal women, sex hormones were associated with incident depressive symptoms.
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Rhinotillexis: a possible heuristic to reduce inappropriate noninvasive cardiac imaging?
By: McEvoy JW, Blaha MJ, Blumenthal RS.
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Computed tomography scans in the evaluation of fatty liver disease in a population based study: the multi-ethnic study of atherosclerosis.
By: Zeb I, Li D, Nasir K, Katz R, Larijani VN, Budoff MJ.

Fatty liver disease is a common clinical entity in hepatology practice. This study evaluates the prevalence and reproducibility of computed tomography (CT) measures for diagnosis of fatty liver and compares commonly used CT criteria for the diagnosis of liver fat. Fatty liver can be reliably diagnosed using nonenhanced CT scans.

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Coronary artery calcium for the prediction of mortality in young adults <45 years old and elderly adults >75 years old.
By: Tota-Maharaj R, Blaha MJ, McEvoy JW, Blumenthal RS, Muse ED, Budoff MJ, Shaw LJ, Berman DS, Rana JS, Rumberger J, Callister T, Rivera J, Agatston A, Nasir K.
The value of coronary artery calcium for predicting mortality extends to both elderly patients and those <45 years old. Elderly persons with no CAC have a lower mortality rate than younger persons with high CAC.
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Diurnal salivary cortisol and urinary catecholamines are associated with diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis.
By: Champaneri S, Xu X, Carnethon MR, Bertoni AG, Seeman T, Diez Roux A, Golden SH.

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Gender differences in coronary plaque composition and burden detected in symptomatic patients referred for coronary computed tomographic angiography.
By: Qureshi W, Blaha MJ, Nasir K, Al-Mallah MH.
Symptomatic women have a lower prevalence of obstructive coronary artery disease and are less likely to have mixed coronary plaque compared to symptomatic men. Future studies are needed to determine the prognostic implications of these findings.
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Interplay of coronary artery calcification and traditional risk factors for the prediction of all-cause mortality in asymptomatic individuals.
By: Nasir K, Rubin J, Blaha MJ, Shaw LJ, Blankstein R, Rivera JJ, Khan AN, Berman D, Raggi P, Callister T, Rumberger JA, Min J, Jones SR, Blumenthal RS, Budoff MJ.
Current guidelines recommend the use of coronary artery calcification (CAC) scoring for intermediate risk patients; however, the potential role of CAC among individuals who have no risk factors is less established. We sought to examine the relationship between the presence and burden of traditional risk factors and CAC for the prediction of all-cause mortality. By highlighting that individuals without risk factors but elevated CAC have substantially higher event rates than those that have multiple risk factors but no CAC, these findings challenge the exclusive use of traditional risk assessment algorithms for guiding the intensity of primary prevention therapies.
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Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International...
By: Cho I, Chang HJ, Sung JM, Pencina MJ, Lin FY, Dunning AM, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Callister TQ, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Maffei E, Cademartiri F, Kaufmann P, Shaw LJ, Raff GL, Chinnaiyan KM, Villines TC, Cheng V, Nasir K, Gomez M, Min JK; on behalf of the CONFIRM Investigators.

Although the prognosis for individuals without chest pain is stratified by coronary computed tomographic angiography (cCTA), the additional risk-predictive advantage by cCTA is not clinically meaningful compared with a risk model based on coronary artery calcium scoring. Therefore, at present, the application of cCTA for risk assessment of individuals without coronary artery calcium scoring should not be justified.

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Interplay of coronary artery calcification and traditional risk factors for the prediction of all-cause mortality in asymptomatic individuals.
By: Nasir K, Rubin J, Blaha MJ, Shaw LJ, Blankstein R, Rivera JJ, Khan A, Berman D, Raggi P, Callister T, Rumberger J, Min J, Jones SR, Blumenthal RS, Budoff MJ.
While both risk factors and CAC were associated with increasing CVD risk, CAC provides classification across a wider range of risk levels than traditional risk factors alone. Even among individuals with no risk factors, increased CAC is associated with a significantly higher CVD risk. While the absence of CAC is associated with very low intermediate term mortality, individuals with no risk factors but severe CAC have a high event rate.
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Waiting for the National Cholesterol Education Program Adult Treatment Panel IV Guidelines, and in the Meantime, Some Challenges and Recommendations.
By: Martin SS, Metkus TS, Horne A, Blaha MJ, Hasan R, Campbell CY, Yousuf O, Joshi P, Kaul S, Miller M, Michos ED, Jones SR, Gluckman TJ, Cannon CP, Sperling LS, Blumenthal RS.
The National Cholesterol Education Program Adult Treatment Panel (ATP) has provided education and guidance for decades on the management of hypercholesterolemia. Its third report (ATP III) was published 10 years ago, with a white paper update in 2004. There is a need for translation of more recent evidence into a revised guideline. To help address the significant challenges facing the ATP IV writing group, this statement aims to increase the likelihood of implementation in clinical practice by offering solutions that translate the totality of published reports into enhanced hyperlipidemia guidelines to better combat the devastating impact of hyperlipidemia on cardiovascular health.
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Lipid parameters and cardiovascular events in patients taking statins.
By: Martin SS, Jones SR.
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Vitamin D for the prevention of stroke incidence and disability: Promising but too early for prime time.
By: Michos ED, Gottesman RF.
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Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: A systematic review and meta-analysis.
By: Yeh HC, Brown TT, Maruthur N, Ranasinghe P, Berger Z, Suh YD, Wilson LM, Haberl EB, Brick J, Bass EB, Golden SH.
Continuous subcutaneous insulin infusion and multiple daily injections have similar effects on glycemic control and hypoglycemia, except continuous subcutaneous insulin infusion has a favorable effect on glycemic control in adults with type 1 diabetes mellitus. For glycemic control, real-time continuous glucose monitoring is superior to self-monitoring of blood glucose, and sensor-augmented insulin pumps are superior to multiple daily injections and self-monitoring of blood glucose without increasing the risk for hypoglycemia.
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Low free testosterone in HIV-infected men is not associated with subclinical cardiovascular disease.
By: Monroe AK, Dobs AS, Xu X, Palella FJ, Kingsley LA, Post WS, Witt MD, Brown TT.

Low testosterone (T) is associated with cardiovascular disease (CVD) and increased mortality in the general population; however, the impact of T on subclinical CVD in HIV disease is unknown. This study examined the relationships among free testosterone (FT), subclinical CVD, and HIV disease. Compared with HIV-uninfected men, HIV-infected men had lower FT, as well as more prevalent carotid lesions. In both groups, FT was not associated with CAC presence, log carotid IMT, or carotid lesion presence, suggesting that FT does not influence subclinical CVD in this population of men with and at risk for HIV infection.

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Lipoprotein(a) particle concentration and lipoprotein(a) cholesterol assays yield discordant classification of patients into four physiologically discrete groups.
By: Konerman M, Kulkarni K, Toth PP, Jones SR.
These findings suggest that the four Lipoprotein(a)-defined groups are physiologically discrete. Further investigation is warranted to assess which parameters among the four can be used to more accurately characterize Lp(a)-associated cardiovascular risk.
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