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2010

Ciccarone Center Research

All Ciccarone Research Articles

The lipid/risk tightrope: 10 simple ways to optimize risk while waiting for the NCEP ATP IV guidelines.
By: Martin SS.
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Response to letter regarding article, "combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death".
By: Wu KC, Gerstenblith G, Marine JE, Dalal D, Cheng A, Lima JA, Tomaselli GF, Weiss RG, Guallar E, Marbán E.

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Coronary artery calcium and primary prevention risk assessment: What is the evidence? An updated meta-analysis on patient and physician behavior.
By: Whelton SP, Nasir K, Blaha MJ, Gransar H, Metkus TS, Coresh J, Berman DS, Blumenthal RS.

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Associations of salivary cortisol levels with inflammatory markers: the Multi-Ethnic Study of Atherosclerosis.
By: DeSantis AS, DiezRoux AV, Hajat A, Aiello AE, Golden SH, Jenny NS, Seeman TE, Shea S.

Socioeconomic and psychosocial factors have been found to be associated with systemic inflammation. Although stress is often proposed as a contributor to these associations, no population studies have investigated the links between inflammation and biomarkers of stress. The current study examines associations between daily cortisol profiles and inflammatory markers interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor (TNF-a) in a population-based sample of 869 adults with repeat measures of cortisol over multiple days. Persons with higher levels of IL-6 had a less pronounced cortisol awakening response, a less steep daily decline, and higher cortisol area under the curve for the day with associations persisting after controls for risk factors and other cytokines. Persons with higher levels of TNF-a had lower cortisol levels upon waking, and flatter daily decline, although associations with decline were attenuated when controlling for inflammatory risk factors. Higher levels of IL-10 were associated with marginally flatter daily cortisol decline (p<.10). This study is the first to identify associations of basal cortisol activity and inflammatory markers in a population based sample. Findings are consistent with the possibility that HPA axis activity may mediate associations between psychosocial stressors and inflammatory processes. Additional prospective data are necessary to clarify the directionality of associations between cortisol and inflammatory markers.

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Health disparities in endocrine disorders: Biological, clinical, and nonclinical factors — an Endocrine Society Scientific Statement.
By: Golden SH, Brown A, Cauley JA, Chin MH, Gary-Webb TL, Kim C, Sosa JA, Sumner AE, Anton B.
There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases.
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A national interactive Web-based physical activity intervention in women, evaluation of the American Heart Association Choose to Move program 2006-2007.
By: Lieber SB, Redberg RF, Blumenthal RS, Gandhi A, Robb KJ, Mora S.
In this national cohort of women, a 12-week Web-based intervention improved physical activity and quality of life measurements, resulting in higher short-term physical activity guideline compliance and better quality of life. Increasing use of this simple Web-based tool could improve physical activity and promote disease prevention.
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A point-by-point response to recent arguments against the use of statins in primary prevention.
By: Joshi PH, Chaudhari S, Blaha MJ, Jones SR, Martin SS, Post WS, Cannon CP, Fonarow GC, Wong ND, Amsterdam E, Hirshfeld JW, Blumenthal RS.
Early in 2012, a debate over the merits of statin therapy in primary prevention was published in the Wall Street Journal. The statin opponent claimed that statins should only be used in secondary prevention and never in any primary-prevention patients at risk for cardiovascular events. In this evidence-based rebuttal to those claims, we review the evidence supporting the efficacy of statin therapy in primary prevention. Cardiovascular risk is a continuum in which those at an elevated risk of events stand to benefit from early initiation of therapy. Statins should not be reserved until after a patient suffers the catastrophic consequences of atherosclerosis. Contrary to the assertions of the statin opponent, this principle has been demonstrated through reductions in heart attacks, strokes, and mortality in numerous randomized controlled primary-prevention statin trials. In selected at-risk individuals, the combination of pharmacotherapy and lifestyle changes is more effective than either alone. Future investigation in prevention should focus on improving our ability to identify these at-risk individuals.
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Niacin and statin combination therapy for atherosclerosis regression and prevention of cardiovascular disease events: Reconciling the AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Heal
By: Michos ED, Sibley CT, Baer JT, Blaha MJ, Blumenthal RS.
Despite substantial risk reductions targeting low-density lipoprotein cholesterol with statins, there remains significant residual risk as evidenced by incident and recurrent CVD events among statin-treated patients. Observational studies have shown that low levels of high-density lipoprotein cholesterol (HDL-C) are associated with increased CVD risk. It remains unclear whether strategies aimed at increasing HDL-C in addition to background statin therapy will further reduce risk.
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Vitamin D deficiency is associated with silent coronary artery disease in cardiovascularly asymptomatic African-Americans with HIV infection.
By: Lai H, Gerstenblith G, Fishman EK, Brinker J, Kickler T, Tong W, Bhatia S, Hong T, Chen S, Li J, Detrick B, Lai S.
Both vitamin D deficiency and silent CAD are prevalent in HIV-infected African-Americans. In addition to management of traditional CAD risk factors and substance abuse, vitamin D deficiency should be evaluated in HIV-infected African-Americans. These data support the conduct of a prospective trial of vitamin D in this high-risk patient population.
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Pharmacogenetics of antihypertensive response.
By: Campbell CY, Blumenthal RS.
We review the current status of the use of pharmacogenetic techniques to improve blood pressure control.
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Vitamin D deficiency is associated with the development of subclinical coronary artery disease in African-Americans with HIV infection: a preliminary study.
By: Lai H, Detrick B, Fishman EK, Gerstenblith G, Brinker JA, Hollis BW, Bartlett J, Cofrancesco J Jr, Tong W, Tai H, Chen S, Bhatia S, Lai S.
The incidence of subclinical CAD in African-Americans with HIV infection is provocatively high. Larger studies are warranted to confirm the role of vitamin D deficiency in the development of CAD in HIV-infected African-Americans.
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Association between traditional cholesterol parameters, lipoprotein particle concentration, novel biomarkers and carotid plaques in retired National Football League players.
By: Virani SS, Pompeii L, Lincoln AE, Dunn RE, Tucker AM, Nambi V, Nasir K, Vogel RA, Boone JL, Roberts AJ, Ballantyne CM.

We assessed whether low-density lipoprotein particle concentration (LDL-P) and high-sensitivity C-reactive protein [hs-CRP] can identify subclinical atherosclerosis better than traditional cholesterol parameters in retired National Football League (NFL) players. Carotid artery plaques were common in retired NFL players and were strongly associated with LDL-P, especially among those with metabolic syndrome. hs-CRP was not associated with carotid plaques in this cohort.

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Metabolic Syndrome: from risk factors to management.
By: Blaha MJ, Tota-Maharaj R.
Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice.
By: Munoz M, Pronovost P, Dintzis J, Kemmerer T, Wang NY, Chang YT, Efird L, Berenholtz SM, Golden SH.
Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives.
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Evidence-based use of statins for primary prevention of cardiovascular disease.
By: Minder CM, Blaha MJ, Horne A, Michos ED, Kaul S, Blumenthal RS.
Current national guidelines recommend statins as part of a comprehensive primary prevention strategy for patients with elevated low-density lipoprotein cholesterol at increased risk for developing coronary heart disease within 10 years. However, we believe data provide compelling evidence to support the use of statins for primary prevention in patients with risk factors for developing coronary heart disease over the next decade.
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Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events.
By: Rana JS, Gransar H, Wong ND, Shaw L, Pencina M, Nasir K, Rozanski A, Hayes SW, Thomson LE, Friedman JD, Min JK, Berman DS.
In this study of asymptomatic subjects without known CVD, the addition of CAC but not biomarkers substantially improved risk reclassification for future CVD events beyond traditional risk factors.
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Regional coronary endothelial function is closely related to local early coronary atherosclerosis in patients with mild coronary artery disease: pilot study.
By: Hays AG, Kelle S, Hirsch GA, Soleimanifard S, Yu J, Agarwal HK, Gerstenblith G, Schär M, Stuber M, Weiss RG.
There is an inverse relationship between coronary endothelial function and local coronary wall thickness in patients with coronary artery disease but not in healthy adults. These findings demonstrate that local endothelial-dependent functional changes are related to the extent of early anatomic atherosclerosis in mildly diseased arteries. This combined MRI approach enables the anatomic and functional investigation of early coronary disease.
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25-Hydroxyvitamin D deficiency is associated with fatal stroke among whites but not blacks: The NHANES-III linked mortality files.
By: Michos ED, Reis JP, Post WS, Lutsey PL, Gottesman RF, Mosley TH, Sharrett AR, Melamed ML.

Deficient 25-hydroxyvitamin D (25[OH]D) levels are associated with cardiovascular disease (CVD) events and mortality. 25(OH)D deficiency and stroke are more prevalent in blacks. We examined whether low 25(OH)D contributes to the excess risk of fatal stroke in blacks compared with whites. Vitamin D deficiency was associated with an increased risk of stroke death in whites but not in blacks. Although blacks had a higher rate of fatal stroke compared with whites, the low 25(OH)D levels in blacks were unrelated to stroke incidence. Therefore 25(OH)D levels did not explain this excess risk.

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Lifetime risks of cardiovascular disease.
By: McEvoy JW.
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Neighborhood health-promoting resources and obesity risk (the Multi-Ethnic Study of Atherosclerosis).
By: Auchincloss AH, Mujahid MS, Shen M, Michos ED, Whitt-Glover MC, Diez Roux AV.

Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.

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C-reactive protein modifies the association of plasma leptin with coronary calcium in asymptomatic overweight individuals.
By: Martin SS, Qasim AN, Rader DJ, Reilly MP.

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How accurate are 3 risk prediction models in US women?
By: Michos ED, Blumenthal RS.
We review the strengths and limitations of the Reynolds Risk Score and the Framingham risk estimates for myocardial infarction (MI) prediction and for major CVD event prediction.
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Metabolic syndrome, diabetes, and incidence and progression of coronary calcium: the Multi-Ethnic Study of Atherosclerosis study.
By: Wong ND, Nelson JC, Granston T, Bertoni AG, Blumenthal RS, Carr JJ, Guerci A, Jacobs DR Jr, Kronmal R, Liu K, Saad M, Selvin E, Tracy R, Detrano R.
This study examines and compares the incidence and progression of CAC among persons with metabolic syndrome and diabetes mellitus (DM) versus those with neither condition. Individuals with metabolic syndrome and DM have a greater incidence and absolute progression of CAC compared with individuals without these conditions, with progression also predicting coronary heart disease events in those with metabolic syndrome and DM.
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Statins and diabetes: rethinking the data.
By: Minder CM, Santos RD, Blumenthal RS.

This article briefly reviews the key evidence linking statins with new-onset diabetes and highlight the relative strengths and weaknesses of existing studies. We also offer clinical insight to help health care providers weigh the potential risks and benefits of statin therapy.

Comparison of cardiac computed tomography examination appropriateness under the 2010 revised versus the 2006 original Appropriate Use Criteria.
By: Wasfy MM, Brady TJ, Abbara S, Nasir K, Hoffmann U, Cury RC, Di Carli MF, Blankstein R.

The 2006 Cardiac CT Appropriate Use Criteria (AUC) were recently revised in 2010. In addition to rating an expanded number of indications, the new criteria adjusted the appropriateness of existing indications to reflect changes in clinical practice and new evidence since 2006. The revision of the AUC for cardiac CT had a significant effect on examination appropriateness. In comparison to the 2006 AUC, the 2010 AUC provided improved clarification of examination appropriateness. This shift was because of the inclusion of many previously unaddressed indications and the designation of more examinations as either appropriate or inappropriate.

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Statin therapy for healthy men identified as “increased risk.”
By: Blaha MJ, Nasir K, Blumenthal RS.
In this featured debate in JAMA, we reviewed the extensive data from randomized clinical trials and observational studies supporting the selective use of lipid lowering therapy in a middle-aged man with hyperlipidemia.
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Comparison of the Diamond-Forrester method and Duke Clinical Score to predict obstructive coronary artery disease by computed tomographic angiography.
By: Wasfy MM, Brady TJ, Abbara S, Nasir K, Ghoshhajra BB, Truong QA, Hoffmann U, Di Carli MF, Blankstein R.

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Achieving secondary prevention low-density lipoprotein particle concentration goals using lipoprotein cholesterol-based data.
By: Mathews SC, Mallidi J, Kulkarni K, Toth PP, Jones SR.

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Potential implications of coronary artery calcium testing for guiding aspirin use among asymptomatic individuals with diabetes.
By: Silverman MG, Blaha MJ, Budoff MJ, Rivera JJ, Raggi P, Shaw LJ, Berman D, Callister T, Rumberger JA, Rana JS, Blumenthal RS, Nasir K.
We conclude that CAC can help risk stratify individuals with diabetes and may aid in selection of patients who may benefit from therapies such as low-dose aspirin for primary prevention of CVD.
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Intracoronary cardiosphere-derived cells for heart regeneration after myocardial infarction (CADUCEUS): a prospective, randomized phase 1 trial.
By: Makkar RR, Smith RR, Cheng K, Malliaras K, Thomson LE, Berman D, Czer LS, Marbán L, Mendizabal A, Johnston PV, Russell SD, Schuleri KH, Lardo AC, Gerstenblith G, Marbán E.
Cardiosphere-derived cells (CDCs) reduce scarring after myocardial infarction, increase viable myocardium, and boost cardiac function in preclinical models. We show that intracoronary infusion of autologous CDCs in patients within six weeks of a MI is safe and decreased infarct size and increased viable myocardium. These findings are consistent with regeneration of myocardium and merit additional assessment in further clinical trials.
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Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death.
By: Wu KC, Gerstenblith G, Guallar E, Marine JE, Dalal D, Cheng A, Marbán E, Lima JA, Tomaselli GF, Weiss RG.
Annually, ~80,000 Americans receive guideline-based primary prevention implantable cardioverter-defibrillators (ICDs), but appropriate firing rates are low. In a cohort of primary prevention ICD candidates, combining a myocardial heterogeneity index with an inflammatory biomarker identified a subgroup with a very low risk for adverse cardiac events, including ventricular arrhythmias. This novel approach warrants further investigation to confirm its value as a clinical risk stratification tool.
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A graphical method for assessing risk factor threshold values using the generalized additive model: the multi-ethnic study of atherosclerosis.
By: Setodji CM, Scheuner M, Pankow JS, Blumenthal RS, Chen H, Keeler E.
We suggest the use of a technique used in the estimation of the effect of risk factors on health outcomes in multivariate regression settings, while accounting for mixture distributions in the outcome of interest and adjusting for covariates. These empirically based thresholds of risk factors could be informative in terms of the highest or lowest point of a risk factor beyond which no additional impact on the outcome should be expected.
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Comparison of exercise treadmill testing with cardiac computed tomography angiography among patients presenting to the emergency room with chest pain: the Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) study.
By: Blankstein R, Ahmed W, Bamberg F, Rogers IS, Schlett CL, Nasir K, Fontes J, Tawakol A, Brady TJ, Nagurney JT, Hoffmann U, Truong QA.
Although patients with a high number of clinical risk factors are more likely to have obstructive coronary artery disease, those who are young or who would be expected to have a very high exercise capacity are unlikely to have coronary stenosis and therefore may benefit from initial treadmill testing instead of CTA.
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Allopurinol acutely increases adenosine triphosphate energy delivery in failing human hearts.
By: Hirsch GA, Bottomley PA, Gerstenblith G, Weiss RG.
Intravenous administration of the XO inhibitor allopurinol acutely improves the relative and absolute concentrations of myocardial high-energy phosphates and ATP flux through creatine kinase (CK) in the failing human heart, offering direct evidence that myofibrillar CK energy delivery can be pharmaceutically augmented in the failing human heart.
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A short-term biomarker modulation study of simvastatin in women at increased risk of a new breast cancer.
By: Higgins MJ, Prowell TM, Blackford AL, Byrne C, Khouri NF, Slater SA, Jeter SC, Armstrong DK, Davidson NE, Emens LA, Fetting JH, Powers PP, Wolff AC, Green H, Thibert JN, Rae JM, Folkerd E, Dowsett M, Blumenthal RS, Garber JE, Stearns V.
This study demonstrates the feasibility of short-term biomarker modulation studies using the contralateral breast of high-risk women. Simvastatin appears to modulate estrone sulfate concentrations and its potential chemopreventive activity in breast cancer warrants further investigation.
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Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer.
By: Bardia A, Arieas ET, Zhang Z, Defilippis A, Tarpinian K, Jeter S, Nguyen A, Henry NL, Flockhart DA, Hayes DF, Hayden J, Storniolo AM, Armstrong DK, Davidson NE, Fetting J, Ouyang P, Wolff AC, Blumenthal RS, Ashen MD, Stearns V.
Competing comorbidities, particularly cardiovascular disease (CVD), should be considered when individualizing adjuvant therapies for postmenopausal women diagnosed with breast cancers. Among postmenopausal women with hormone receptor-positive (HR+), non-metastatic breast cancer, the majority had a predicted 10-year CVD risk that was equivalent to or higher than breast cancer recurrence risk. Physicians should weigh competing risks and offer early screening and cardiac prevention strategies for women at a greater risk for CVD.
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Choose maximal statin monotherapy before unproven combination therapy.
By: Harkness JR, Blumenthal RS.
Potential use of coronary artery calcium progression to guide the management of patients at risk for coronary artery disease events.
By: McEvoy JW, Blaha MJ, Nasir K, Blumenthal RS, Jones SR.
We believe that the data argues against the use of CAC progression as a clinical surrogate marker of preventive therapy efficacy. Further studies with non-statin medications and with concomitant outcome data are needed. However, CAC progression has potential for monitoring subclinical coronary artery disease (CAD) in some patients with mild CAC and may facilitate treatment decisions. In this review we provide recommendations for repeat CAC testing and discuss when repeat CAC testing may be helpful to assess CAD progression.
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Common genetic variation in the 3’-BCL11B gene desert is associated with carotid-femoral pulse wave velocity and excess cardiovascular disease risk: the AortaGen Consortium.
By: Mitchell GF, Verwoert GC, Tarasov KV, Isaacs A, Smith AV, Yasmin, Rietzschel ER, Tanaka T, Liu Y, Parsa A, Najjar SS, O’Shaughnessy KM, Sigurdsson S, De Buyzere ML, Larson MG, Sie MP, Andrews JS, Post WS, et al.

Carotid-femoral pulse wave velocity (CFPWV) is a heritable measure of aortic stiffness that is strongly associated with increased risk for major cardiovascular disease events. Common genetic variation in a locus in the BCL11B gene desert that is thought to harbor 1 or more gene enhancers is associated with higher CFPWV and increased risk for cardiovascular disease. Elucidation of the role this novel locus plays in aortic stiffness may facilitate development of therapeutic interventions that limit aortic stiffening and related cardiovascular disease events.

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Prevalence of traditional modifiable cardiovascular risk factors in patients with rheumatoid arthritis: comparison with control subjects from the multi-ethnic study of atherosclerosis.
By: Chung CP, Giles JT, Petri M, Szklo M, Post W, Blumenthal RS, Gelber AC, Ouyang P, Jenny NS, Bathon JM.
We tested the hypotheses that major modifiable cardiovascular risk factors were more frequent and rates of treatment, detection, and control were lower in patients with rheumatoid arthritis than in non-rheumatoid arthritis controls. Hypertension is more common in patients with rheumatoid arthritis, while other traditional CV risk factors are highly prevalent, under-diagnosed, and poorly controlled in patients with rheumatoid arthritis, as well as controls.
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Adverse outcome analyses of observational data: assessing cardiovascular risk in HIV disease.
By: Triant VA, Josephson F, Rochester CG, Althoff KN, Marcus K, Munk R, Cooper C, D’Agostino RB, Costagliola D, Sabin CA, Williams PL, Hughes S, Post WS, Chandra-Strobos N, Guaraldi G, Young SS, Obenchain R, Bedimo R, Miller V, Strobos J.

Clinical decisions are ideally based on randomized trials but must often rely on observational data analyses, which are less straightforward and more influenced by methodology. The authors, from a series of expert roundtables convened by the Forum for Collaborative HIV Research on the use of observational studies to assess cardiovascular disease risk in human immunodeficiency virus infection, recommend that clinicians who review or interpret epidemiological publications consider 7 key statistical issues: (1) clear explanation of confounding and adjustment; (2) handling and impact of missing data; (3) consistency and clinical relevance of outcome measurements and covariate risk factors; (4) multivariate modeling techniques including time-dependent variables; (5) how multiple testing is addressed; (6) distinction between statistical and clinical significance; and (7) need for confirmation from independent databases. Recommendations to permit better understanding of potential methodological limitations include both responsible public access to de-identified source data, where permitted, and exploration of novel statistical methods.

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Prediction of coronary artery calcium progression in individuals with low Framingham Risk Score: the Multi-Ethnic Study of Atherosclerosis.
By: Okwuosa TM, Greenland P, Burke GL, Eng J, Cushman M, Michos ED, Ning H, Lloyd-Jones DM.
In individuals at low predicted risk, according to Framingham Risk Scores, traditional risk factors predicted CAC progression in the short term with good discrimination and calibration. Prediction improved minimally when various novel markers were added to the model.
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Who should get statins for primary prevention?
By: Martin SS, Horne A, Blumenthal RS.
Evidence of dependence of lipoprotein(a) on triglyceride and high-density lipoprotein metabolism.
By: Konerman M, Kulkarni K, Toth PP, Jones SR.

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Association of baseline sex hormone levels with baseline and longitudinal changes in waist-to-hip ratio: Multi-Ethnic Study of Atherosclerosis.
By: Vaidya D, Dobs A, Gapstur SM, Golden SH, Cushman M, Liu K, Ouyang P.
Sex hormones are associated with waist-to-hip ratio at baseline and also during follow-up above and beyond their baseline association. Future research is needed to determine if manipulation of hormones is associated with changes in central obesity.
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LDL cholesterol: the lower the better.
By: Martin SS, Blumenthal RS, Miller M.
Multiple statin trials and meta-analyses support a treatment target of LDL-C levels less than 70 mg/dL, as this is associated with improved clinical outcomes and atherosclerosis regression. In fact, no threshold has yet been identified below which patients do not benefit from lowering of LDL-C.
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Effects of physical activity on cardiovascular disease.
By: Ahmed HM, Blaha MJ, Nasir K, Rivera JJ, Blumenthal RS.
Much attention has been directed toward lifestyle modifications as effective means of reducing cardiovascular disease risk. We review recent observational and interventional trials investigating the effects of physical activity on markers of (or causal factors for) atherosclerotic burden and vascular disease. There is a strong correlation between physical activity and triglyceride reduction, apolipoprotein B reduction, HDL increase, change in LDL particle size, increase in tissue plasminogen activator activity, and decrease in CAC. Further research is needed to elucidate the effect on inflammatory markers and intima-media thickness.
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Creatine kinase-mediated improvement of function in failing mouse hearts provides causal evidence the failing heart is energy starved.
By: Gupta A, Akki A, Wang Y, Leppo MK, Chacko VP, Foster DB, Caceres V, Shi S, Kirk JA, Su J, Lai S, Paolocci N, Steenbergen C, Gerstenblith G, Weiss RG.
It has long been hypothesized that reduced energy delivery contributes to the contractile dysfunction of heart failure (HF). These observations provide direct evidence that the failing heart is “energy starved” as it relates to cardiac CK. In addition, these data identify CK as a promising therapeutic target for preventing and treating HF and possibly diseases involving energy-dependent dysfunction in other organs with temporally varying energy demands.
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The relationship between resting heart rate and incidence and progression of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis (MESA).
By: Rubin J, Blaha MJ, Budoff MJ, Rivera JJ, Shaw LJ, Blankstein R, Mallah MA, Carr JJ, Jones DL, Blumenthal RS, Nasir K.
We conclude that elevated resting heart rate, a well-described predictor of cardiovascular mortality with unclear mechanism, is associated with increased incidence and progression of coronary atherosclerosis among individuals free of CVD at baseline.
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Coronary artery calcium scanning should be used for primary prevention: pros and cons.
By: Nasir K, Shaw LJ, Budoff MJ, Ridker PM, Peña JM.
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