Framingham Heart Study Andersson, Charlotte; Nayor, Matthew; Tsao, Connie W. ...
Journal of the American College of Cardiology,
06/2021, Letnik:
77, Številka:
21
Journal Article
Recenzirano
The Framingham Heart Study is the longest-running cardiovascular epidemiological study, starting in 1948. This paper gives an overview of the various cohorts, collected data, and most important ...research findings to date. In brief, the Framingham Heart Study, funded by the National Institutes of Health and managed by Boston University, spans 3 generations of well phenotyped White persons and 2 cohorts comprised of racial and ethnic minority groups. These cohorts are densely phenotyped, with extensive longitudinal follow-up, and they continue to provide us with important information on human cardiovascular and noncardiovascular physiology over the lifespan, as well as to identify major risk factors for cardiovascular disease. This paper also summarizes some of the more recent progress in molecular epidemiology and discusses the future of the study.
Display omitted
•The FHS is the longest-running cardiovascular epidemiological study, starting in 1948.•FHS spans 3 generations of well phenotyped White persons and 2 cohorts comprised of racial and ethnic minority groups.•Major risk factors for cardiovascular disease in the community have been identified through the FHS.
Framingham Heart Study: JACC Focus Seminar, 1/8 Andersson, Charlotte; Nayor, Matthew; Tsao, Connie W ...
Journal of the American College of Cardiology,
06/2021, Letnik:
77, Številka:
21
Journal Article
Recenzirano
The Framingham Heart Study is the longest-running cardiovascular epidemiological study, starting in 1948. This paper gives an overview of the various cohorts, collected data, and most important ...research findings to date. In brief, the Framingham Heart Study, funded by the National Institutes of Health and managed by Boston University, spans 3 generations of well phenotyped White persons and 2 cohorts comprised of racial and ethnic minority groups. These cohorts are densely phenotyped, with extensive longitudinal follow-up, and they continue to provide us with important information on human cardiovascular and noncardiovascular physiology over the lifespan, as well as to identify major risk factors for cardiovascular disease. This paper also summarizes some of the more recent progress in molecular epidemiology and discusses the future of the study.
Purpose of Review
Metabolomics enables rapid interrogation of widespread metabolic processes making it well suited for studying diabetes. Here, we review the current status of metabolomic ...investigation in diabetes, highlighting its applications for improving risk prediction and mechanistic understanding.
Recent findings
Findings of metabolite associations with type 2 diabetes risk have confirmed experimental observations (e.g., branched-chain amino acids) and also pinpointed novel pathways of diabetes risk (e.g., dimethylguanidino valeric acid). In type 1 diabetes, abnormal metabolite patterns are observed prior to the development of autoantibodies and hyperglycemia. Diabetes complications display specific metabolite signatures that are distinct from the metabolic derangements of diabetes and differ across vascular beds. Lastly, metabolites respond acutely to pharmacologic treatment, providing opportunities to understand inter-individual treatment responses.
Summary
Metabolomic studies have elucidated biological mechanisms underlying diabetes development, complications, and therapeutic response. While not yet ready for clinical translation, metabolomics is a powerful and promising precision medicine tool.
To describe the intent and early outcomes of elective inotrope use during heart failure hospitalization.
A prospective multisite design was used to collect data for hemodynamically stable patients ...started electively on inotrope therapy between January 1 and August 31, 2018. We prospectively recorded data when intravenous inotropic therapy was initiated, including survey of the attending cardiologists regarding expectations for the clinical course. Patients were followed up for events through hospital discharge and an additional survey was administered at the end of hospitalization.
For the 92 patients enrolled, average age was 60 years and ejection fraction was 24%±12%. At the time of inotrope initiation, attending heart failure cardiologists predicted that 50% (n=46) of the patients had a “high or very high” likelihood of becoming dependent on intravenous inotropic therapy and 58% (n=53) had a “high” likelihood of death, transplant, or durable ventricular assist device placement within the next 6 months. Provider predictions regarding death/hospice or need for continued home infusions were accurate only 51% (47 of 92) of the time. Only half the patients (n=47) had goals-of-care conversations before inotrope treatment initiation.
More than half the patients (51 of 92) electively started on inotrope treatment without present or imminent cardiogenic shock ultimately required home inotrope therapy, died during admission, or were discharged with hospice. Heart failure clinicians could not reliably identify those patients at the time of inotrope therapy initiation and goals-of-care discussions were not frequently performed.
Abstract only
Background:
Cardiorespiratory fitness (CRF) is a key indicator of cardiovascular health (CVH) and is inversely associated with cardiovascular disease (CVD) and mortality, but its ...relations with lifestyle behaviors and factors linked with CVH are incompletely elucidated.
Hypothesis:
Greater CVH, as assessed by a score comprising lifestyle and standard risk factors, is associated with greater CRF.
Aim:
To evaluate the cross-sectional relations of AHA’s Life’s Essential 8 (LE8) metrics with CRF in the community.
Methods:
Maximal cardiopulmonary exercise tests (CPET) were performed in the Framingham Heart Study (FHS). An LE8 score was constructed for each participant by averaging scores across all LE8 components (ranging 0-100). We related CRF and other CPET measures with total LE8 score, individual LE8 components as three-level variables (optimal/suboptimal/poor), and changes in LE8 score over an ≈8 year interval.
Results:
In 1838 FHS participants (age 54±9 years, 54% women, BMI 28±5 kg/m
2
), mean LE8 score was 76±12. In age- and sex-adjusted models, a higher LE8 score was associated with higher peak VO
2
, better ventilatory efficiency, lower resting heart rate, and favorable blood pressure response to exercise (p<0.0001 for all). A clinically meaningful 5-point higher LE8 score was associated with a 6.0% greater peak VO
2
(≈1.4 ml/kg/min at the sample mean). There was no evidence of effect modification by age, sex, or CVD status. The eight LE8 score components were statistically significantly associated with peak VO
2
in models adjusted for age and sex, but blood lipids, diet, and sleep health were no longer statistically significant after adjustment for all other LE8 components (
Figure
). Over an ≈8-year interval, a 5-unit increase in LE8 score was associated with a 3.7% higher peak VO
2
(p<0.0001).
Conclusion:
Higher LE8 score is associated with greater CRF in the community, highlighting the importance of CVH as assessed by LE8 metrics in maintaining and promoting CRF.
Abstract only Objective: We evaluated whether intra-individual changes in blood metabolites in response to an oral glucose challenge were associated with incident CVD and mortality. Methods: An oral ...glucose tolerance test (OGTT; 75g glucose) was administered to a subsample of non-diabetic Framingham Heart Study participants (n=361). Metabolite profiling was performed on blood samples drawn before and 2 hours post OGTT. We compared pre- and post-OGTT log2(metabolite levels) using t-tests; for each metabolite with statistically significant changes from pre- to post-OGTT (Δmetabolites), we calculated log2(post/pre) and standardized values to mean=0, standard deviation=1. We constructed multivariable-adjusted Cox models relating each Δmetabolite with CVD and death. Models were adjusted for clinical risk factors of age, sex, baseline metabolite level, diabetes, systolic blood pressure, hypertension treatment, BMI, smoking, and total/HDL cholesterol. Results: Our sample included 42% women, with a mean age of 56±9 years, and body mass index of 30.2±5.3 kg/m 2 . The pre- to post-OGTT change (Δmetabolite) was statistically significant for 170 metabolites (at FDR ≤0.05). A total of 132 CVD events and 144 deaths occurred during follow up (mean 23±5 years for CVD, 26±2 years for death). In Cox models, four Δmetabolites were associated with incident CVD and six Δmetabolites were associated with death, at P<0.05 ( Table ). Notably, baseline metabolite levels were not associated with either outcome in models excluding Δmetabolites. Significant Δmetabolites included those with established roles in cardiometabolic disease (e.g., glutamate, α-ketoglutarate, N-methylmalonamic acid) and metabolites with less defined roles (e.g., glucoronate, lipid species). Conclusion: Intra-individual changes in circulating metabolites in response to an OGTT were associated with CVD and death beyond their resting measures. Dynamic changes in metabolite levels with an OGTT have potential relevance for understanding and predicting CVD risk.
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