Myocardial H2 receptor activation may promote cardiac fibrosis and apoptosis in pre-clinical models and histamine H2 receptor antagonist (H2RA) use may improve symptoms in participants with heart ...failure (HF); however, relationships between H2RA use, incident HF, and longitudinal change in left ventricular (LV) morphology are not known.
This study sought to determine whether H2RA use is associated with incident HF and change in LV morphology over time.
We included 6,378 men and women from MESA (Multi-Ethnic Study of Atherosclerosis), a multicenter prospective observational cohort of participants without cardiovascular disease at baseline. Cox proportional hazards were used to estimate the association between H2RA use and incident HF in adjusted models. In participants with cardiac magnetic resonance imaging, associations between H2RA use, baseline LV morphology (n = 4,691), and longitudinal change in the LV (n = 2,806) were estimated using linear regression.
H2RAs were used by 313 participants but not by the other 6,065 individuals. During a median follow-up of 11.2 years, 236 participants developed HF. In adjusted models, baseline H2RA use relative to nonuse was associated with 62% lower risk for incident HF (p = 0.02). H2RA use was associated with preserved stroke volume, LV end-diastolic volume, and mass/volume ratio as measured by cardiac magnetic resonance imaging over approximately 10 years (all p < 0.05). There were no associations between H2RA use and LV mass or ejection fraction.
H2RA use was associated with reduced risk for incident HF. Left heart morphology over time suggests less age-related change in H2RA users. These associations suggest histamine signaling may be important in the pathogenesis of HF. (Multi-Ethnic Study of Atherosclerosis MESA; NCT00005487).
Objective. We evaluated the association of 1-h oral glucose challenge test (OGCT) and 3-h oral glucose tolerance test (OGTT) results with preeclampsia. Methods. A retrospective cohort study was ...performed among 26,105 women. Results. Preeclampsia was associated with the upper OGCT quartiles 114-132 mg dL: odds ratio (OR) = 1.25, 95% confidence interval (CI) 1.09-1.44; >132 mg dL: OR = 1.40, 95% CI 1.21-1.61 compared with <98 mg dL adjusting for age, primigravidity, and gestational diabetes, and also to one abnormal OGTT value (adjusted OR 1.38, 95% CI 1.09-1.75) or gestational diabetes (adjusted OR 1.45, 95% CI 1.15-1.83). Conclusion. Higher glucose levels are associated with preeclampsia suggesting a pathophysiological role for glucose metabolism.
Congestive heart failure (CHF) definitions vary across epidemiologic studies. The Framingham Heart Study criteria include CHF signs and symptoms assessed by a physician panel. In the Cardiovascular ...Health Study, a committee of physicians adjudicated CHF diagnoses, confirmed by signs, symptoms, clinical tests, and/or medical therapy. The authors used data from the Cardiovascular Health Study, a population-based cohort study of 5,888 elderly US adults, to compare CHF incidence and survival patterns following onset of CHF as defined by Framingham and/or Cardiovascular Health Study criteria. They constructed an inception cohort of nonfatal, hospitalized CHF patients. Of 875 participants who had qualifying CHF hospitalizations between 1989 and 2000, 54% experienced a first CHF event that fulfilled both sets of diagnostic criteria (concordant), 31% fulfilled only the Framingham criteria (Framingham only), and 15% fulfilled only the Cardiovascular Health Study criteria (Cardiovascular Health Study only). No significant survival difference was found between the Framingham-only group (hazard ratio = 0.87, 95% confidence interval: 0.71, 1.07) or the Cardiovascular Health Study-only group (hazard ratio = 0.89, 95% confidence interval: 0.68, 1.15) and the concordant group (referent). Compared with Cardiovascular Health Study central adjudication, Framingham criteria for CHF identified a larger group of participants with incident CHF, but all-cause mortality rates were similar across these diagnostic classifications.
This analysis was conducted to study the effect of a 1-yr moderate-intensity aerobic exercise program on serum lipoproteins among overweight/obese postmenopausal women.
We randomized 173 sedentary ...(VO2max = 20.2 mL.kg(-1).min(-1)), overweight/obese women (body mass index (BMI) 25.0-42.0 kg.m(-2) or body fat > 33% if BMI 24.0-25.0) aged 50-75 yr, not using hormone therapy, living in the Seattle area, to an exercise intervention or stretching control group. The exercise intervention included facility and home-based exercise (45 min, 5 d.wk(-1) of moderate-intensity sports or recreational exercise). Total cholesterol (TC), triglycerides, and high-density lipoprotein (HDL) were determined by chemical assay; low-density lipoprotein (LDL) was then calculated.
Of the 173 women, 170 (98.3%) completed the study with exercisers averaging 176 (SD 91) min.wk(-1) of moderate- to vigorous-intensity (60%-75% HRmax) exercise, expending approximately 3828 kJ.wk(-1) (SD 2053). Exercisers, compared with stretchers, significantly increased their VO2max (+11%, P<0.001) and lost more body weight (-1.4 kg, P < 0.05), DEXA-% total body fat (-1.0, P < 0.005), L4-5 computed tomography intraabdominal fat (-8.6 cm2, P < 0.05) and subcutaneous abdominal fat (-28.8 cm2, P < 0.005) after 12 months. Mean (SD) baseline lipoprotein levels for TC, LDL, HDL, and triglycerides were 231 (39), 152 (39), 52 (12), and 135 (65) mg.dL(-1), respectively. We observed no significant change in serum lipoprotein levels among exercisers compared with stretchers at either 3 or 12 months postrandomization. We did not observe a statistically significant effect of exercise on serum lipoproteins in subgroups that changed their intraabdominal and subcutaneous fat, percent total body fat, or VO2max the most, or that adhered to the exercise regimen the most over 1 yr.
It appears that a year long moderate-intensity exercise program alone does not significantly alter serum lipoprotein levels among overweight/obese postmenopausal women.
AbstractBackground: High rates of disability associated with chronic airway obstruction may be caused by impaired pulmonary function, pulmonary symptoms, other chronic diseases, or systemic ...inflammation. Methods: We analyzed data from the Cardiovascular Health Study, a longitudinal cohort of 5888 older adults. Categories of lung function (normal; restricted; borderline, mild-moderate, and severe obstruction) were delineated by baseline spirometry (without bronchodilator). Disability-free years were calculated as total years alive and without self-report of difficulty performing &γτ;1 Instrumental Activities of Daily Living over 6 years of follow-up. Using linear regression, we compared disability-free years by lung disease category, adjusting for demographic factors, body mass index, smoking, cognition, and other chronic co-morbidities. Among participants with airflow obstruction, we examined the association of respiratory factors (FEV1 and dyspnea) and non-respiratory factors (ischemic heart disease, congestive heart failure, diabetes, muscle weakness, osteoporosis, depression and cognitive impairment) on disability-free years. Results: The average disability free years were 4.0 out of a possible 6 years. Severe obstruction was associated with 1 fewer disability-free year compared to normal spirometry in the adjusted model. For the 1,048 participants with airway obstruction, both respiratory factors (FEV1 and dyspnea) and non-respiratory factors (heart disease, coronary artery disease, diabetes, depression, osteoporosis, cognitive function, and weakness) were associated with decreased disability-free years. Conclusions: Severe obstruction is associated with greater disability compared to patients with normal spirometery. Both respiratory and non-respiratory factors contribute to disability in older adults with abnormal spirometry.
Background
Few studies have examined the relationship of α‐linolenic acid (ALA 18:3n‐3), an intermediate‐chain essential n‐3 polyunsaturated fatty acid derived from plants and vegetable oils, with ...incident atrial fibrillation (AF).
Methods and Results
The study population included participants from the Cardiovascular Health Study, a community‐based longitudinal cohort of adults aged 65 or older, free of prevalent coronary heart disease and atrial fibrillation. We assessed the associations of plasma phospholipid and dietary ALA with incident AF using Cox regression. The biomarker analysis comprised a total of 2899 participants, and the dietary analysis comprised 4337 participants. We found no association of plasma phospholipid ALA and incident AF. Comparing each of the second, third, and fourth quartiles to the lowest quartile, the hazard ratios for AF were 1.11 (95% CI, 0.90 to 1.37), 1.09 (95% CI, 0.88 to 1.35), and 0.92 (95% CI, 0.74 to 1.15), after adjustment for age, sex, race, clinic, education, smoking, alcohol, body mass index, waist circumference, diabetes, heart failure, stroke, treated hypertension, and physical activity (P trend=0.48). When dietary ALA was considered the exposure of interest, results were similar.
Conclusions
Results from this prospective cohort study of older adults indicate no association of plasma phospholipid or dietary ALA and incident AF.
The relative risk of ischemic stroke associated with transient ischemic attack (TIA) is not well defined because most studies of stroke after TIA did not include comparison groups. We sought to ...estimate short-term and long-term relative risks of ischemic stroke associated with clinically diagnosed TIA.
We used data from a population-based case-control study. Cases were hypertensive men and women and postmenopausal women, ages 30 to 79, with incident ischemic stroke. Control subjects were sampled within strata of age, sex, hypertension status, and calendar year. The index date was the stroke date for cases and a random date for control subjects. Clinically diagnosed TIA was ascertained from medical records. We used logistic regression to calculate ORs.
The study included 1914 stroke cases and 9874 control subjects. Clinically diagnosed TIA was present in 215 (11.2%) cases and 252 (2.5%) control subjects. Analyses focused on the most recent TIA before the index date. For TIA <1 month before the index date, the adjusted OR for stroke was 30.4 (95% CI, 10.4 to 89.4); for TIA 1 to 3 months before the index date, it was 18.9 (8.58 to 41.6); for TIA 4 to 6 months before the index date, it was 3.16 (1.27 to 7.82); and for TIA >5 years before the index date, it was 1.87 (1.22 to 2.85).
The relative risk of ischemic stroke was high for TIA diagnosed within the past 3 months and moderately high for TIA diagnosed >5 years in the past compared with no history of clinically diagnosed TIA.
Tools for the prediction of atrial fibrillation (AF) may identify high-risk individuals more likely to benefit from preventive interventions and serve as a benchmark to test novel putative risk ...factors.
Individual-level data from 3 large cohorts in the United States (Atherosclerosis Risk in Communities ARIC study, the Cardiovascular Health Study CHS, and the Framingham Heart Study FHS), including 18 556 men and women aged 46 to 94 years (19% African Americans, 81% whites) were pooled to derive predictive models for AF using clinical variables. Validation of the derived models was performed in 7672 participants from the Age, Gene and Environment-Reykjavik study (AGES) and the Rotterdam Study (RS). The analysis included 1186 incident AF cases in the derivation cohorts and 585 in the validation cohorts. A simple 5-year predictive model including the variables age, race, height, weight, systolic and diastolic blood pressure, current smoking, use of antihypertensive medication, diabetes, and history of myocardial infarction and heart failure had good discrimination (C-statistic, 0.765; 95% CI, 0.748 to 0.781). Addition of variables from the electrocardiogram did not improve the overall model discrimination (C-statistic, 0.767; 95% CI, 0.750 to 0.783; categorical net reclassification improvement, -0.0032; 95% CI, -0.0178 to 0.0113). In the validation cohorts, discrimination was acceptable (AGES C-statistic, 0.664; 95% CI, 0.632 to 0.697 and RS C-statistic, 0.705; 95% CI, 0.664 to 0.747) and calibration was adequate.
A risk model including variables readily available in primary care settings adequately predicted AF in diverse populations from the United States and Europe.
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