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  • 1
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    Abstract P379: Atherosclerotic Abdominal Aortic Plaque and All-Cause Mortality: The Framingham Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 139, No. Suppl_1 ( 2019-03-05)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 139, No. Suppl_1 ( 2019-03-05)
    Abstract: Introduction: Atherosclerotic abdominal aortic plaque (AAP) is often seen incidentally on magnetic resonance (MR) scans. Prevalence and burden of AAP are associated with cardiovascular disease (CVD) risk factors, but the relationship between AAP and all-cause mortality (“Death”) is not well characterized. We sought to determine whether AAP predicts Death among community-dwelling adults initially without clinically overt CVD. Methods: 318 Framingham Offspring cohort members (age 60±9 yrs, 51% women) underwent noncontrast abdominal MR at 1.5 Tesla in 1998-1999. Participants were recruited from equal strata of age, sex and quintile of Framingham Risk Score (FRS), with double sampling of the top quintile. MR used ECG-triggered black-blood T2W turbo spin-echo with 1.03 x 0.64 x 5-mm 3 voxels. AAP was hand-traced and comprised discrete protrusions of ≥1mm into the aortic lumen. Participants were stratified into three levels of AAP: zero (AAP0); then among those with nonzero-AAP, subdivided into below median (AAP1) and above median (AAP2). FRS was calculated for each participant (using age, sex, systolic blood pressure, total and HDL cholesterol, diabetes, smoking); A Cox proportional hazards model adjusted for standardized, log-transformed FRS (zFRS) was used to determine hazard ratio (HR) for Death with AAP0 as the referent. The log-rank test was used to compare event-free survival. Results: AAP by MR was present in 40.4% of women and 42.1% of men. Over a median 14.8 years of follow up, there were 52 Deaths (5 CVD, 22 cancer, 25 other causes). AAP2 had HR=2.08 (95% CI 1.07 - 4.08, p=0.03); AAP1 was HR=1.37 (CI=0.65 - 2.92, p=0.4). The figure shows the Kaplan-Meier plot for survival; log-rank p=0.034. Conclusions: Among adults initially free of clinically overt CVD, above median burden of AAP was associated with 2-fold greater hazard of all-cause mortality. Although the majority of deaths were not principally due to CVD, excess AAP was a predictor of mortality over nearly 15 year follow up.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.139.suppl_1.P379
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 2
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    Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 141, No. 9 ( 2020-03-03)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 141, No. 9 ( 2020-03-03)
    Abstract: The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year’s edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association’s 2020 Impact Goals. Results: Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. Conclusions: The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIR.0000000000000757
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 3
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    Abstract 12077: Impact of Overweight and Obesity on Left Ventricular Structure and Function in a Community Dwelling Cohort Free of Cardiovascular Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Obesity is associated with excess cardiovascular morbidity and mortality as well as structural and functional differences in left ventricular (LV) mass (LVM), end-diastolic volume (LVEDV), and stroke volume despite indexation. Hypothesis: We hypothesize that overweight and obesity impact LV structure and function in a healthy community dwelling cohort. Methods: Framingham Offspring study participants (N=678, 62%F; 65±9y) free of any history of hypertension, myocardial infarction, heart failure, or CMR wall-motion abnormality and underwent bSSFP CMR at 1.5T. They were stratified by sex and body mass index (BMI) category (normal weight =18.5 to 24.9; overweight =25.0 to 29.9; obese ≥30 kg/m 2 ). LVM was measured from contiguous short-axis images, then indexed to height (HT, m), body surface area (BSA, m 2 ), and weight (WT, kg). We calculated myocardial contraction fraction (MCF), a marker of LV myocardial shortening, as LV stroke volume divided by LV myocardial volume. The ratio of LVM/LVEDV was used as a measure of LV concentricity to evaluate LV structure. Results: The Table shows MCF, LV concentricity, and indexed LVM (LVMi) stratified by BMI. WT-indexation resulted in a declining LVMi with increasing BMI in both men and women. However, indexation to HT showed an increasing LVMi with higher BMI. BSA-indexation remained consistent across BMI categories in both men and women. MCF decreased and concentricity increased with increasing BMI in both sexes. Conclusion: The association of LVMi with BMI varies by indexation method. In a healthy, community-dwelling cohort, BSA yields “consistent” LVM indexation across BMI categories. However, MCF decreased, and concentricity increased with increasing categories of BMI. These adverse alterations of MCF and concentricity may provide insight into obesity-related LV remodeling, whereas consideration of LVM alone may not. These data lay the groundwork for further outcomes analyses in this population.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.12077
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 4
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    Abstract MP14: Relations of Arterial Stiffness and Incident Heart Failure in the Community
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 129, No. suppl_1 ( 2014-03-25)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. suppl_1 ( 2014-03-25)
    Abstract: Background: The structure and function of the aorta and left ventricle are closely coupled, but the relations of arterial stiffness, pressure pulsatility, and wave reflection to clinical heart failure (HF) are not well described. Methods: We evaluated 2904 Framingham Heart Study participants (mean age 64+11 yrs, 56% F) who were free of clinical HF and myocardial infarction (MI). Carotid-femoral pulse wave velocity (CFPWV), central pulse pressure, forward wave amplitude, and augmentation index were assessed by applanation tonometry. Cox proportional hazards models accounted for competing risk of death and adjusted for age, sex, body mass index, mean arterial pressure, total and HDL cholesterol, use of hypertensive medications, prevalent diabetes, current smoking, and prevalent cardiovascular disease. Results: On follow-up (mean 9.2 years, limits 0.04-13 years), 170 participants developed new-onset HF while 106 experienced an MI. The incidence of HF rose across CFPWV tertiles ( Figure ). Each standard deviation (SD) higher CFPWV conferred a 50% (95% CI 1.21-1.85, p=0.0002) and 30% (95% CI 1.02-1.64, p=0.037) increased risk of incident HF in age- and sex-adjusted and multivariable-adjusted analyses, respectively. CFPWV was associated with increased risk of MI (hazards ratio [HR] per SD 1.46, 95% CI 1.01-2.12, p=0.04). The inclusion of interim MI in multivariable models attenuated the association of CFPWV with HF incidence (HR per SD 1.26, 95% CI 0.99-1.60, p=0.061). Central pulse pressure, forward wave amplitude, and augmentation index were not associated with incident HF in multivariable-adjusted models. Conclusions: Higher aortic stiffness as assessed by CFPWV is associated with increased risk of incident HF, mediated in part by the increased risk of interim MI associated with vascular stiffness. These findings illustrate the importance of ventricular-vascular coupling, and underscore the need for studies to examine the benefit of therapies that modify aortic stiffness for lowering the population burden of MI and HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.129.suppl_1.mp14
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 5
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    Abstract 17161: Reduced Ventilatory Function and Gas Exchange are Associated With Cardiac Remodeling and Changes in Systolic and Diastolic Function in the Community
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Chronic lung disease and heart failure have been reported to be associated, but the pathophysiologic relations between cardiac and pulmonary structure and function in the community are not well understood. We evaluated cross-sectional associations between measures of pulmonary function and echocardiographic traits related to cardiac remodeling and systolic and diastolic function in a large, community-based sample. Hypothesis: We hypothesized that lower ventilatory function and diffusion capacity would be associated with adverse cardiac remodeling and reduced left ventricular (LV) systolic and diastolic function. Methods: Forced expiratory volume in 1 second (FEV1), single-breath carbon monoxide diffusion capacity (DLCO), and comprehensive echocardiographic measures were obtained in approximately 2500 participants (mean age 67±9 years; 55% women) attending the 8 th Framingham Offspring examination cycle. Results: Using multivariable-adjusted linear regression models, we observed lower DLCO to be associated with lower fractional shortening, relatively higher early LV filling (E/A ratio), greater LV filling pressures (E/e’ ratio), and smaller right ventricular (RV) size ( Table) . Similarly, lower FEV1 was associated with smaller left atrial size, relatively higher early LV filling (E/A ratio), smaller RV size, and smaller right atrial area ( Table ). Conclusions: Lower ventilatory function and diffusion capacity are associated with smaller cardiac chamber dimensions, worse LV systolic function, and changes in measures of LV diastolic filling. The mechanisms responsible for these relations require further investigation, but these associations provide evidence for a pathophysiologic association between chronic lung disease and abnormalities in cardiac structure and function in the community.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.17161
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 6
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    Abstract 14235: Aortic Volume and Dimensions by Cardiovascular Magnetic Resonance Predict Incident Cardiovascular Events
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Pathophysiology of the aorta negatively impacts cardiovascular health. Hypothesis: Assessment of aortic anatomy facilitates population-based cardiovascular disease (CVD) risk stratification. Methods: Framingham Heart Study Offspring Cohort participants without prevalent CVD (n=1576, 64±9 years, 44% men) underwent 1.5T ECG-gated axial T2W black-blood CMR of the thoracoabdominal aorta (2002-2006). The diameters of the descending thoracic and proximal and distal abdominal aorta (infrarenal and aortic bifurcation) were measured ( Figure A ). Additionally, the maximum diameter and the total intravascular volume of the descending thoracic and abdominal aorta were calculated. Cox proportional hazards regression analyses adjusting for age, gender, systolic blood pressure, total cholesterol/HDL cholesterol ratio, diabetes mellitus, smoking, as well as treatment for hyperlipidemia, hypertension, and diabetes were undertaken to evaluate the association of aortic anatomy with incident CVD ( Figure ). Results: During follow-up (median 9.5 years, range 0 - 12.2 yrs), 163 incident CVD events occurred, of which 66 were major events (myocardial infarction, ischemic stroke, and CVD death). In multivariable-adjusted Cox regression models, each SD unit greater descending thoracic and maximum aortic diameter, as well as natural logarithmic transformed total aortic volume were associated with a 〉 20% increased risk for incident CVD (per SD Unit hazard ratio [HR]: 1.21, 95% CI: 1.03-1.42, P=0.019; HR 1.22, 95% CI: 1.04-1.43, P=0.014; HR: 1.24, 95% CI: 1.10-1.39, P 〈 0.001, respectively; Figure B ). Abdominal aortic diameters were not associated with CVD. Conclusions: In this middle-aged community-dwelling Caucasian adult cohort followed over 10 years, greater thoracoabdominal aortic dimensions and volume, predicted incident CVD. Future investigations may determine the implications of aortic size modification on CVD outcomes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.14235
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 7
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    Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Circulation Vol. 135, No. 10 ( 2017-03-07)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 135, No. 10 ( 2017-03-07)
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIR.0000000000000485
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 8
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    Abstract P140: Linear Versus Volumetric Measures Of Left Ventricular Sphericity: Concordance And Normal Reference Values
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 141, No. Suppl_1 ( 2020-03-03)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 141, No. Suppl_1 ( 2020-03-03)
    Abstract: Introduction: Greater left ventricular (LV) sphericity, a more globular shape, is associated with poor outcomes. Two measures of sphericity are commonly used: Linear sphericity (LinS) is the ratio of LV end-diastolic diameter (EDD) to 4-chamber length (4cL); volumetric sphericity (VolS) is the ratio of end-diastolic volume (EDV) to the volume of a sphere with diameter=4cL. We sought to compare LinS to VolS and to determine: 1) whether LinS and VolS differ with sex and age group; 2) normal values for LinS and VolS, 3) whether LinS and VolS are concordant in how they stratify individuals. Methods: 1794 adults (age 65±9y, 47.1% men) in the Framingham Offspring cohort underwent CMR imaging; LV EDD, EDV and 4cL were measured. A referent group (340M, 512W) free of clinical cardiovascular disease, hypertension, diabetes and smoking was identified. Among these, we compared LinS and VolS between sexes and across age groups ( 〈 55, 55-64, ≥65y). Referent-group upper 90 th percentile (P90) cutpoints for LinS and VolS were determined and applied to the entire cohort (N=1794) to stratify each individual as having or not having high sphericity. Concordance between LinS and VolS was assessed using kappa coefficient and McNemar’s test. Methods: LinS was greater than VolS for each sex, but there was robust, positive linear (Pearson) correlation between LinS and VolS for men (r=0.864) and women (r=0.855), p 〈 0.0001 both. The Table shows women had minimally greater sphericity than men. Sphericity did not vary with age group in either sex. LinS and VolS were concordant in classifying individuals as having high (≥P90) sphericity with kappa=0.63 (men) and 0.62 (women), p 〈 0.0001 for both. McNemar’s test for difference was not significant (p 〉 0.27) for either sex. Conclusion: Linear and volumetric measures of LV sphericity are concordant in how they rank and stratify adults in a community dwelling cohort, but the measures are not directly comparable, as mean LinS is markedly greater than VolS. Neither measure of sphericity varies with age among healthy adults.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.141.suppl_1.P140
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 9
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    Aortic Stiffness, Increased White Matter Free Water, and Altered Microstructural Integrity : A Continuum of Injury
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 6 ( 2017-06), p. 1567-1573
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    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 6 ( 2017-06), p. 1567-1573
    Abstract: Previous reports from the Framingham Heart Study have identified cross-sectional associations of arterial stiffness, as reflected by carotid–femoral pulse wave velocity (CFPWV) and systolic blood pressure with vascular brain injury. The purpose of this study is to examine free water (FW), fractional anisotropy (FA), and white matter hyperintensities (WMH) in relation to arterial stiffness among subjects of the Framingham Offspring and Third-Generation cohorts. Methods— In 2422 participants aged 51.3±11.6 years, FA, FW, and WMH were related to CFPWV using voxel-based linear and generalized linear regressions, adjusting for relevant covariables. Mean FW, mean FA, and WMH burden (log transformed) were computed within white matter (WM) region and related to systolic blood pressure and CFPWV using multiple mediation analyses. Results— CFPWV was found to be associated with higher FW, lower FA, and higher WMH incidence in WM areas covering, respectively, 356.1, 211.8, and 10.9 mL of the WM mask. Mediation analyses revealed that the effect of systolic blood pressure on FW was mediated by CFPWV (direct and indirect effects: a=0.040; P 〈 0.001, and a′=0.020; P 〉 0.05). Moreover, the effect of CFPWV on FA was mediated by FW (direct and indirect effects: b=−0.092; P 〈 0.001, and b′=0.012; P 〉 0.05), whose effect on WMH was, in turn, mediated by FA (direct and indirect effects: c=0.246; P 〈 0.001, and c′=0.116; P 〉 0.05). Conclusions— From these data, we propose a biomechanical hypothesis designed for future research experiments to explain how hemodynamic alteration may lead to WM injury by impacting cerebral water content and more subtly WM integrity, to finally lead to WMH development.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.016321
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    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Elsevier BV ; 2016
    In:  JACC: Heart Failure Vol. 4, No. 10 ( 2016-10), p. 828-829
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    In: JACC: Heart Failure, Elsevier BV, Vol. 4, No. 10 ( 2016-10), p. 828-829
    Type of Medium: Online Resource
    ISSN: 2213-1779
    URL: Article
    DOI: 10.1016/j.jchf.2016.06.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2705621-1
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