Suchergebnisse

<p><strong>Objective</strong>: Red blood cell distribution width (RDW) has been shown to associate with increased risk of cardiovascular and non-cardiovascular death. To our knowledge, no study has examined secular trends in RDW over the last decade.</p><p><strong>Design</strong>: Serial cross-sectional design. <strong></strong></p><p><strong>Setting</strong>: Data from the National Health and Nutrition Examination Survey (NHANES), 1999-2012, were used.</p><p><strong>Patients</strong>: 34,171 adults. <strong></strong></p><p><strong>Main Outcome Measure</strong>: RDW was assessed from a blood sample derived from the coefficient of variation of the red cell volume distribution histogram and reported as a percent. Elevated RDW was defined as an RDW &gt; 14.6%.</p><p><strong>Results</strong>: The overall age-adjusted mean RDW increased progressively and significantly (P&lt;.05) from 12.59% in 1999-2000 to 12.89% in 2011-2012. The overall age-adjusted prevalence of elevated RDW increased progressively and significantly (P&lt;.05) from 4.01% in 1999-2000 to 6.25% in 2011-2012. Statistically significant increases over this time period also occurred among non-Hispanic White women, non-Hispanic Black men and women, and Mexican American men and women. Across all sex and race-ethnicity combinations, women, compared with men, had higher RDW and larger increases over time in mean and elevated RDW. </p><p><strong>Conclusion</strong>: Mean and elevated RDW has progressively increased from 1999-2012 among adults in the United States, with increases observed among non-Hispanic Whites, Blacks, and Mexican Americans. Future research is needed to describe the determinants and implications of this RDW rise, as well as explanations for why a greater RDW change has occurred among women. <em>Ethn Dis. </em>2016;26(1):45-50; doi:10.18865/ed.26.1.45</p>

Objective: To evaluate interest in coronary artery calcium (CAC) among the general public during the past 17 years and to compare trends with real-world data on number of CAC procedures performed. Methods: We used Google Trends, a publicly available database, to access search query data in a systematic and quantitative fashion to search for CAC-related key terms. Search terms included calcium test, heart score, calcium score, coronary calcium, and calcium test score. We accessed Google Trends in January 2021 and analyzed data from 2004 to 2020. Results: From 2004 to December 31, 2020, CAC-related search interest (in relative search volume) increased continually worldwide (+201.9%) and in the United States (+354.8%). Three main events strongly influenced search interest in CAC: reports of a CAC scan of the president of the United States led to a transient 10-fold increase in early January 2018. American College of Cardiology/American Heart Association guideline release led to a sustained increase, and lockdown after the global pandemic due to COVID-19 led to a transient decrease. Real-world data on performed CAC scans showed an increase between 2006 and 2017 (+200.0%); during the same time period, relative search volume for CAC-related search terms increased in a similar pattern (+70.6%-1511.1%). For the search term coronary calcium scan near me, a potential representative of active online search for CAC scanning, we found a +28.8% increase in 2020 compared with 2017. Conclusion: Google Trends, a valuable tool for assessing public interest in health-related topics, suggests increased overall interest in CAC during the last 17 years that mirrors real-world usage data. Increased interest is seemingly linked to reports of CAC testing in world leaders and endorsement in major guidelines.

Objective: Smoking is a well-known cardio­vascular risk factor associated with weight loss. We aimed to evaluate the association between smoking, serum leptin levels, and abdominal fat.Design: Cross-sectionalSetting: Data from examinations 2 or 3 (2002-2005) of the Multi-Ethnic Study of Atherosclerosis (MESA)Participants: 1,875 asymptomatic, commu­nity-dwelling adultsMain Outcomes Measures: We used multivariable linear regression models to assess the race/ethnicity-specific associations between smoking, serum loge-leptin levels, and computed tomography ascertained abdominal fat. Results were adjusted for de­mographic and relevant clinical covariates.Results: Participants (mean age 64.5±9.6 years; 50.6% women; 42.2% former, 11.4% current smokers) were White (40.1%), His­panic (25.8%), African American (21.1%), and Chinese (13.0%). Overall, median (25th – 75th percentile) leptin levels were signifi­cantly lower among current (11.14 ng/mL; 4.13 – 26.18) and former smokers (11.68 ng/mL; 4.72 – 27.57), as compared with never smokers (15.61 ng/mL; 3.05 – 30.12) (P<.001). The difference in median leptin levels between current and never smok­ers were significantly higher for Hispan­ics (Δ9.64 ng/mL) and African Americans (Δ8.81 ng/mL) than Whites (Δ2.10 ng/mL) and Chinese (Δ4.70 ng/mL) (P<.001). After adjustment for total abdominal fat, loge- leptin levels remained lower for former (-.14 [-.22 – -.07]) and current (-.17 [-.28 – -.05]) smokers, compared with never smokers. Results differed by race/ethnicity, with signif­icantly lower loge-leptin levels observed only among current and former African Ameri­cans and Hispanic smokers, compared with their never smoker counterparts. (Ps for interaction <.05)Conclusions: Among smokers, leptin levels significantly vary by race/ethnicity. Former and current smoking are associ­ated with lower leptin levels, although this may be restricted to Hispanics and African Americans. Ethn Dis. 2018;28(4):531-538; doi:10.18865/ed.28.4.531

BACKGROUND AND AIMS: Inflammatory biomarkers and adipocytokines (IBA) may contribute to atherosclerosis by promoting vascular inflammation. The association between IBA and coronary artery calcium (CAC), a marker of subclinical atherosclerosis, is not well defined in South Asians (SA). We hypothesized that IBA (high sensitivity C-reactive protein [hsCRP], tumor necrosis factor alpha [TNF-α], adiponectin, and leptin) were independently associated with and improved discrimination of CAC among SA. METHODS: We analyzed IBA and CAC among participants in the prospective Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. We used logistic regression models to examine cross-sectional associations of IBA with CAC presence (CAC >0) and severity (CAC >100), and C-statistics to assess the incremental contribution of each IBA to traditional risk factors (TRF) from the AHA/ACC Pooled Cohort Equations (PCE) for discrimination of CAC. RESULTS: Among 906 participants of the MASALA study, women (n=420) had significantly higher levels of hsCRP, adiponectin, and leptin but lower levels of TNF-α than men (p<0.01 for all). There was no significant association between any of the four IBA and either CAC category in multivariable-adjusted models, respectively. Lastly, none of the four IBA improved discrimination of CAC presence or severity when added to elements of the PCE. CONCLUSIONS: IBA were not associated with CAC presence or severity in the MASALA population. IBA did not help identify SA at risk of subclinical atherosclerosis, although associations with ASCVD events remain unclear. In SA, CAC may have a distinct pathophysiology independent of inflammation as measured by IBA.

OBJECTIVES. To quantify and model conversion of a normal to an abnormal coronary artery calcium (CAC) scan. BACKGROUND. While absence of CAC is associated with excellent prognosis, progression to CAC>0 confers increased risk. The time interval for repeat scanning remains poorly defined. METHODS. Our study included 3,116 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with baseline CAC=0 and follow-up scans over 10 years after baseline. Prevalence of incident CAC, defined by thresholds of either CAC>0, CAC>10, or CAC>100, was calculated and time-to-progression was derived from a Weibull parametric survival model. Warranty periods were modeled as a function of sex, race/ethnicity, cardiovascular risk, and desired yield of repeat CAC testing. We further analyzed the proportion of coronary events occurring in participants with baseline CAC=0 that precede and follow repeat CAC testing at different time intervals. RESULTS. Mean age was 58 ± 9 years, with 63% women, and mean 10-year cardiovascular risk of 14%. Prevalence of CAC>0, CAC>10, and CAC>100 was 53%, 36%, and 8% respectively at 10 years. Using a 25% testing yield (Number Needed to Scan=4) the estimated warranty period of CAC>0 varied between 3 to 7 years depending on sex and race/ethnicity. Approximately 15% progressed to CAC>10 in 5 to 8 years, while 10-year progression to CAC>100 was rare. Presence of diabetes was associated with significantly shorter warranty period, while family history and smoking had small effects. 19% of all 10-year coronary events occurred in CAC=0 prior to performance of a subsequent scan at 3–5 years, while new detection of CAC>0 preceded 55% of future events and identified individuals at 3-fold higher risk of coronary events. CONCLUSION. In a large population of individuals with baseline CAC=0, we provide a robust estimation of the CAC=0 warranty period, considering progression to CAC>0, CAC>10, and CAC>100, and impact on missed vs. detectable 10-year year CHD events. ...