Center for Prevention and Wellness

Miami, FL, United States

Center for Prevention and Wellness

Miami, FL, United States

Time filter

Source Type

Al Rifai M.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Silverman M.G.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Silverman M.G.,Brigham and Women's Hospital | Nasir K.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | And 6 more authors.
Atherosclerosis | Year: 2015

Introduction: We characterized the association of 3 metabolic conditions - obesity, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) - with increased inflammation and subclinical atherosclerosis. Methods: We conducted cross-sectional analysis of 3976 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with adequate CT imaging to diagnose NAFLD. Obesity was defined as BMI≥30kg/m2, metabolic syndrome by AHA/NHLBI criteria, and NAFLD using non-contrast cardiac CT and a liver/spleen attenuation ratio (L/S)<1. Increased inflammation was defined as high sensitivity C-reactive protein (hsCRP) ≥2mg/L and subclinical atherosclerosis as coronary artery calcium (CAC)>0. We studied the association of a stepwise increase in number of these metabolic conditions (0-3) with increased inflammation and CAC, stratifying results by gender and ethnicity. Results: Mean age of participants was 63 (±10) years, 45% were male, 37% white, 10% Chinese, 30% African American, and 23% were Hispanic. Adjusting for obesity, metabolic syndrome and traditional risk factors, NAFLD was associated with a prevalence odds ratio for hsCRP ≥2mg/L and CAC >0 of 1.47 (1.20-1.79) and 1.37 (1.11-1.68) respectively. There was a positive interaction between female gender and NAFLD in the association with hsCRP ≥2mg/L (p=0.006), with no interaction by race. With increasing number of metabolic conditions, there was a graded increase in prevalence odds ratios of hsCRP ≥2mg/L and CAC >0. Conclusion: NAFLD is associated with increased inflammation and CAC independent of traditional risk factors, obesity and metabolic syndrome. There is a graded association between obesity, metabolic syndrome, and NAFLD with inflammation and CAC. © 2015 Elsevier Ireland Ltd.


Keenan T.,Johns Hopkins Ciccarone Preventive Cardiology Center | Blaha M.J.,Johns Hopkins Ciccarone Preventive Cardiology Center | Nasir K.,Johns Hopkins Ciccarone Preventive Cardiology Center | Nasir K.,Center for Prevention and Wellness | And 7 more authors.
American Journal of Cardiology | Year: 2012

Increased uric acid (UA) is strongly linked to cardiovascular disease. However, the independent role of UA is still debated because it is associated with several cardiovascular risk factors including obesity and metabolic syndrome. This study assessed the association of UA with increased high-sensitivity C-reactive protein (hs-CRP), increased ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL), sonographically detected hepatic steatosis, and their clustering in the presence and absence of obesity and metabolic syndrome. We evaluated 3,518 employed subjects without clinical cardiovascular disease from November 2008 through July 2010. Prevalence of hs-CRP <3 mg/L was 19%, that of TG/HDL <3 was 44%, and that of hepatic steatosis was 43%. In multivariable logistic regression after adjusting for traditional cardiovascular risk factors and confounders, highest versus lowest UA quartile was associated with hs-CRP <3 mg/L (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.01 to 2.28, p = 0.04), TG/HDL <3 (OR 3.29, 95% CI 2.36 to 4.60, p <0.001), and hepatic steatosis (OR 3.10, 95% CI 2.22 to 4.32, p <0.001) independently of obesity and metabolic syndrome. Association of UA with hs-CRP <3 mg/L became nonsignificant in analyses stratified by obesity. Ascending UA quartiles compared to the lowest UA quartile demonstrated a graded increase in the odds of having 2 or 3 of these risk conditions and a successive decrease in the odds of having none. In conclusion, high UA levels were associated with increased TG/HDL and hepatic steatosis independently of metabolic syndrome and obesity and with increased hs-CRP independently of metabolic syndrome. © 2012 Elsevier Inc.


Nasir K.,Center for Prevention and Wellness | Nasir K.,Johns Hopkins University | Clouse M.,Beth Israel Deaconess Medical Center
Radiology | Year: 2012

Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper"for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals. © RSNA, 2012.


Whelton S.P.,Welch Center for Prevention | Whelton S.P.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Blankstein R.,Brigham and Women's Hospital | Al-Mallah M.H.,Cardiac Guard | And 9 more authors.
Hypertension | Year: 2013

Resting heart rate is an easily measured, noninvasive vital sign that is associated with cardiovascular disease events. The pathophysiology of this association is not known. We investigated the relationship between resting heart rate and stiffness of the carotid (a peripheral artery) and the aorta (a central artery) in an asymptomatic multi-ethnic population. Resting heart rate was recorded at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA). Distensibility was used as a measure of arterial elasticity, with a lower distensibility indicating an increase in arterial stiffness. Carotid distensibility was measured in 6484 participants (98% of participants) using B-mode ultrasound, and aortic distensibility was measured in 3512 participants (53% of participants) using cardiac MRI. Heart rate was divided into quintiles and we used progressively adjusted models that included terms for physical activity and atrioventricular nodal blocking agents. Mean resting heart rate of participants (mean age, 62 years; 47% men) was 63 bpm (SD, 9.6 bpm). In unadjusted and fully adjusted models, carotid distensibility and aortic distensibility decreased monotonically with increasing resting heart rate (P for trend <0.001 and 0.009, respectively). The relationship was stronger for carotid versus aortic distensibility. Similar results were seen using the resting heart rate taken at the time of MRI scanning. Our results suggest that a higher resting heart rate is associated with an increased arterial stiffness independent of atrioventricular nodal blocker use and physical activity level, with a stronger association for a peripheral (carotid) compared with a central (aorta) artery. © 2013 American Heart Association, Inc.


Makadia S.S.,Johns Hopkins Medical Institutes | Blaha M.,Johns Hopkins Medical Institutes | Keenan T.,Johns Hopkins Ciccarone Preventative Cardiology Center | Ndumele C.,Johns Hopkins Medical Institutes | And 10 more authors.
American Journal of Cardiology | Year: 2013

Hepatic steatosis is closely associated with the metabolic syndrome. We assessed for an independent association between hepatic steatosis and atherogenic dyslipidemia after adjustment for obesity, physical activity, hyperglycemia, and systemic inflammation. We studied 6,333 asymptomatic subjects without clinical cardiovascular disease undergoing a health screen in Brazil from November 2008 to July 2010. Hepatic steatosis was diagnosed by ultrasound. Atherogenic dyslipidemia was defined using 2 definitions: criteria for (1) metabolic syndrome or (2) insulin resistance (triglyceride/high-density- lipoprotein cholesterol ratio of ≥2.5 in women and ≥3.5 in men). In hierarchical multivariate regression models, we evaluated for an independent association of hepatic steatosis with atherogenic dyslipidemia. Hepatic steatosis was detected in 36% of participants (average age 43.5 years, 79% men, average body mass index 26.3 kg/m2). Subjects with hepatic steatosis had similar levels of low-density-lipoprotein cholesterol, with significantly lower level of high-density-lipoprotein cholesterol and higher level of triglyceride compared with those without steatosis. Hepatic steatosis remained significantly independently associated with atherogenic dyslipidemia of both definitions (metabolic syndrome [odds ratio 2.47, 95% confidence interval 2.03 to 3.02] and insulin resistance [odds ratio 2.50, 95% confidence interval 2.13 to 2.91]) after multivariate adjustment. Stratified analyses showed a persistent independent association in nonobese subjects, those without metabolic syndrome, those with normal high-sensitivity C-reactive protein, nonalcohol abusers, and those with normal liver enzymes. Hepatic steatosis was significantly associated with atherogenic dyslipidemia independent of obesity, physical activity, hyperglycemia, and systemic inflammation after multivariate adjustment. In conclusion, this adds to the growing body of evidence that hepatic steatosis may play a direct metabolic role in conferring increased cardiovascular risk. © 2013 Elsevier Inc. All rights reserved.


Quaglia L.A.,University of Campinas | Freitas W.M.,University of Campinas | Soares A.A.,University of Sao Paulo | Santos R.D.,University of Sao Paulo | And 7 more authors.
Aging Clinical and Experimental Research | Year: 2014

Aim of the study: In contrast to the general population, individuals with primarily persistent elevation of inflammatory activity display a significant association between inflammatory biomarkers and atherosclerotic burden. In older individuals, immunosenescence upregulates the innate response and, by this way, may hypothetically favor the presence of this association. The aim of this study was to evaluate this hypothesis in healthy octogenarians. Methods: Participants (n = 208) aged 80 years or older, asymptomatic and without medical and laboratory evidence of chronic diseases or use of anti-inflammatory treatments were included in the study. Lipid profile and plasma C-reactive protein (CRP) were measured at baseline and cardiac computed tomography was performed within 1-week interval for measuring coronary calcium score (CCS). Results: The median plasma CRP was 1.9 mg/L (1.0-3.4) and 33% of the participants had elevated CRP defined as ≥3 mg/L. Among those with high CRP, there was an increased frequency of high CCS (≥100) as compared with their counterparts (71 vs 50%, p = 0.001). The association between CRP and CCS persisted even after adjustment for age, sex, cardiovascular risk factors and statin therapy. The area under the receiver-operating curve for CRP was 0.606 using CCS ≥100 as a binary outcome. The sensitivities for CCS ≥100 were 40 and 74% for the cutoff points of CRP ≥3 or 1 mg/L, respectively. Conclusion: The present study was able to confirm that in very elderly individuals, systemic inflammatory activity is independently associated with coronary atherosclerosis burden. © Springer International Publishing 2013.


Graham G.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Blaha M.J.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Budoff M.J.,University of California at Los Angeles | Rivera J.J.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | And 11 more authors.
Atherosclerosis | Year: 2012

Background: Coronary artery calcium (CAC) has emerged as an important prognostic indicator for coronary heart disease risk. The purpose of this study was to assess the impact of increasing CAC burden among those with and without hypertension (HTN). Methods: The study cohort consisted of 44,052 consecutive asymptomatic individuals free of known coronary heart disease referred for electron beam computed tomography (EBT) for the assessment of subclinical atherosclerosis. Patients were followed for a mean of 5.6 ± 2.6 years (range 1-13 years). The primary endpoint for the study cohort was mortality from any cause. Results: About one third (34%) of the subjects were affected by hypertension. There were 901 deaths (2.05%) in the total study population over a mean follow-up of 5.6 ± 2.6 years (range 1-13 years). The lowest event rate was observed in those with no CAC among those without hypertension (1.6 events per 1000 person years), whereas those with CAC ≥400 and hypertension had the highest all fatality rate (9.8 per 1000 person years). Compared to a CAC score of 0, increasing CAC scores (1-99, 100-399, and ≥400) were associated with increases in all-cause mortality. The hazard ratio was 2.19-7.74-fold among those without HTN and 3.00-5.83 fold among those with HTN. Overall likelihood ratio chi square statistics demonstrated that the addition of CAC scores increased mortality prediction beyond traditional risk among those with hypertension. Conclusion: Addition of CAC scores contributed significantly in predicting mortality in addition to just traditional risk factors alone among those with and without hypertension. © 2012 Elsevier Ireland Ltd.


Al Rifai M.,The Johns Hopkins Ciccarone Center for Prevention of Heart Disease | McEvoy J.W.,The Johns Hopkins Ciccarone Center for Prevention of Heart Disease | Nasir K.,The Johns Hopkins Ciccarone Center for Prevention of Heart Disease | Nasir K.,Center for Prevention and Wellness | And 4 more authors.
Atherosclerosis | Year: 2015

Introduction: Coronary artery calcium (CAC) reflects coronary plaque burden and independently predicts all-cause mortality. There is marked heterogeneity in the prognosis of individuals with a high burden of subclinical atherosclerosis, yet little research has focused on the proximate determinants of poor outcomes in this subgroup. Methods: Among 4234 persons with baseline CAC ≥400, multivariable Cox proportional hazards models were used to study the association of traditional cardiovascular risk factors with 1-year all-cause mortality. Results: The mean age was 64±10 years, with 56% male and a median CAC score of 809 (IQR 761). In multivariable models, diabetes, cigarette smoking, age (per SD), CAC (per SD) and dyslipidemia were significantly associated with all-cause mortality at 1 year: HR (95% confidence interval)=2.62 (1.55-4.43), 2.42 (1.41-4.15), 1.52 (1.16-1.99), 1.33 (CAC 1.11-1.56) and 0.58 (0.34-0.98) respectively. There was no association with hypertension [HR (95% confidence interval)=0.90 (0.55-1.47)]. Conclusion: Smoking and diabetes are strongly associated with one-year all-cause mortality among persons with extensive CAC, perhaps suggesting that these risk factors serve as triggers of acute events. © 2015 Elsevier Ireland Ltd.


Whelton S.P.,Welch Center for Prevention | Whelton S.P.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Narla V.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Narla V.,University of California at San Francisco | And 8 more authors.
American Journal of Cardiology | Year: 2014

Heart rate (HR) at rest is associated with adverse cardiovascular events; however, the biologic mechanism for the relation is unclear. We hypothesized a strong association between HR at rest and subclinical inflammation, given their common interrelation with the autonomic nervous system. HR at rest was recorded at baseline in the Multi-Ethnic Study of Atherosclerosis, a cohort of 4 racial or ethnic groups without cardiovascular disease at baseline and then divided into quintiles. Subclinical inflammation was measured using high-sensitivity C-reactive protein, interleukin-6, and fibrinogen. We used progressively adjusted regression models with terms for physical activity and atrioventricular nodal blocking agents in the fully adjusted models. We examined inflammatory markers as both continuous and categorical variables using the clinical cut point of ≥3 mg/L for high-sensitivity C-reactive protein and the upper quartiles of fibrinogen (≥389 mg/dl) and interleukin-6 (≥1.89 pg/ml). Participants had a mean age of 62 years (SD 9.7), mean resting heart rate of 63 beats/min (SD 9.6) and were 47% men. Increased HR at rest was significantly associated with higher levels of all 3 inflammatory markers in both continuous (p for trend <0.001) and categorical (p for trend <0.001) models. Results were similar among all 3 inflammatory markers, and there was no significant difference in the association among the 4 racial or ethnic groups. In conclusion, an increased HR at rest was associated with a higher level of inflammation among an ethnically diverse group of subjects without known cardiovascular disease. © 2014 Elsevier Inc. All rights reserved.


PubMed | Center for Prevention and Wellness
Type: Journal Article | Journal: Radiology | Year: 2012

Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a gatekeeper for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.

Loading Center for Prevention and Wellness collaborators
Loading Center for Prevention and Wellness collaborators