King Abdul Aziz Cardiac Center

Riyadh, Saudi Arabia

King Abdul Aziz Cardiac Center

Riyadh, Saudi Arabia
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Morris P.B.,Medical University of South Carolina | Ference B.A.,Wayne State University | Jahangir E.,University of New Orleans | Feldman D.N.,New York Medical College | And 12 more authors.
Journal of the American College of Cardiology | Year: 2015

Cardiovascular morbidity and mortality as a result of inhaled tobacco products continues to be a global healthcare crisis, particularly in low- and middle-income nations lacking the infrastructure to develop and implement effective public health policies limiting tobacco use. Following initiation of public awareness campaigns 50 years ago in the United States, considerable success has been achieved in reducing the prevalence of cigarette smoking and exposure to secondhand smoke. However, there has been a slowing of cessation rates in the United States during recent years, possibly caused by high residual addiction or fatigue from cessation messaging. Furthermore, tobacco products have continued to evolve faster than the scientific understanding of their biological effects. This review considers selected updates on the genetics and epigenetics of smoking behavior and associated cardiovascular risk, mechanisms of atherogenesis and thrombosis, clinical effects of smoking and benefits of cessation, and potential impact of electronic cigarettes on cardiovascular health. © 2015 American College of Cardiology Foundation.

Al-Mallah M.H.,Ford Motor Company | Al-Mallah M.H.,Wayne State University | Al-Mallah M.H.,King Abdul Aziz Cardiac Center | Keteyian S.J.,Ford Motor Company | And 3 more authors.
Clinical Cardiology | Year: 2014

Although physical fitness is a powerful prognostic marker in clinical medicine, most cardiovascular population-based studies do not have a direct measurement of cardiorespiratory fitness. In line with the call from the National Heart Lung and Blood Institute for innovative, low-cost, epidemiologic studies leveraging electronic medical record (EMR) data, we describe the rationale and design of the Henry Ford ExercIse Testing Project (The FIT Project). The FIT Project is unique in its combined use of directly measured clinical exercise data retrospective collection of medical history and medication treatment data at the time of the stress test, retrospective supplementation of supporting clinical data using the EMR and administrative databases and epidemiologic follow-up for cardiovascular events and total mortality via linkage with claims files and the death registry. The FIT Project population consists of 69885 consecutive physician-referred patients (mean age, 54±10years; 54% males) who underwent Bruce protocol treadmill stress testing at Henry Ford Affiliated Hospitals between 1991 and 2009. Patients were followed for the primary outcomes of death, myocardial infarction, and need for coronary revascularization. The median estimated peak metabolic equivalent (MET) level was 10, with 17% of the patients having a severely reduced fitness level (METs < 6). At the end of the follow-up duration, 15.9%, 5.6%, and 6.7% of the patients suffered all-cause mortality, myocardial infarction, or revascularization procedures, respectively. The FIT Project is the largest study of physical fitness to date. With its use of modern electronic clinical epidemiologic techniques, it is poised to answer many clinically relevant questions related to exercise capacity and prognosis. © 2014 Wiley Periodicals, Inc.

Roberson L.L.,Center for Prevention and Wellness Research | Aneni E.C.,Center for Prevention and Wellness Research | Maziak W.,Florida International University | Agatston A.,Center for Prevention and Wellness Research | And 12 more authors.
BMC Public Health | Year: 2014

Background: A subgroup has emerged within the obese that do not display the typical metabolic disorders associated with obesity and are hypothesized to have lower risk of complications. The purpose of this review was to analyze the literature which has examined the burden of cardiovascular disease (CVD) and all-cause mortality in the metabolically healthy obese (MHO) population. Methods. Pubmed, Cochrane Library, and Web of Science were searched from their inception until December 2012. Studies were included which clearly defined the MHO group (using either insulin sensitivity and/or components of metabolic syndrome AND obesity) and its association with either all cause mortality, CVD mortality, incident CVD, and/or subclinical CVD. Results: A total of 20 studies were identified; 15 cohort and 5 cross-sectional. Eight studies used the NCEP Adult Treatment Panel III definition of metabolic syndrome to define "metabolically healthy", while another nine used insulin resistance. Seven studies assessed all-cause mortality, seven assessed CVD mortality, and nine assessed incident CVD. MHO was found to be significantly associated with all-cause mortality in two studies (30%), CVD mortality in one study (14%), and incident CVD in three studies (33%). Of the six studies which examined subclinical disease, four (67%) showed significantly higher mean common carotid artery intima media thickness (CCA-IMT), coronary artery calcium (CAC), or other subclinical CVD markers in the MHO as compared to their MHNW counterparts. Conclusions: MHO is an important, emerging phenotype with a CVD risk between healthy, normal weight and unhealthy, obese individuals. Successful work towards a universally accepted definition of MHO would improve (and simplify) future studies and aid inter-study comparisons. Usefulness of a definition inclusive of insulin sensitivity and stricter criteria for metabolic syndrome components as well as the potential addition of markers of fatty liver and inflammation should be explored. Clinicians should be hesitant to reassure patients that the metabolically benign phenotype is safe, as increased risk cardiovascular disease and death have been shown. © 2014 Roberson et al.; licensee BioMed Central Ltd.

Tam L.M.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Kim J.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Kim J.,Michigan State University | Blumenthal R.S.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | And 5 more authors.
Atherosclerosis | Year: 2013

Objective: We sought to identify the predictors of non-calcified plaque (NCP) burden in patients with low coronary artery calcium (CAC) scores of 1-100. Methods: We studied 920 consecutive patients clinically referred for coronary CT angiography (CCTA) with concomitant CAC scoring. The 276 patients with CAC 1-100 were divided into four groups based on the CAC score: CAC=0, 1-10, 11-50, and 51-100. Univariate and multivariate linear regression analyses were performed for the demographic, risk factor, and CAC score predictors of number of coronary segments with NCP. Results: Mean age was 55±11 years and 56% were women. Demographics and risk factors failed to identify NCP involvement in univariate models. The lone predictor of NCP burden was the absolute CAC score, which was persistently associated with NCP in multivariable models (CAC 51-100 vs. CAC 1-10, β-coefficient 0.35, p=0.03). Conclusions: Absolute CAC score is the lone robust predictor of NCP burden when CAC is 1-100. Risk within this mild coronary calcification group is likely heterogeneous, driven by the absolute CAC score. © 2013 Elsevier Ireland Ltd.

Tota-Maharaj R.,Johns Hopkins Hospital | Tota-Maharaj R.,Danbury Hospital | Al-Mallah M.H.,Wayne State University | Al-Mallah M.H.,King Abdul Aziz Cardiac Center | And 5 more authors.
Atherosclerosis | Year: 2015

Background: The Agatston coronary artery calcium (CAC) score predicts cardiovascular events through its association with overall burden of coronary atherosclerosis. It is unclear whether adding regional measures of CAC distribution to the Agatston score improves this association. Methods: We studied 920 consecutive patients (mean age 57±12, 53% female), referred for 64-slice Coronary CT angiography (CCTA) who had concomitant CAC scoring. Total atherosclerosis burden was quantified as the segment involvement score (SIS), which describes the number of coronary segments with plaque on CCTA. We studied the heterogeneity between CAC group (0, 1-100, 101-400, >400) and the number of vessels with CAC (0-4), and related this to SIS on CCTA. In patients with multi-vessel disease, we examined the relationship of concentrated vs. diffuse CAC (> or ≤75% total CAC in one vessel) with SIS. Results: When CAC was intermediate (1-400), considerable heterogeneity was noted between CAC group and the number of vessels with CAC (CAC 1-100: 53% 1-vessel, 29% 2-vessel, 16% 3-vessel, 2% 4-vessel; CAC 101-400: 9% 1-vessel, 28% 2-vessel, 43% 3-vessel, 20% 4-vessel). Within each CAC group, increase in the number of vessels with CAC was significantly associated with increased SIS. In multi-vessel disease, a higher SIS was associated with diffuse versus concentrated CAC (CAC 1-100: 3.8 vs. 2.8, CAC 101-400: 5.5 vs. 4.3 [both p<0.01]). These associations persisted after adjustment for age, gender, and the absolute Agatston CAC score (p<0.01). Conclusion: Addition of measures of regional CAC distribution improves the association of the Agatston CAC score with total plaque burden. © 2014 Elsevier Ireland Ltd.

PubMed | Johns Hopkins Ciccarone Center for Prevention of Heart Disease, University of California at Los Angeles, Princeton Longevity Center, Emory University and 4 more.
Type: | Journal: Journal of cardiovascular computed tomography | Year: 2016

Although coronary artery calcium (CAC) has been investigated for over two decades, there is very limited data on the association of CAC with cause of death. The CAC Consortium is a large ongoing multi-center observational cohort of individuals who underwent non-contrast cardiac-gated CAC testing and systematic, prospective, long-term follow-up for mortality with ascertainment of cause of death.Four participating institutions from three states within the US (California, Minnesota, and Ohio) have contributed individual-level patient data to the CAC Consortium (spanning years 1991-2010). All CAC scans were clinically indicated and physician-referred in patients without a known history of coronary heart disease. Using strict inclusion and exclusion criteria to minimize missing data and to eliminate non-dedicated CAC scans (i.e. concomitant CT angiography), a sharply defined and well-characterized cohort of 66,636 patients was assembled. Mortality status was ascertained using the Social Security Administration Death Master File and a validated algorithm. In addition, death certificates were obtained from the National Death Index and categorized using ICD (International Classification of Diseases) codes into common causes of death.Mean patient age was 5411 years and the majority were male (67%). Prevalence of CVD risk factors was similar across sites and 55% had a <5% estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Approximately 45% had a Calcium score of 0 and 11% had an Agatston Score 400. Over a mean follow-up of 124 years, there were 3158 deaths (4.15 per 1000 person-years). The majority of deaths were due to cancer (37%) and CVD (32%). Most CVD deaths were due to CHD (54%) followed by stroke (17%). In general, CAC score distributions were similar across sites, and there were similar cause of death patterns.The CAC Consortium is large and highly generalizable data set that is uniquely positioned to expand the understanding of CAC as a predictor of mortality risk across the spectrum of disease states, allowing innovative modeling of the competing risks of cardiovascular and non-cardiovascular death.

Ferwana M.,King Saud bin Abdulaziz University for Health Sciences | Firwana B.,King Saud bin Abdulaziz University for Health Sciences | Firwana B.,University of Missouri | Firwana B.,Knowledge and Evaluation Research Unit | And 11 more authors.
Diabetic Medicine | Year: 2013

Aims: Pioglitazone, a thiazolidinedione, was approved for treatment of Type 2 diabetes. However, several observational studies suggest an association of pioglitazone with an increased risk of bladder cancer in patients with diabetes. Therefore, we sought to perform a systematic review and meta-analysis to evaluate the magnitude of this association and the quality of the supporting evidence. Methods: Electronic databases were queried to identify controlled studies of pioglitazone that measured the risk of bladder cancer. Results: Six studies involving 215 142 patients using pioglitazone were included, with a median period of follow-up of 44 months. The hazard of developing bladder cancer was significantly higher in patients using pioglitazone (hazard ratio 1.23; 95% CI 1.09-1.39; I2 = 0%) compared with control groups. The risk of bias was moderate across the six studies. Considering an incidence rate of 20.8 per 100 000 person years, the number needed to harm was five additional cases of bladder cancer per 100 000 person years. Conclusions: Patients treated with pioglitazone have a slight increased risk of bladder cancer compared to general population. Patient involvement and weighing treatment benefits versus risks should be discussed with patient toward shared decision. Patients with type 2 diabetes with risk factors, such as family history, smoking, or exposure to certain forms of chemotherapy may need to consider other anti-hyperglycemic agents. Also, pioglitazone should be discontinued in type 2 diabetes patients with newly diagnosed bladder cancer. © 2013 Diabetes UK.

Aneni E.C.,Center for Prevention and Wellness Research | Roberson L.L.,Center for Prevention and Wellness Research | Maziak W.,Florida International University | Agatston A.S.,Center for Prevention and Wellness Research | And 11 more authors.
PLoS ONE | Year: 2014

Context: The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs. Evidence Acquisition: We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing - weight, BP, lipids, smoking, physical activity, diet, and blood glucose. Evidence Synthesis: A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6-24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners. Conclusion: Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations. © 2014 Aneni et al.

Hung R.K.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Al-Mallah M.H.,King Abdul Aziz Cardiac Center | Al-Mallah M.H.,Ford Motor Company | McEvoy J.W.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | And 8 more authors.
Mayo Clinic Proceedings | Year: 2014

Objective To examine the prognostic value of exercise capacity in patients with nonrevascularized and revascularized coronary artery disease (CAD) seen in routine clinical practice.Patients and Methods We analyzed 9852 adults with known CAD (mean ± SD age, 61±12 years; 69% men [n=6836], 31% black race [n=3005]) from The Henry Ford ExercIse Testing (FIT) Project, a retrospective cohort study of patients who underwent physician-referred stress testing at a single health care system between January 1, 1991, and May 31, 2009. Patients were categorized by revascularization status (nonrevascularized, percutaneous coronary intervention [PCI], or coronary artery bypass graft [CABG] surgery) and by metabolic equivalents (METs) achieved on stress testing. Using Cox regression models, hazard ratios for mortality, myocardial infarction (MI), and downstream revascularizations were calculated after adjusting for potential confounders, including cardiac risk factors, pertinent medications, and stress testing indication.Results There were 3824 all-cause deaths during median follow-up of 11.5 years. In addition, 1880 MIs, and 1930 revascularizations were ascertained. Each 1-MET increment in exercise capacity was associated with a hazard ratio (95% CI) of 0.87 (0.85-0.89), 0.87 (0.85-0.90), and 0.86 (0.84-0.89) for mortality; 0.98 (0.96-1.01), 0.88 (0.84-0.92), and 0.93 (0.90-0.97) for MI; and 0.94 (0.92-0.96), 0.91 (0.88-0.95), and 0.96 (0.92-0.99) for downstream revascularizations in the nonrevascularized, PCI, and CABG groups, respectively. In each MET category, the nonrevascularized group had similar mortality risk as and higher MI and downstream revascularization risk than the PCI and CABG surgery groups (P<.05).Conclusion Exercise capacity was a strong predictor of mortality, MI, and downstream revascularizations in this cohort. Furthermore, patients with similar exercise capacities had an equivalent mortality risk, irrespective of baseline revascularization status. © 2014 Mayo Foundation for Medical Education and Research.

Blaha M.J.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Dardari Z.A.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Blumenthal R.S.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | Martin S.S.,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease | And 4 more authors.
Atherosclerosis | Year: 2014

Background: The 2013 ACC/AHA Report on the Assessment of Cardiovascular (CVD) Risk redefined "intermediate risk". We sought to critically compare the intermediate risk groups identified by prior guidelines and the new ACC/AHA guidelines. Methods: We analyzed data from 30,005 adult men free of known CVD from a large, multi-ethnic study of middle-aged adults. The Framingham Risk Score was calculated using published equations, and CVD risk was calculated using the new ACC/AHA Pooled Cohort Equations Risk Estimator. We first compared the size and characteristics of the intermediate risk group identified by the old (ATP III, 10-20% 10-year CHD risk) and new guidelines (5-7.4% 10-year CVD risk). We then defined time-to-high-risk as the length of time an individual patient resides in the intermediate risk group before progressing to high risk status based on advancing age alone. Results: The mean age of the study population was 53±13 years, and 24% were African-American. Patients identified as intermediate risk by the new ACC/AHA Guidelines were younger and more likely to be African-American and have lower risk factor burden (all p<0.05). The new intermediate risk group was just 37% the size of the traditional ATP III intermediate risk group, while the new high risk group was 103% larger. Under the new guidelines, men remain intermediate risk for an average of just 3 years, compared to 8 years under the prior guidelines (63% shorter time-to-high-risk, p<0.05), before progressing to high risk based on advancing age alone. Conclusion: The new 2013 ACC/AHA risk assessment guidelines produce a markedly smaller, lower absolute risk, and more temporary "intermediate risk" group. These findings reshape the modern understanding of "intermediate risk", and have distinct implications for risk assessment, clinical decision making, and pharmacotherapy in primary prevention. © 2014 Elsevier Ireland Ltd. All rights reserved.

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