Tulane Center for Cardiovascular Health

New Orleans, LA, United States

Tulane Center for Cardiovascular Health

New Orleans, LA, United States
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Lai C.-C.,Tulane Center for Cardiovascular Health | Lai C.-C.,Peking Union Medical College | Sun D.,Tulane Center for Cardiovascular Health | Sun D.,Peking University | And 7 more authors.
Journal of the American College of Cardiology | Year: 2014

Background Cardiovascular risk factors are associated with left ventricular hypertrophy (LVH), but little is known regarding related impact of longitudinal measures of childhood adiposity and LV hemodynamic variables.Objectives The aim of this study was to examine the impact of cumulative long-term burden and trends of excessive adiposity and elevated blood pressure (BP) during childhood on adulthood LVH and LV geometric remodeling patterns.Methods This longitudinal study consisted of 1,061 adults, age 24 to 46 years, who had been examined 4 or more times for body mass index (BMI) and BP starting in childhood, with a mean follow-up of 28.0 years. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI and BP from childhood to adulthood. Four LV geometric types were defined - normal, concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH) - all on the basis of LV mass indexed for body height (m2.7) and relative wall thickness.Results Higher values of BMI and systolic and diastolic BP in childhood and adulthood, as well as total AUC and incremental AUC, were all significantly associated with higher LV mass index and LVH, adjusted for race, sex, and age. In addition, higher values of BMI and BP in childhood and adulthood, total AUC, and incremental AUC were significantly associated with EH and CH but not with CR. Importantly, all of these measures of BMI had a consistently and significantly greater influence on EH than did measures of BP.Conclusions These findings indicate that the adverse influence of excessive adiposity and elevated BP levels on LVH begins in childhood. © 2014 American College of Cardiology Foundation.

Abul Y.,Ministry of Health Bismil Government Hospital | Karakurt S.,Marmara University | Ozben B.,Marmara University | Toprak A.,Tulane Center for Cardiovascular Health | Celikel T.,Ministry of Health Bismil Government Hospital
Journal of Investigative Medicine | Year: 2011

Background: Right ventricular dysfunction and N-terminal proB-type natriuretic peptide (NT-proBNP) are established determinants of prognosis in acute pulmonary embolism (PE). The aim of the study was to investigate the prognostic value of C-reactive protein (CRP) in PE. Methods: Fifty-six patients (mean age, 64.4 ± 14.8years; 22 male subjects) with acute PE were consecutively enrolled and followed for 36 months after discharge. Serum CRP, NT-proBNP, and troponin T levels were determined. Right ventricular function was evaluated by transthoracic echocardiography. Results: Right ventricular dysfunction was present in 31 patients and was more frequent in patients with higher CRP and NT-proBNP levels (P = 0.020 and P = 0.045, respectively). During the 36-month follow-up, there were 15 terminal events (death due to recurrent PE). The mortality rate was 41.2% in patients with NT-proBNP levels greater than 1000 pg/mL, whereas it was 5.9% in patients with less than 500 pg/mL (P = 0.011). Mortality rates also were higher in patients with elevated CRP and troponin T levels, but the differences did not reach clinical significance. The survival rate of acute PE patients with lower NT-proBNP and CRP levels was better than that of patients with higher NT-proBNP and CRP levels. Receiver operating characteristic curve analysis demonstrated cutoff values for NT-proBNP as 1800 pg/mL (sensitivity, 93.3%; specificity, 68.2%; positive predictive values, 66.7%; and negative predictive values, 93.8%) and for CRP as 48mg/L (sensitivity, 72.7%; specificity, 61.9%; positive predictive values, 50.0%; and negative predictive values, 81.3%) to predict mortality in PE patients. Conclusions: C-reactive protein is associated with right ventricular dysfunction, which is a predictor of prognosis in PE and may become a promising biomarker for risk stratification of PE, although CRP is not found superior to NT-proBNP. Copyright © 2011 American Federation for Medical Research..

Camhi S.M.,Pennington Biomedical Research Center | Katzmarzyk P.T.,Pennington Biomedical Research Center | Broyles S.,Pennington Biomedical Research Center | Srinivasan S.R.,Tulane Center for Cardiovascular Health | And 3 more authors.
Metabolic Syndrome and Related Disorders | Year: 2010

Background: Metabolic risk varies within adult body mass index (BMI) categories; however, the development of BMI-specific metabolic risk from childhood is unknown. Methods: The sample included 895 adults (20-38 years of age; 43% male, 34% black) from the Bogalusa Heart Study (1995-2002), who had been measured as children (5-18 years of age) in 1981-1982. Adult metabolic risk was assessed using two definitions: Cardiometabolic risk factor clustering (RFC) included two or more abnormal risk factors [blood pressure, high-density lipoprotein cholesterol (HDL-C), triglycerides, and fasting glucose] and insulin resistance (IR), comprising the top quartile of the homeostasis model of insulin resistance (HOMA-IR) distribution. Logistic regression, within BMI categories, was used to predict adult metabolic risk from childhood mean arterial pressure (MAP), HDL-C, low-density lipoprotein cholesterol (LDL-C), glucose, and triglycerides. Covariates included childhood age, race, sex, adult BMI, and length of follow-up. Results: The prevalence of the adult abnormal metabolic risk profile varied by definitions of metabolic risk (normal weight, 5%-9%; overweight, 15%-23%; and obese, 40%-53%). The adult abnormal profile was associated with higher childhood LDL-C [IR, odds ratio (OR), 1.95; 95% confidence interval (CI), 1.06-3.58) and insulin (IR, OR, 1.69; CI, 1.10-2.58) in normal-weight adults; lower childhood HDL-C in overweight adults (RFC, OR, 0.61; CI, 0.40-0.94); and higher childhood MAP (RFC, OR, 1.75; CI, 1.24-2.47) and glucose (IR, OR,1.38; CI, 1.06-1.81) in obese adults. Conclusions: Some childhood metabolic risk factors are moderately associated with adult BMI-specific metabolic risk profiles. The ability to identify children with high future adult cardiovascular risk may initiate early treatment options. © 2010 Mary Ann Liebert, Inc.

Levy-Marchal C.,French Institute of Health and Medical Research | Levy-Marchal C.,University Paris Diderot | Arslanian S.,University of Pittsburgh | Cutfield W.,University of Auckland | And 35 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Objective: Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. Participants: The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. Evidence: An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. Consensus Process: The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. Conclusions: Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases. Copyright © 2010 by The Endocrine Society.

Bazzano L.A.,Tulane University | Belame S.N.,Hospitals Office of Public Health | Patel D.A.,Tulane Center for Cardiovascular Health | Chen W.,Tulane University | And 6 more authors.
Clinical Cardiology | Year: 2011

Background: Cardiac enlargement is an important predictor of adverse cardiovascular (CV) events. Left ventricular (LV) dilatation is a precursor both of LV dysfunction and clinical heart failure. The present study examines risk factors for LV dilatation among 832 young adults (341 male, 491 female) who participated in the Bogalusa Heart Study. Hypothesis: A unique set of risk factors predicts LV dilatation among young adults. Methods: Standard ventricular dimensions were determined by M-mode echocardiography and indexed to height using a standard method. LV dilatation was considered as the top 20th percentile of LV end-diastolic dimension indexed to height. Logistic regression models were used, stratified by race and sex, to assess the relationship of CV risk factors with quintile of LV end-diastolic dimension indexed to height. Results: The mean age (standard deviation) of men and women in the population was 36.4 years (3.9 years) and 35.9 years (4.6 years), respectively. In sex-specific models adjusted for age, race, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and glycosylated hemoglobin, body mass index (BMI) was a significant predictor of LV dilatation in both men and women. The odds ratio (95% confidence interval) for a 1-unit change in BMI was 1.12 (1.02-1.19) in men and 1.09 (1.05-1.13) in women. Among men, triglyceride level was also significantly associated with LV dilatation (P = 0.03), whereas among women there was no such association. Conclusions: Our findings indicate that obesity is the most consistent predictor of LV dilatation in both men and women, whereas triglyceride level was a significant predictor among men only. © 2011 Wiley Periodicals, Inc.

Sharma D.,Rapides Regional Medical Center | Dasmahapatra P.,Tulane Center for Cardiovascular Health | Fernandez C.,Tulane Center for Cardiovascular Health | Chen W.,Tulane Center for Cardiovascular Health | And 3 more authors.
Journal of Human Hypertension | Year: 2013

Atherogeneis is a chronic progressive syndrome caused by endothelial dysfunction, vascular inflammation, vessel wall remodeling and eventual vascular flow compromise. Emerging data suggest that arterial compliance inversely correlates with atherogenesis and cardiovascular (CV) events. However, information is scant on the association of chronic systemic inflammation with arterial elasticity in young asymptomatic adults. The association of hsC-reactive protein (CRP) and central-vascular compliance was studied in 641 individuals (45.2% males; 71.8% whites), aged 31-43 years enrolled in the Bogalusa Heart Study. The measured variables included large-artery compliance (capacitive, C1), representative of the aorta and its major branches; and small-artery compliance (oscillatory, C2), representative of the distal part of the circulation; hsCRP, as a measure of systemic inflammation; along with traditional CV risk factor variables. Significant race and sex differences were noted for C1 (white males>black males P-value <0.0001; males>females P-value 0.04), C2 (whites>blacks P-value 0.0004; males>females P-value<0.0001) and hsCRP (blacks>whites P-value 0.03; females>males P-value 0.002). Mean values of C1 in subjects with high hsCRP levels (>3 mg l -1) were significantly lower than those with average (1-3 mg l -1) and low levels (<1 mg l -1) (14.2 ml per mmHg × 10 versus 15.2 ml per mm Hg × 10 versus 15.7 ml per mmHg × 10, P for trend=0.02), after adjusting for age, race, sex and body surface area (BSA). hsCRP showed a trend toward inverse correlation with C1 (-0.07, P=0.07) but no such trend for C2, after adjusting for race and sex. In the multivariate linear regression model, adding age, race, sex, BSA, mean arterial pressure, insulin resistance, lipoprotein variables and smoking status, the effect persisted between C1 and hsCRP (β=-0.35, P=0.01). In an asymptomatic population of young adults, hsCRP predicts reduced large-artery compliance (C1). These findings support the role of systemic inflammation in early pathological changes in artery wall in atherogenesis. Small-artery compliance (C2) however did not correlate with hsCRP. © 2013 Macmillan Publishers Limited All rights reserved.

Berenson G.S.,Tulane Center for Cardiovascular Health
Preventive Cardiology | Year: 2010

Cardiovascular (CV) risk factors in childhood result in a lifetime burden on the CV system. The Bogalusa Heart Study, a prevention program for children, addresses behaviors and lifestyles associated with CV risk. This prevention program utilizes the substructure of a Parish (County) that can be a model for other areas. All aspects in educating school children-the classroom, physical activity, cafeteria, teachers, and parents with community involvement-are included. The program requires cooperation of parents, schools, physicians, and political and business personnel. Their collaboration helps implement and sustain the program. Understanding the origin of coronary artery disease, hypertension, diabetes, and now the obesity epidemic shows the need to develop a framework for improving lifestyles and behaviors beginning in childhood. In addition to nutrition and exercise, the program addresses tobacco, alcohol, and drug use, and societal problems such as dropping out of school, violent behavior, and teenage pregnancy. An initial accomplishment is the entry into all elementary schools, representing approximately 7000 children. Early results show reduction in obesity, increased physical activity, improved decision making, and healthy attitudes. This public health model is inexpensive by utilizing prior research findings and integrating into community resources. Health education of children is an important aspect of preventive cardiology with a need for pediatric and adult cardiologists' involvement.Prev Cardiol. © 2009 Wiley Periodicals, Inc.

Toprak D.,Tulane Center for Cardiovascular Health | Toprak A.,Tulane Center for Cardiovascular Health | Chen W.,Tulane Center for Cardiovascular Health | Xu J.H.,Tulane Center for Cardiovascular Health | And 2 more authors.
Obesity | Year: 2011

To determine the association between cardiovascular (CV) risk factors in childhood and high-sensitivity C-reactive protein (hsCRP) and adiponectin in adulthood, 835 eligible white and African-American young adult subjects (age range 24-42 years, average 34 years, 43% men, 31% African Americans) who had CV risk-factor variable data from their childhood (20 years earlier, age range 5-18 years, average 14 years) were selected. Stepwise linear regression models revealed that mean logarithmic hsCRP level in adulthood was 0.02 greater with every increase of 1 mm in skinfold thickness in childhood, 0.25 greater for African Americans than whites, 0.36 greater for girls than boys, and 0.15 greater for every unit increase in BMI z score. Mean logarithmic adiponectin level in adulthood was 0.36 greater for girls than boys, 0.22 greater for whites than African Americans, and 0.01 less with every increase of 1 mm of childhood skinfold thickness. Seventy participants (8%) were overweight or obese in their childhood, and 64 of these (91%) remained obese in their young adulthood. In conclusion, childhood adiposity and African-American race were associated with higher hsCRP and lower adiponectin levels in their adulthood. Skinfold thickness and BMI z score in childhood were the main obesity determinants for higher hsCRP and lower adiponectin levels in young adulthood. © 2010 The Obesity Society.

Dasmahapatra P.,Tulane Center for Cardiovascular Health | Srinivasan S.R.,Tulane Center for Cardiovascular Health | Mokha J.,Tulane Center for Cardiovascular Health | Fernandez C.,Tulane Center for Cardiovascular Health | And 3 more authors.
Annals of Epidemiology | Year: 2011

Purpose: Chronic kidney disease (CKD) remains asymptomatic until its late stage, and also significantly increases the risk of cardiovascular (CV) disease morbidity and mortality. However, information in scant on the prevalence of CKD, and its association with subclinical atherosclerosis as depicted by carotid intima media thickness (IMT) in younger adults. Methods: This cross-sectional study included 1193 participants (43% males, 30% blacks) aged 23 to 43 years, residing in the semi-rural biracial (black-white) community of Bogalusa, Louisiana. The measured variables include estimated glomerular filtration rate (eGFR) to determine functional renal changes and urine album creatinine ratio to diagnose albuminuria, along with CV risk factor variables, and both segmental and composite carotid IMT. Results: Ninety-nine (8.5%) subjects had CKD, with blacks showing higher prevalence than whites (p = .01). Subjects with albuminuria had significantly greater internal carotid IMT (p = .03), common carotid IMT (p = .005), and composite carotid IMT (p = .04) than those without. In the multivariate logistic regression model, albuminuria was associated with black race (odds ratio [OR], 1.92; p = .005), female gender (OR, 2.24; p = .002), diabetes (OR, 6.26; p < .001), hypertension (OR, 2.36; p < .001), obesity (OR, 1.73; p = 0.02), and composite carotid IMT (OR, 1.83; p = .02), after adjusting for age. However, reduction in eGFR did not show significant independent association with carotid IMT. Conclusion: Among asymptomatic young adults, subclinical atherosclerosis and structural renal damage depicted by albuminuria coexist, which has implications for early prevention and control. © 2011 Elsevier Inc.

PubMed | Tulane Center for Cardiovascular Health
Type: | Journal: BMC cardiovascular disorders | Year: 2012

Conflicting information exists regarding the association between hsCRP and the progression of early stages of atherosclerosis. The purpose of the study was to investigate the association of high sensitiviy c-reactive protein (hsCRP) along with major cardiovascular (CV) risk factors on early carotid atherosclerosis progression in a large, population-based cohort study.The study cohort included 839 young adults (aged 24 to 43 years, 70% white, 42% men) enrolled in Bogalusa Heart Study, who in 2001-2002 attended baseline examination with measurements of CV risk factors. Progression of carotid artery intima-media thickness (IMT) was assessed during a mean follow-up of 2.4 years.Carotid artery IMT progression rates were as follows: composite carotid artery = 9.2 52 m/y, common carotid artery = 0.0 51 m/y, carotid bulb = 8.8 103 m/y, and internal carotid artery = 18.9 81 m/y. Elevated baseline hsCRP, reflecting an inflammatory state, showed independent association with composite carotid artery IMT progression. Increased age, systolic blood pressure, fasting glucose, LDL cholesterol, and current smoking were other risk associates of carotid artery IMT progression in young adults, indicating an underlying burden on the CV system by multiple risk factors.In this population-based study, we observed independent categorical association of increased hsCRP with carotid artery IMT progression in young adults. This study underlines the importance of assesssing hsCRP levels along with smoking and traditional CV risk factor profiles in asymptomatic young adults.

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