The Effect of Electronic Nudges on Influenza Vaccination Rate in Older Adults With Cardiovascular Disease: a Prespecified Analysis of the NUDGE-FLU Trial
Influenza vaccines have been demonstrated to effectively reduce the incidence of influenza infection and potentially associated risks of cardiovascular events in patients with cardiovascular disease (CVD). Despite strong guideline and public health endorsements, global influenza vaccination rates in patients with…
Virtual Care Team-Guided Therapeutic Optimization During Hospitalization in Patients with Heart Failure: The IMPLEMENT-HF Study
Scalable and safe approaches for heart failure guideline-directed medical therapy (GDMT) optimization are needed. The authors assessed the safety and effectiveness of a virtual care team guided strategy on GDMT optimization in hospitalized patients with heart failure with reduced ejection…
Electronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial
Influenza vaccination rates remain suboptimal despite effectiveness in preventing influenza infection and related complications. We investigated whether behavioural nudges, delivered via a governmental electronic letter system, would increase influenza vaccination uptake among older adults in Denmark. We did a nationwide,…
Nationwide Utilization of Danish Government Electronic Letter System for Increasing InFLUenza Vaccine Uptake (NUDGE-FLU)
NUDGE-FLU was a nationwide, pragmatic, registry-based, cluster-randomized implementation trial during the 2022-23 influenza season in Denmark. NUDGE FLU randomized >960,000 Danish citizens aged 65 years or older to usual care or 9 different behaviorally informed electronic letters (9:1:1:1:1:1:1:1:1:1) promoting influenza…
Go, Alan S.
Klatsky, Arthur L.
Coronary Artery Risk Development in Young Adults (CARDIA)
This landmark 35-year study describes the distribution of coronary heart disease risk factors in a biracial cohort of men and women aged 18 to 30 years at entry; and identifies habits, behaviors and lifestyles that are associated with initial levels…
Motivational Determinants of Postpartum Lifestyle Behaviors, Weight Retention, and Metabolic Syndrome
The proposed study aims to identify affective influences on key lifestyle behaviors (healthy eating and objectively measured self-weighing and physical activity) associated with postpartum weight retention and cardiometabolic profile (e.g., metabolic syndrome). We propose a longitudinal study design within a…
Optimizing Care to Prevent Diabetes and Promote Cardiovascular Health Among Younger Adults with Severe Mental Illness
This K23 career development project seeks to leverage electronic health record data from KPNC and 2 health system collaborators within the Mental Health Research Network to investigate population health management strategies to prevent diabetes and improve cardiovascular health among people…
Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen in Acute Coronary Syndrome (CLEAR ACS) Study
The overall objective of the Cholesterol Lowering via Bempedoic Acid/Ezetimibe, an ACL-Inhibiting Regimen in Acute Coronary Syndrome ACS (CLEAR ACS) study is to determine the efficacy, safety, and tolerability of bempedoic acid/ezetimibe (BA/E) in a contemporary and real-world population, enriched…
Differences in Health Characteristics of Geographic Subgroups of Arab Americans in a Northern California Health Plan
Arab Americans are a diverse ethnic group originating from a large geographic area in the Middle East and North Africa (MENA). We aim to characterize differences in health between Arab Americans from different geographic subgroups within MENA. We used cross-sectional…
Clinical Characteristics and Outcomes of Patients with Asymptomatic, Moderate Severity Aortic Stenosis (ASSESS-AS)
The prevalence of aortic stenosis (AS), currently estimated to be 4% among adults 70 years of age and over is projected to double by 2040 and triple by 2060. However, the prevalence, clinical characteristics, and outcomes of the condition have…
Young Adult and Midlife Transitions in Physical Activity and Sedentary Behavior with Heart Failure Risk and Progression: Coronary Artery Risk Development in Young Adults (CARDIA)
This CARDIA ancillary study will examine the longitudinal relations of 35-year changes in reported physical activity from young adulthood to late midlife with indicators of subclinical heart failure collected at late midlife, and evaluate interaction in these relations by race,…
A Natural Language Processing-Based Approach for Identifying Hospitalizations for Worsening Heart Failure Within an Integrated Health Care Delivery System
The current understanding of epidemiological mechanisms and temporal trends in hospitalizations for worsening heart failure (WHF) is based on claims and national reporting databases. However, these data sources are inherently limited by the accuracy and completeness of diagnostic coding and/or…
Anticoagulant treatment satisfaction with warfarin and direct oral anticoagulants for venous thromboembolism
Treatment options for patients with venous thromboembolism (VTE) include warfarin and direct oral anticoagulants (DOACs). Although DOACs are easier to administer than warfarin and do not require routine laboratory monitoring, few studies have directly assessed whether patients are more satisfied…
Multi-ancestry genome-wide gene-sleep interactions identify novel loci for blood pressure
Long and short sleep duration are associated with elevated blood pressure (BP), possibly through effects on molecular pathways that influence neuroendocrine and vascular systems. To gain new insights into the genetic basis of sleep-related BP variation, we performed genome-wide gene…
Long-Term Levels of LDL-C and Cognitive Function: The CARDIA Study
It is uncertain if long-term levels of low-density lipoprotein-cholesterol (LDL-C) affect cognition in middle age. We examined the association of LDL-C levels over 25 years with cognitive function in a prospective cohort of black and white US adults. Lipids were…
Sex Differences in Cardiovascular Outcomes in CKD: Findings From the CRIC Study
Cardiovascular events are less common in women than men in general populations; however, studies in chronic kidney disease (CKD) are less conclusive. We evaluated sex-related differences in cardiovascular events and death in adults with CKD. Prospective cohort study. 1,778 women…
Cardiovascular risk and midlife cognitive decline in the Study of Women’s Health Across the Nation
Cardiovascular risk factors in midlife have been linked to late life risk for Alzheimer's disease and related dementias (ADRD). The relation of vascular risk factors on cognitive decline within midlife has been less studied. Using data from the Study of…
Validation of Natural Language Processing to Determine the Presence and Size of Abdominal Aortic Aneurysms in a Large Integrated Health System
Previous studies of the natural history of abdominal aortic aneurysms (AAAs) have been limited by small cohort sizes or heterogeneous analyses of pooled data. By quickly and efficiently extracting imaging data from the health records, natural language processing (NLP) has…
Association Between Kidney Clearance of Secretory Solutes and Cardiovascular Events: The Chronic Renal Insufficiency Cohort (CRIC) Study
The clearance of protein-bound solutes by the proximal tubules is an innate kidney mechanism for removing putative uremic toxins that could exert cardiovascular toxicity in humans. However, potential associations between impaired kidney clearances of secretory solutes and cardiovascular events among…
Comparison of type 2 diabetes pharmacotherapy regimens using targeted learning
This study is designed to help patients with type 2 diabetes and their clinicians identify which glucose-lowering medications among SGLT2 inhibitors, GLP-1 receptor agonists, DPP4 inhibitors, or Sulfonylureas have the most favorable effects on heart health and other patient-important outcomes;…
Reducing Variation in Hospitalization and Processes of Care in Emergency Department Patients with Atrial Fibrillation: A Stepped Wedge Cluster Randomized Trial
This stepped-wedge cluster randomized trial will stagger implementation of a clinical decision support system (CDSS) across 13 KPNC emergency departments to assist emergency physicians and hospitalists in the comprehensive management of patients with atrial fibrillation/flutter. We will compare hospitalization rates,…
Optimizing Management of Valvular Heart Disease
This study will characterize the management and outcomes of KPNC patients with valvular heart disease by evaluating surveillance patterns for moderate and severe valve disease, assessing clinical outcomes in those with guideline-recommended surveillance, developing methods to ensure evidence-based follow-up and…
Optimizing Abdominal Aortic Aneurysm Surveillance and Intervention to Prevent Rupture
Optimizing Abdominal Aortic Aneurysm Surveillance and Intervention to Prevent Rupture
Particulate Matter and Cardiovascular Risk in Adults with Chronic Obstructive Pulmonary Disease
Rationale: People with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular disease and may be more susceptible to air pollution exposure. However, no study has examined the association between long-term fine particulate matter exposure (≤2.5 μm in…
Mediating Effects of Cardiometabolic Risk Factors on the Association Between Maternal Race-Ethnicity and Cesarean Delivery Among Low-Risk Women
Background: While racial-ethnic disparities in cesarean delivery rates among nulliparous women delivering a term singleton in the vertex position (NTSV) exist, it remains unclear the extent to which potentially modifiable maternal cardiometabolic risk factors (obesity, maternal hyperglycemia and hypertensive disorders)…
Physical Activity and Hypertension From Young Adulthood to Middle Age
The optimum physical activity dose to achieve during young adulthood to prevent hypertension using the 2017 American College of Cardiology/American Heart Association guidelines remains undefined. This study aims to determine the association between level and change in physical activity through…
DNA methylation GrimAge and Incident Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
DNA methylation (DNAm)-based biological age (epigenetic age) has been suggested as a useful biomarker of age-related conditions including type 2 diabetes (T2D), and its newest iterations (GrimAge measurements) have shown early promise. In this study, we explored the association between…
Bidirectional associations of accelerometer measured sedentary behavior and physical activity with knee pain, stiffness, and physical function: The CARDIA study
The objective was to examine bidirectional associations of accelerometer estimated sedentary time and physical activity with reported knee symptoms. Participants were 2,034 adults (mean age 45.3 ± 3.6 years, 58.7% female) from CARDIA. Generalized estimating equations for logistic regression and linear mixed regression…
COPD comorbidity profiles and two-year trajectory of acute and post-acute care utilization
Multiple morbidity is the norm in advanced COPD and contributes to high symptom burden and worse outcomes. Can distinct comorbidity profiles be identified and validated in a community-based sample of patients with COPD from a large integrated health care system…
Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-life Cognition: Study of Healthy Aging in African Americans (STAR)
Midlife cardiovascular risk factors (CVRF) increase risk of dementia. Black Americans experience an elevated prevalence of CVRF and dementia. However, little is known of how CVRF prior to midlife affect late-life cognition. We examined CVRF in adolescence, young adulthood, and…
The Association of Lactation Duration with Visceral and Pericardial Fat Volumes in Parous Women: the CARDIA Study
Lactation is associated with lower risks for cardiovascular disease in women. Organ-related adiposity, which plays significant roles in the development of cardiometabolic diseases, could help explain this observation. We evaluated the association of lactation duration with visceral (VAT) and pericardial…
Whole-genome sequencing association analysis of quantitative red blood cell phenotypes: The NHLBI TOPMed program
Whole-genome sequencing (WGS), a powerful tool for detecting novel coding and non-coding disease-causing variants, has largely been applied to clinical diagnosis of inherited disorders. Here we leveraged WGS data in up to 62,653 ethnically diverse participants from the NHLBI Trans-Omics…
Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association
This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease (CVD) risk factors and of developing…
The Study of Women’s Health Across the Nation (SWAN)
SWAN VI aims to elucidate menopause transition characteristics and trajectories of midlife health markers (inflammation, metabolic and cardiovascular risk factors, body composition, and bone, genitourinary, and vascular health) that are related to the preservation of physical and cognitive functioning, avoidance…
Blood Pressure, Obesity, and Diabetes in Relation to Perinatal and Postpartum Complications
By leveraging the KPNC Gestational diabetes and Glucose Tolerance Registry, which includes rich data on blood glucose levels, obesity, gestational weight gain, we will add blood pressure levels for the earliest years to evaluate the individual and joint impact of…
GUARD-AF: reducinG stroke by screening for UndiAgnosed atRial fibrillation in elderly inDividuals
To determine if one-time screening for atrial fibrillation using the 14-day Zio XT patch leads to a reduced risk of stroke compared with usual care among adults aged 70 years or older without prior known atrial fibrillation or atrial flutter.
Collaborative Cohort of Cohorts for COVID-19 Research
The goal of this study is to obtain COVID-19 surveillance study (questionnaire and serology) in 6 cohort studies funded by NHLBI including the CARDIA study. A surveillance questionnaire will be administered 3 times at approximately 6 month intervals and blood…
Determinants and Cardiovascular Consequences of Disparities in Sleep and Circadian Rhythms between Black and White Adults
Determine the independent and joint contributions of behavioral, psychosocial and clinical characteristics over 35 years of CARDIA participation on sleep and circadian characteristics in middle-aged adults. Identify the relationship of sleep and circadian characteristics to the pathophysiologic stress response. Determine…
Cardiovascular Health Associations with Minority Stress: Behavioral Evaluations and Self-Reported Sociopsychological Outcomes by SOGI Status (CHAMBERS)
In CARDIA Year 35 exam: Assess whether sexual minority and gender minority (SGM) individuals in CARDIA have increased odds of objectively-determined traditional cardiovascular disease (CVD) risk factors and poorer CVD outcomes compared to their non-SGM counterparts. Determine whether self and/or…
Rationale and Design of the Pragmatic Randomized Trial of Icosapent Ethyl for High Cardiovascular Risk Adults (MITIGATE)
The MITIGATE study aims to evaluate the real-world clinical effectiveness of pre-treatment with icosapent ethyl (IPE), compared with usual care, on laboratory-confirmed viral upper respiratory infection (URI)-related morbidity and mortality in adults with established atherosclerotic cardiovascular disease (ASCVD). IPE is…
Prospective Validation and Comparative Analysis of Coronary Risk Stratification Strategies Among Emergency Department Patients With Chest Pain
Background Coronary risk stratification is recommended for emergency department patients with chest pain. Many protocols are designed as "rule-out" binary classification strategies, while others use graded-risk stratification. The comparative performance of competing approaches at varying levels of risk tolerance has…
Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study
Background Low cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood. Methods and Results Participants in the CARDIA (Coronary…
Racial/Ethnic Disparities in Young Adulthood and Midlife Cardiovascular Risk Factors and Late-life Cognitive Domains: The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
Midlife cardiovascular risk factors (CVRF) increase dementia risk. Less is known about whether CVRF identified before midlife impact late-life cognition in diverse populations. Linear regression models examined hypertension, hyperlipidemia, and overweight/obesity at ages 30 to 59 with late-life executive function,…
Maternal weight change from prepregnancy to 18 months postpartum and subsequent risk of hypertension and cardiovascular disease in Danish women: A cohort study
One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD). We conducted a cohort study of 47,966 women with…
Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study
Gestational diabetes (GD) leads to earlier onset and heightened risk of type 2 diabetes, a strong risk factor for cardiovascular disease (CVD). However, it is unclear whether attaining normoglycemia can ameliorate the excess CVD risk associated with GD history. This…
Non-alcoholic fatty liver disease and cognitive function in middle-aged adults: the CARDIA study
Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease (CVD) risk factors that have been linked to cognitive decline. Whether NAFLD is associated with cognitive performance in midlife remains uncertain. Coronary Artery Risk Development in Young Adults study participants with…
Atrial Fibrillation and Longitudinal Change in Cognitive Function in CKD
Studies in the general population suggest that atrial fibrillation (AF) is an independent risk factor for decline in cognitive function, but this relationship has not been examined in adults with chronic kidney disease (CKD). We investigated the association between incident…
Closing the gap: Identification and management of familial hypercholesterolemia in an integrated healthcare delivery system
Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder that causes markedly elevated risk for early onset coronary artery disease. Despite availability of effective therapy, only 5-10% of affected individuals worldwide are diagnosed. To develop and evaluate a novel approach…
Long-term Stroke Risk with Carotid Endarterectomy in Patients with Severe Carotid Stenosis
Informed debate regarding the optimal use of carotid endarterectomy (CEA) for stroke risk reduction requires contemporary assessment of both long-term risk and periprocedural risk. In this study, we report long-term stroke and death risk after CEA in a large integrated…
Association between marijuana use and electrocardiographic abnormalities by middle age The Coronary Artery Risk Development in Young Adults (CARDIA) Study
To evaluate the prevalence of electrocardiogram (ECG) abnormalities in marijuana users as an indirect measure of subclinical cardiovascular disease (CVD). Longitudinal and cross-sectional secondary data analysis from the CARDIA (Coronary Artery Risk Development in Young Adults) study. Four communities in…
Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40 and Beyond
More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline…
Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure
Background Variation in outcomes by race/ethnicity in adults with heart failure (HF) has been previously observed. Identifying factors contributing to these variations could help target interventions. We evaluated the association of race/ethnicity with HF outcomes and potentially contributing factors within…
The Use of Natural Language Processing to Characterize Episodes of Outpatient Worsening Heart Failure within an Integrated Health Care Delivery System
This study will assess the accuracy of using a natural language processing-based approach to retrospectively identify episodes of outpatient worsening heart failure in unstructured electronic health record data within an integrated health care delivery system and assess the burden and…
A Multicenter, Randomized, Placebo-controlled Pragmatic Phase 3 Study Investigating the Efficacy and Safety of Rivaroxaban to Reduce the Risk of Major Venous and Arterial Thrombotic Events in Medically Ill Outpatients with Acute Symptomatic COVID-19 (PRE
This virtual, pragmatic randomized clinical trial will evaluate whether rivaroxaban reduces the risk of a composite endpoint of major venous and arterial thrombotic events, all-cause hospitalization, and all-cause mortality compared with placebo in outpatients with acute, symptomatic COVID-19 infection.
Association of Major Dietary Protein Sources With All-Cause and Cause-Specific Mortality: Prospective Cohort Study
Background Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient. Methods and Results We included 102 521 postmenopausal women enrolled in the Women's Health…
A prospective cohort study that examined acute kidney injury and kidney outcomes, cardiovascular events and death informs on long-term clinical outcomes
Acute kidney injury (AKI) has been reported to be associated with excess risks of death, kidney disease progression and cardiovascular events although previous studies have important limitations. To further examine this, we prospectively studied adults from four clinical centers surviving…
Research Priorities in Atrial Fibrillation Screening: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop
Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure…
Health Risks and Chronic Health Conditions among Arab American and White Adults in Northern California
To characterize the prevalence of chronic cardiovascular conditions and risk factors among Arab American adults stratified by sex and compare these with non-Hispanic Whites. Cross-sectional study using electronic health record data from visits between January 2015 and December 2016. Age-adjusted…
The Degree of the Predischarge Pulmonary Congestion in Patients Hospitalized for Worsening Heart Failure Predicts Readmission and Mortality
Prediction of readmission and death after hospitalization for heart failure (HF) is an unmet need. We evaluated the ability of clinical parameters, NT-proBNP level and noninvasive lung impedance (LI), to predict time to readmission (TTR) and time to death (TTD).…
Impact of nulliparity, hypertensive disorders of pregnancy, and gestational diabetes on vasomotor symptoms in midlife women
To determine whether women with a history of nulliparity, hypertensive disorders of pregnancy (HDP), or gestational diabetes mellitus (GDM) have a higher odds of reporting vasomotor symptoms (VMS) at midlife. A longitudinal analysis was performed with 2,249 women with pregnancy…
Natural history of achondroplasia: A retrospective review of longitudinal clinical data
There are limited data on the longitudinal frequency and severity of the symptoms and complications of achondroplasia. We undertook a retrospective electronic chart review of 114 patients to develop a more thorough understanding of the lifetime impact of achondroplasia. Craniocervical…
Sociopolitical stress and acute cardiovascular disease hospitalizations around the 2016 presidential election
Previous research suggests that stressors may trigger the onset of acute cardiovascular disease (CVD) events within hours to days, but there has been limited research around sociopolitical events such as presidential elections. Among adults ≥18 y of age in Kaiser…
Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation
The aim of this study was to determine the prognostic utility of baseline functional status and its impact on the outcomes of transcatheter mitral valve repair (TMVr) in patients with heart failure (HF) with secondary mitral regurgitation (SMR). The COAPT…
Acute Emergency Care and Outcomes for Stroke, Myocardial Infarction, and Surgery During the COVID-19 Pandemic in Kaiser Permanente Northern California: Implications for Care Delivery During COVID-19 Recovery Phase and Future Surges
The decreased trend in patients seeking care for acute stroke, acute MI, and acute surgical presentations during the COVID-19 pandemic is concerning for potential long-term morbidity, mortality, rehabilitation costs, and preventable downstream health care utilization. We aim to assess the…
Outpatient Worsening Heart Failure in an Integrated Health Care Delivery System: An Innovative Approach to Characterizing a Novel Clinical Entity
While the Affordable Care Act-mandated Hospital Readmission Reduction Program launched in 2012 has modestly reduced readmissions, an unintended consequence has been the shift of a significant fraction of heart failure (HF)-related care to the outpatient setting. However, little is known…
Acute Kidney Injury and Risk of CKD and Hypertension after Pediatric Cardiac Surgery
The association of AKI after pediatric cardiac surgery with long-term CKD and hypertension development is unclear. The study objectives were to determine whether AKI after pediatric cardiac surgery is associated with incident CKD and hypertension. This was a prospective cohort…
The Heart Failure Readmission Intervention by Variable Early Follow-up (THRIVE) Study: A Pragmatic Randomized Trial
In-person clinic follow-up within 7 days after discharge from a heart failure hospitalization is associated with lower 30-day readmission. However, health systems and patients may find it difficult to complete an early postdischarge clinic visit, especially during the current pandemic.…
Angiotensin-Neprilysin Inhibition in Black Americans: Data From the PIONEER-HF Trial
This study compared the efficacy and safety of sacubitril/valsartan to enalapril in Black and non-Black Americans with acute decompensated heart failure (ADHF). Black patients have a different response to treatment with angiotensin-converting enzyme inhibitors compared with other racial and ethnic…
Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic
Shelter-in-place (SIP) orders implemented to mitigate severe acute respiratory syndrome coronavirus 2 spread may inadvertently discourage patient care-seeking behavior for critical conditions like acute ischemic stroke. We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics,…
Sacubitril/Valsartan in Advanced Heart Failure With Reduced Ejection Fraction: Rationale and Design of the LIFE Trial
The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure…
Automated retrospective calculation of the EDACS and HEART scores in a multicenter prospective cohort of emergency department chest pain patients
Coronary risk scores are commonly applied to emergency department patients with undifferentiated chest pain. Two prominent risk score-based protocols are the Emergency Department Assessment of Chest pain Score Accelerated Diagnostic Protocol (EDACS-ADP) and the History, ECG, Age, Risk factors, and…
Non-cardiac-related morbidity, mobility limitation, and outcomes in older adults with heart failure
To examine the individual and combined associations of noncardiac-related conditions and mobility limitation with morbidity and mortality in adults with heart failure (HF). We conducted a retrospective cohort study in a large, diverse group of adults with HF from five…
Risk of Distal Embolization From tPA (Tissue-Type Plasminogen Activator) Administration Prior to Endovascular Stroke Treatment
In large artery occlusion stroke, both intravenous (IV) tPA (tissue-type plasminogen activator) and endovascular stroke treatment (EST) are standard-of-care. It is unknown how often tPA causes distal embolization, in which a procedurally accessible large artery occlusion is converted to a…
Angiotensin Receptor-Neprilysin Inhibition Based on History of Heart Failure and Use of Renin-Angiotensin System Antagonists
The PIONEER-HF (comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode) trial demonstrated the efficacy and safety of sacubitril/valsartan (S/V) in stabilized patients with acute decompensated heart failure (HF) and reduced ejection…
Myocardial infarction accelerates breast cancer via innate immune reprogramming
Disruption of systemic homeostasis by either chronic or acute stressors, such as obesity1 or surgery2, alters cancer pathogenesis. Patients with cancer, particularly those with breast cancer, can be at increased risk of cardiovascular disease due to treatment toxicity and changes…
Association of blood pressure with cognitive function at midlife: a Mendelian randomization study
Whether high blood pressure has a causal effect on cognitive function as early as middle age is unclear. We investigated whether high blood pressure (BP) causally impairs cognitive function at midlife using Mendelian Randomization (MR). We applied a two-sample MR…
Cardiovascular Risk Factors and Accelerated Cognitive Decline in Midlife: the CARDIA Study
Increasing evidence supports an association between midlife cardiovascular risk factors (CVRFs) and risk of dementia, but less is known about whether CVRFs influence cognition in midlife. We examined the relationship between CVRFs and midlife cognitive decline. In 2,675 black and…
Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics
To describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities. Serial cross sectional analysis of cause specific heart disease mortality rates using national death…
Life Course Changes in Cardiometabolic Risk Factors Associated With Preterm Delivery: The 30-Year CARDIA Study
Background Women who deliver preterm infants (
Meta-analysis of 26,638 Individuals Identifies Two Genetic Loci Associated with Left Ventricular Ejection Fraction
Left ventricular ejection fraction (EF) is an indicator of cardiac function, usually assessed in individuals with heart failure and other cardiac conditions. Although family studies indicate that EF has an important genetic component with heritability estimates up to 0.61, to…
Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life-Course Analysis in CARDIA Women
This study hypothesized that both preconception and postchildbearing patterns of cardiometabolic risk factors may be different for women with gestational diabetes mellitus (GDM) compared with women without GDM. Among 1,302 (51% black) women in the Coronary Artery Risk Development in…
Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study
Neighborhood-level residential segregation is implicated as a determinant for poor health outcomes in black individuals, but it is unclear whether this association extends to cognitive aging, especially in midlife. To examine the association between cumulative exposure to residential segregation during…
Cardiovascular Outcomes in Relation to Antihypertensive Medication Use in Women with and Without Cancer: Results from the Women’s Health Initiative
Recent clinical trials have evaluated angiotensin-converting enzyme (ACE) inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta blockers (BBs) in relation to cardiotoxicity in patients with cancer, typically defined by ejection fraction declines. However, these trials have not examined long-term, hard…
Fetal and Early Postnatal Influences on Child Metabolic Health After Gestational Diabetes
This 5-year RO1 study will determine the independent contribution of fetal exposures and early postnatal lifestyle factors on subsequent development of child adiposity and metabolic health among youth (ages 9 to 13 ) exposed to gestational diabetes in utero. The…
COVID-19 Response Grant
Adults with intellectual or developmental disabilities may be especially impacted by the ways the COVID-19 pandemic has led to drastic changes in usual daily routines and the way healthcare encounters have been transitioned to virtual (video, telephone) visits. This project…
Transcatheter Mitral-Valve Repair in Patients with Heart Failure and Functional Mitral Regurgitation – Potential Scope and Clinical Benefit of Early Adoption at an Integrated Healthcare Delivery System
This study will look at the clinical benefit of early adoption of the MitraClip device in patients with heart failure in a real-world setting. Previous research showed patients who have the MitraClip procedure have 50% fewer hospitalizations for heart failure…
Evaluating Inpatient and OutpatIent Encounters Within a Learning and Integrated Health Care Delivery Organization Due to Worsening Heart Failure (UTILIZE-WHF)
This study will assess the inpatient and outpatient health care utilization and mortality of patients with heart failure and how it relates to their degree of systolic dysfunction.
Pragmatic RandomIzed Trial of Icosapent Ethyl for High-Cadiovascular Risk Adults (MITIGATE)
The MITIGATE Study will evaluate the real-world clinical effectiveness of icosapent ethyl (Vascepa®) compared to usual care in patients with established atherosclerotic cardiovascular disease. The study will evaluate whether the drug, which is used to reduce the risk of heart…
Associations Between Cardiac Biomarkers and Cardiac Structure and Function in CKD
Subclinical changes to cardiac structure and function detected with echocardiography precede the development of clinical heart failure (HF) in persons with chronic kidney disease (CKD). Circulating cardiac biomarkers may reflect these pathophysiological changes. This study investigated associations between established biomarkers…
Association between systolic ejection time and outcomes in heart failure by ejection fraction
Worsening heart failure (HF) is associated with shorter left ventricular systolic ejection time (SET), but there are limited data describing the relationship between SET and clinical outcomes. Thus, the objective was to describe the association between SET and clinical outcomes…
Glycemic Control and Dementia: The Role of Pharmacotherapy and Vascular Complications
About 25% of people over the age of 65 are living with diabetes, with 90% of them managing type 2 diabetes. Studies have shown that older individuals with type 2 diabetes have a 51-62% higher risk of dementia than those…
Extended Window for Thrombectomy – Have we extended our resources appropriately and effectively
Study will evaluate the performance of the RAPID software interpretation of CT perfusion (CTP) studies and determination of qualifications for endovascular therapy (EST). It will include a retrospective case review of prospectively collected data on consecutive stroke patients seen during…
Association of Childhood Psychosocial Environment With 30-Year Cardiovascular Disease Incidence and Mortality in Middle Age
Background Childhood adversity and trauma have been shown to be associated with poorer cardiovascular disease (CVD) outcomes in adulthood. However, longitudinal studies of this association are rare. Methods and Results Our study used the CARDIA (Coronary Artery Risk Development in…
Chronic psychosocial and financial burden accelerates 5-year telomere shortening: findings from the Coronary Artery Risk Development in Young Adults Study
Leukocyte telomere length, a marker of immune system function, is sensitive to exposures such as psychosocial stressors and health-maintaining behaviors. Past research has determined that stress experienced in adulthood is associated with shorter telomere length, but is limited to mostly…
Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals
Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain. To determine whether cumulative BP levels explain racial…
Association of Blood Pressure Patterns in Young Adulthood With Cardiovascular Disease and Mortality in Middle Age
Determining blood pressure (BP) patterns in young adulthood that are associated with cardiovascular disease (CVD) events in later life may help to identify young adults who have an increased risk for CVD. To determine whether the long-term variability of BP…
The effect of frequent hemodialysis on matrix metalloproteinases, their tissue inhibitors, and FGF23: Implications for blood pressure and left ventricular mass modification in the Frequent Hemodialysis Network trials
Frequent hemodialysis modifies serum phosphorus, blood pressure, and left ventricular mass (LVM). We ascertained whether frequent hemodialysis is associated with specific changes in biomarker profile among patients enrolled in the frequent hemodialysis network (FHN) trials. This was a post hoc…
Recommendations for Cardiovascular Health and Disease Surveillance for 2030 and Beyond: A Policy Statement From the American Heart Association
The release of the American Heart Association's 2030 Impact Goal and associated metrics for success underscores the importance of cardiovascular health and cardiovascular disease surveillance systems for the acquisition of information sufficient to support implementation and evaluation. The aim of…
Polygenic Risk, Fitness, and Obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Obesity is a major determinant of disease burden worldwide. Polygenic risk scores (PRSs) have been posited as key predictors of obesity. How a PRS can be translated to the clinical encounter (especially in the context of fitness, activity, and parental…
Sedentary Time and Physical Activity Across Occupational Classifications
To examine differences in activity patterns across employment and occupational classifications. Cross-sectional. A 2005-2006 Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants with valid accelerometry data (n = 2068). Uniaxial accelerometry data (ActiGraph 7164), accumulated during waking hours,…
Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
Few studies have investigated racial disparities in survival among dialysis patients in a manner that considers risk factors and mortality during the phase of kidney disease before maintenance dialysis. Our objective was to explore racial variations in survival among dialysis…
Comparison of Long-Term Adverse Outcomes in Patients With Atrial Fibrillation Having Ablation Versus Antiarrhythmic Medications
The impact of atrial fibrillation (AF) catheter ablation versus chronic antiarrhythmic therapy alone on clinical outcomes such as death and stroke remains unclear. We compared adverse outcomes for AF ablation versus chronic antiarrhythmic therapy in 1,070 adults with AF treated…
Statin Therapy and Risk of Incident Diabetes Mellitus in Adults With Cardiovascular Risk Factors
The association between statins and diabetes mellitus (DM) remains controversial. The Kaiser Permanente CHAMP Study identified adults without DM who had cardiovascular (CV) risk factors and no previous lipid lowering therapy (LLT) between 2008 and 2010. The CV risk factors…
Initiation of Angiotensin-Neprilysin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial
In PIONEER-HF, among stabilized patients with acute decompensated heart failure (ADHF), the in-hospital initiation of sacubitril/valsartan was well tolerated and led to improved outcomes compared with enalapril. However, there are limited data comparing the strategies of in-hospital vs postdischarge initiation…
Are existing and emerging biomarkers associated with cardiorespiratory fitness in patients with chronic heart failure?
Cardiorespiratory fitness (CRF) is closely linked to health status and clinical outcomes in heart failure (HF) patients. We aimed to test whether biomarkers can reflect CRF and its change over time. This post hoc analysis used data from ambulatory cohorts…
Individualized Relative Intensity Physical Activity Accelerometer Cut-points
Physical activity (PA) intensity is expressed as either absolute or relative intensity. Absolute intensity refers to the energy required to perform an activity. Relative intensity refers to a level of effort that takes into account how hard an individual is…
Adult Life-Course Trajectories of Lung Function and the Development of Emphysema: The CARDIA Lung Study
Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory comorbid conditions. Associations between lung function trajectories and emphysema have not been explored. Using data from the population-based CARDIA Study, we sought to describe the prevalence of…
Risk of Cardiovascular Events in Statin-Treated Patients with Type 2 Diabetes and Metabolic Dyslipidemia without Prevalent Atherosclerotic Cardiovascular Disease
The relationship between achieved low-density lipoprotein cholesterol (LDL-C) levels and risk of incident atherosclerotic cardiovascular disease events among patients with diabetes and metabolic dyslipidemia has not been well described. We conducted an observational cohort study of statin-treated adults (ages 21-90…
Lifecourse CVD Risk and Midlife Cognitive Trajectories and Brain Aging: Implications for Alzheimer’s and Dementia Prevention
Determinants of cognitive aging may begin decades prior to the development of pathological brain changes, but it is unknown whether risk factors such as hypertension and diabetes exert their influence as early as young adulthood. In this CARDIA Year 35…
Gestational diabetes phenotypes, glucose tolerance transitions and lifestyle behaviors related to cardiovascular risk status
The Study of Women, Infant Feeding, and Type 2 Diabetes after GDM Pregnancy (SWIFT) is a prospective, community-based cohort of mothers aged 20-45 years of age and diagnosed with gestational diabetes mellitus (GDM) who delivered a singleton pregnancy longer than…
Exogenous surfactant utilization for respiratory failure in late and moderately preterm infants: impact on short- and long-term outcomes
The goal is to define and refine the current epidemiology, clinical characteristics, and treatment practices in respiratory failure in late and moderately preterm Infants. Specific aims include determining the incidence and epidemiology of respiratory failure in the neonates born at…
Longitudinal epigenomic study of gestational diabetes mellitus and cardiac structure and function
The goal of this study is to identify epigenetic changes (evaluation of DNA methylation over time) associated with a previous history of GDM and the relationship of these markers to subsequent changes in cardiovascular structure and function in women during…
Functional validity, role, and implications of heavy alcohol consumption genetic loci
High alcohol consumption is a risk factor for morbidity and mortality, yet few genetic loci have been robustly associated with alcohol intake. Here, we use U.K. Biobank (n = 125,249) and GERA (n = 47,967) datasets to determine genetic factors…
Renin-Angiotensin System Blockade after Acute Kidney Injury (AKI) and Risk of Recurrent AKI
How to best medically manage patients who survived hospitalized AKI is unclear. Use of renin-angiotensin system blockers in this setting may increase risk of recurrent AKI. This is a cohort study of 10,242 members of an integrated health care delivery…
Association Between Objective Activity Intensity & Heart Rate Variability: CVD Risk Factor Mediation (CARDIA)
We evaluated the associations between accelerometer-estimated physical activity (PA) intensity and heart rate variability (HRV) and examined mediation of these associations by glycemic control indices and other cardiovascular disease (CVD) risk factors. Data were from 1,668 participants (X[Combining Overline]age=45.9±3.5 years,…
Comparison of Mortality and Major Cardiovascular Events Among Adults With Type 2 Diabetes Using Human vs Analogue Insulins
The comparative cardiovascular safety of analogue and human insulins in adults with type 2 diabetes who initiate insulin therapy in usual care settings has not been carefully evaluated using machine learning and other rigorous analytic methods. To examine the association…
Sex Hormone-binding Globulin, Cardiometabolic Biomarkers, and Gestational Diabetes: A Longitudinal Study and Meta-analysis
This study investigated the prospective associations of circulating levels of sex hormone-binding globulin (SHBG) levels with cardiometabolic biomarkers and risk of gestational diabetes (GDM) during pregnancy. It also examines the longitudinal trajectory of SHBG in women with and without GDM.…
Identifying hypertension in pregnancy using electronic medical records: The importance of blood pressure values
To incorporate blood pressure (BP), diagnoses codes, and medication fills from electronic medical records (EMR) to identify pregnant women with hypertension. A retrospective cohort study of singleton pregnancies at three US integrated health delivery systems during 2005-2014. Women were considered…
Changing Results-Engage and Activate to Enhance Wellness: A Randomized Clinical Trial to Improve Cardiovascular Risk Management
Background Despite the success of current cardiovascular disease (CVD) management programs, many patients do not achieve optimal control of CVD-related risk factors. New strategies are needed to better activate and engage these patients. Methods and Results We conducted a parallel,…
Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation
Studies evaluating the effects of atrial fibrillation (AF) catheter ablation versus antiarrhythmic therapy on outcomes have shown mixed results. In addition, guidelines recommend continuing oral anticoagulation (OAC) after ablation for those at risk of stroke, but real-world data are lacking.…
Incidence rates of cardiovascular outcomes in a community-based population of cancer patients
There are limited data on the incidence of cardiovascular disease among cancer patients in the pre-tyrosine kinase inhibitor (TKI) era. Such data are important in order to contextualize the incidence of various cardiovascular outcomes among cancer patients enrolled in clinical…
Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017
A deceleration in the rate of decrease of heart disease (HD) mortality between 2011 and 2014 has been reported. In the context of the rapid increase in the population of adults aged 65 years and older, extending the examination of…
Statins as a free pass: Body mass index and other cardiovascular risk factors among lipid-lowering medication users and nonusers in the California Men’s Health Study
To lower risk from cardiovascular disease (CVD), national guidelines recommend lifestyle changes followed by use of lipid-lowering medications when appropriate. Previous studies have questioned whether individuals taking these medications are less likely to modify their dietary intake and physical activity,…
Single Measurements of Carboxy-Terminal Fibroblast Growth Factor 23 and Clinical Risk Prediction of Adverse Outcomes in CKD
An elevated fibroblast growth factor 23 (FGF-23) level is independently associated with adverse outcomes in populations with chronic kidney disease, but it is unknown whether FGF-23 testing can improve clinical risk prediction in individuals. Prospective cohort study. Participants in the…
Risk Estimates for Diabetes and Hypertension with Different Physical Activity Methods
To estimate risks of incident type 2 diabetes (T2D) and stage 2 and greater hypertension associated with self-reported and accelerometer-determined moderate-vigorous physical activity (MVPA) separately and adjusted for each other. The sample included 2291 black and white men and women,…
Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The Cardiovascular Research Network Venous Thromboembolism (CVRN VTE) Study
Few studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the United States. A multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism or deep venous thrombosis during the years 2004 through 2010…
Understanding racial disparities in renal cell carcinoma incidence: estimates of population attributable risk in two US populations
Renal cell carcinoma (RCC) incidence is higher among black than white Americans. The reasons for this disparity remain unclear. We calculated race- and sex-specific population attributable risk percentages (PAR%) and their 95% confidence intervals (CI) for hypertension and chronic kidney…
Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study
Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of…
Contribution of rare coding mutations in CD36 to type 2 diabetes and cardio-metabolic complications
We sequenced coding regions of the cluster of differentiation 36 (CD36) gene in 184 French individuals of European ancestry presenting simultaneously with type 2 diabetes (T2D), arterial hypertension, dyslipidemia, and coronary heart disease. We identified rare missense mutations (p.Pro191Leu/rs143150225 and…
Research Needs and Priorities for Catheter Ablation of Atrial Fibrillation: A Report from a National Heart, Lung, and Blood Institute Virtual Workshop
Catheter ablation has brought major advances in the management of patients with atrial fibrillation (AF). As evidenced by multiple randomized trials, AF catheter ablation can reduce the risk of recurrent AF and improve quality of life. In some studies, AF…
Serum Calcification Propensity and Clinical Events in CKD
Patients with CKD are at high risk for cardiovascular disease, ESKD, and mortality. Vascular calcification is one pathway through which cardiovascular disease risks are increased. We hypothesized that a novel measure of serum calcification propensity is associated with cardiovascular disease…
Cardiac Biomarkers and Risk of Incident Heart Failure in Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study
Background Cardiac biomarkers may signal mechanistic pathways involved in heart failure (HF), a leading complication in chronic kidney disease. We tested the associations of NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity troponin T (hsTnT), galectin-3, growth differentiation factor-15 (GDF-15), and soluble…
Cardiac and Stress Biomarkers and Chronic Kidney Disease Progression: The CRIC Study
Increases in cardiac and stress biomarkers may be associated with loss of kidney function through shared mechanisms involving cardiac and kidney injury. We evaluated the associations of cardiac and stress biomarkers [N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT),…
Adipose Tissue Distribution and Cardiovascular Disease Risk Among Breast Cancer Survivors
Cardiovascular disease (CVD) is a major source of morbidity and mortality among breast cancer survivors. Although body mass index (BMI) is associated with CVD risk, adipose tissue distribution may better identify patients with a high risk of CVD after breast…
Incident Anemia in Older Adults with Heart Failure Rate, Etiology, and Association with Outcomes
Limited data exist on the epidemiology, evaluation, and prognosis of otherwise unexplained anaemia of the elderly in heart failure (HF). Thus, we aimed to determine the incidence of anaemia, to characterize diagnostic testing patterns for potentially reversible causes of anaemia,…
Leveraging Multi-omics Approaches to Examine Metabolic Challenges of Obesity in Relation to Cardiovascular Diseases
This project will generate longitudinal plasma metabolomic profiles in the CARDIA study cohort to better understand underlying molecular mechanisms for cardiovascular disease (CVD). We will identify metabolites and metabolic pathways related to CVD risk factors and CVD incidence; identify specific…
Alzheimer’s Disease and Related Dementias in a Diverse Cohort of Asian Americans
This study considers the extent to which immigration history, social factors, cardiometabolic health, and genetic factors contribute to heterogeneity in dementia incidence between Asian American subgroups and between Asian Americans and whites.
Plasma phospholipid n-3 and n-6 polyunsaturated fatty acids in relation to cardiometabolic markers and gestational diabetes: A longitudinal study within the prospective NICHD Fetal Growth Studies
Despite dietary recommendations of polyunsaturated fatty acids (PUFAs) for cardiometabolic health, n-3 and n-6 PUFAs and their interplay in relation to diabetes risk remain debated. Importantly, data among pregnant women are scarce. We investigated individual plasma phospholipid n-3 and n-6…
Duration and stability of metabolically healthy obesity over 30 years
Obese adults who are free from metabolic risk factors may develop risk factors over time. Our objective was to characterize development of obesity and duration of metabolically healthy obese (MHO) over 30 years. Participants in CARDIA who developed obesity (BMI???30?kg/m2)…
Multimorbidity and Treatment-Related Outcomes in Older Heart Failure Patients
This multicenter Cardiovascular Research Network (CVRN) collaborative project will examine the risks and benefits of targeted medical therapies used for heart failure across the spectrum of multimorbidity burden and level of left ventricular systolic function, as well as several targeted…
Healthy Eating as a Means for Active Living in Heart Failure (HEAL-HF) Study
There is an unmet clinical need to better understand the impact of lifestyle choices with respect to diet and nutrition in high-risk heart failure patients who have been recently hospitalized. We will conduct a survey-based project using a combination of…
Cardiac Biomarkers and Risk of Atrial Fibrillation in Chronic Kidney Disease: The CRIC Study
Background We tested associations of cardiac biomarkers of myocardial stretch, injury, inflammation, and fibrosis with the risk of incident atrial fibrillation (AF) in a prospective study of chronic kidney disease patients. Methods and Results The study sample was 3053 participants…
Association of Daily Rest-Activity Patterns With Adiposity and Cardiometabolic Risk Measures in Teens
Emerging data indicate that the timing and rhythms of energetic behaviors may influence metabolism and obesity risk. Our aim was to derive diurnal rest-activity patterns from actigraphy in adolescents and analyze associations with adiposity measures and cardiometabolic risk factors. Adolescents…
Fasting glucose variability in young adulthood and incident diabetes, cardiovascular disease and all-cause mortality
The aim of this study was to determine whether long-term intra-individual variability in fasting glucose (FG) during young adulthood is associated with incident diabetes, cardiovascular disease (CVD) and mortality. We included participants from the Coronary Artery Risk Development in Young…
Disparities in Residual Risk in Patients Receiving Statins for Primary or Secondary Prevention at an Integrated Health Care Delivery System
Patients with risk factors for or established atherosclerotic cardiovascular disease (ASCVD) remain at high risk for first-time or recurrent nonfatal and fatal events, despite guideline-directed medical therapy for primary and secondary prevention. In fact, even among patients who are appropriately…
Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women
Current public health guidelines for obesity prevention and control focus on promoting a normal body mass index (BMI), rarely addressing central obesity, which is reflected by high waist circumference (WC) and common in the general population. Studies of the association…
A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk
Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are…
Body Composition and Cardiovascular Events in Patients With Colorectal Cancer: A Population-Based Retrospective Cohort Study
Patients with colorectal cancer (CRC) are up to 4-fold more likely than individuals without a history of cancer to develop cardiovascular disease. Clinical care guidelines recommend that physicians counsel patients with CRC regarding the association between obesity (defined using body…
Treatment of atrial fibrillation with concomitant coronary or peripheral artery disease: Results from the outcomes registry for better informed treatment of atrial fibrillation II
Treatment patterns and outcomes of individuals with vascular disease who have new-onset atrial fibrillation (AF) are not well characterized. Among patients with new-onset AF, we analyzed treatment and outcomes in those with or without vascular disease in the ORBIT-AF II…
Influence of Multimorbidity on Burden and Appropriateness of Implantable Cardioverter-Defibrillator Therapies
To determine whether burden of multiple chronic conditions (MCCs) influences the risk of receiving inappropriate vs appropriate device therapies. Retrospective cohort study. Seven US healthcare delivery systems. Adults with left ventricular systolic dysfunction receiving an implantable cardioverter-defibrillator (ICD) for primary…
MINERVA Biomarkers Substudy
We will conduct assays of a selected panel of cardiac, metabolic, and cancer biomarkers in 3,000 blood samples collected by the MINERVA (MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease) Study and stored at the Kaiser Biobank. The…
Blood pressure lowering medication initiation and fracture risk: a SWAN pharmacoepidemiology study
We examined the fracture risk after initiation of blood pressure-lowering drugs compared with initiation of antidepressants. Multivariable regression models demonstrated an increased risk of fracture among women initiating a blood pressure-lowering medication (HR 1.73, 95% CI 1.02-2.95). This is likely…
Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease
Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited. This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the…
Coronary Artery Calcium From Early Adulthood to Middle Age and Left Ventricular Structure and Function
Background The relationship of coronary artery calcium (CAC) with adverse cardiac remodeling is not well established. We aimed to study the association of CAC in middle age and change in CAC from early adulthood to middle age with left ventricular…
Perceived and objective characteristics of the neighborhood environment are associated with accelerometer-measured sedentary time and physical activity, the CARDIA Study
We investigated cross-sectional and longitudinal associations of neighborhood environment characteristics with accelerometer-measured sedentary time (SED), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA). Participants were 2120 men and women in the year 20 (2005-2006) and year 30 CARDIA…
Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study
Coronary artery calcification (CAC) is prevalent among patients with chronic kidney disease (CKD) and increases risks for cardiovascular disease events and mortality. We hypothesized that a novel serum measure of calcification propensity is associated with CAC among patients with CKD…
Maternal diabetes and hypertensive disorders in association with autism spectrum disorder
Previous studies have shown complications of pregnancy, often examined in aggregate, to be associated with autism spectrum disorder (ASD). Results for specific complications, such as maternal diabetes and hypertension, have not been uniformly consistent and should be investigated independently in…
Multi-Ancestry Genome-Wide Association Study of Lipid Levels Incorporating Gene-Alcohol Interactions
A person's lipid profile is influenced by genetic variants and alcohol consumption, but the contribution of interactions between these exposures has not been studied. We therefore incorporated gene-alcohol interactions into a multiancestry genome-wide association study of levels of high-density lipoprotein…
Lipids, Apolipoproteins, and Risk of Atherosclerotic Cardiovascular Disease in Persons With CKD
A large residual risk for atherosclerotic cardiovascular disease (ASCVD) remains in the setting of chronic kidney disease (CKD) despite treatment with statins. We sought to evaluate the associations of lipid and apolipoprotein levels with risk for ASCVD in individuals with…
Optimizing Atrial Fibrillation Management in Chronic Kidney Disease
As an extension of the ATRIA-CVRN collaboration in Kaiser Permanente Northern California and Southern California, we will examine the recent use and associated outcomes of different management strategies for atrial fibrillation in adults with and without underlying chronic kidney disease.
Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry)
Systolic blood pressure (SBP) and its association with clinical outcomes in atrial fibrillation (AF) patients in community practice are poorly characterized. In patients with AF, we sought to (1) examine the prevalence of baseline uncontrolled hypertension and the overall change…
Association of Social and Behavioral Risk Factors With Earlier Onset of Adult Hypertension and Diabetes
The National Academy of Medicine has recommended incorporating information on social and behavioral factors associated with health, such as educational level and exercise, into electronic health records, but questions remain about the clinical value of doing so. To examine whether…
Trends in Readmissions and Length of Stay for Patients Hospitalized With Heart Failure in Canada and the United States
Over the past decade, reducing 30-day readmission rates has been emphasized in the United States (including via the implementation of the Hospital Readmissions Reduction Program) but not Canada. To examine changes that occurred from April 1, 2005, to December 31,…
Effects of seafood consumption and toenail mercury and selenium levels on cognitive function among American adults: 25 y of follow up
The aim of this study was to examine the longitudinal association between seafood and intake of long-chain ω-3 polyunsaturated fatty acids (LCω-3 PUFA) and cognitive function and to explore the possible effect modifications owing to mercury (Hg) and selenium (Se)…
Predicting Renal Recovery After Dialysis-Requiring Acute Kidney Injury
After dialysis-requiring acute kidney injury (AKI-D), recovery of sufficient kidney function to discontinue dialysis is an important clinical and patient-oriented outcome. Predicting the probability of recovery in individual patients is a common dilemma. This cohort study examined all adult members…
Shared Antecedents to Preterm Birth and Cardiovascular Disease in Women
This study will conduct a secondary data analysis of CARDIA women that leverages existing data to evaluate the relation of pre-pregnancy inflammation to the occurrence of pre-term birth and to determine whether the inflammatory profile is exacerbated following pregnancy, perhaps…
Genome-wide Association and Functional Studies Reveal Novel Pharmacological Mechanisms for Allopurinol
Allopurinol, which lowers uric acid (UA) concentration, is increasingly being recognized for its benefits in cardiovascular and renal disease. However, response to allopurinol is variable. We gathered samples from 4,446 multiethnic subjects for a genome-wide association study of allopurinol response.…
Comparison of Cross-Sex Hormone Therapies in Relation to Risks of Vascular Events
The risk of acute thrombotic events such as venous thromboembolism (VTE) and ischemic stroke in transgender women receiving hormone therapy was addressed in our longitudinal Study of Transition, Outcomes & Gender (STRONG), supported by the Patient-Centered Outcomes Research Institute. STRONG…
Study of Healthy Aging in African Americans (STAR)
Rates of dementia and Alzheimer’s disease are 40% to 100% higher among African Americans compared to non-Hispanic whites. STAR is a longitudinal cohort study of lifecourse vascular risk and brain aging in 700 African Americans ages 50 and older. The goals…
Racial Differences in Maintaining Optimal Health Behaviors Into Middle Age
Earlier development of cardiovascular disease risk factors in blacks versus whites may result from differences in maintaining health behaviors. Age-specific racial differences in maintaining health behaviors from ages 18 to 50 years were determined. In 1985-1986, the population-based Coronary Artery…
Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy
The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and…
Use of Measures of Inflammation and Kidney Function for Prediction of Atherosclerotic Vascular Disease Events and Death in Patients With CKD: Findings From the CRIC Study
Traditional risk estimates for atherosclerotic vascular disease (ASVD) and death may not perform optimally in the setting of chronic kidney disease (CKD). We sought to determine whether the addition of measures of inflammation and kidney function to traditional estimation tools…
The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (the Diabetes & Aging Study)
To examine for a legacy effect of early glycemic control on diabetic complications and death. This cohort study of managed care patients with newly diagnosed type 2 diabetes and 10 years of survival (1997-2013, average follow-up 13.0 years, N =…
Risk factors for medication non-adherence among atrial fibrillation patients
Atrial fibrillation (AF) patients are routinely prescribed medications to prevent and treat complications, including those from common co-occurring comorbidities. However, adherence to such medications may be suboptimal. Therefore, we sought to identify risk factors for general medication non-adherence in a…
Changes in physical and mental health are associated with cardiovascular disease incidence in postmenopausal women
physical and mental health are important risk factors for cardiovascular disease (CVD) incidence and death among postmenopausal women. The objective of this study was to assess whether changes in physical and mental health were associated with CVD incidence and death.…
Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure
Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States annually. Whether the initiation of sacubitril-valsartan therapy is safe and effective among patients who are hospitalized for acute decompensated heart failure is unknown. We enrolled…
Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies
Adults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable or modifiable HIV-related and traditional risk…
Risk Factors for Recurrent Acute Kidney Injury in a Large Population-Based Cohort
Acute kidney injury (AKI) has numerous sequelae. Repeated episodes of AKI may be an important determinant of adverse outcomes, including chronic kidney disease and death. In a population-based cohort study, we sought to determine the incidence of and predictors for…
Prenatal Blood Pressure Patterns to Predict Pregnancy-Related Hypertension and Later-Life Cardiovascular Risk
This study utilizes clinical prenatal-care blood pressure measurements and other clinical and biochemical variables to develop models for the early prediction of hypertensive disorders of pregnancy, and evaluates the relationship of pregnancy blood-pressure patterns to new onset hypertension and cardiovascular…
Assessing and Optimizing the Impact of an Electronic Clinical Decision Support Tool for Chest Pain Risk Stratification in the Emergency Department STEWARD Project (Phase 3)
Conducted with co-investigator Dustin G. Mark, MD, this study helps emergency physicians with estimates of individual patient risk for patients with chest pain. The research team will evaluate impacts on guideline-supported acute coronary syndrome evaluations.
Nor-Cal-CSC for Northern California Regional Coordinating Center
The Northern California Regional Coordinating Stroke Center (NorCal-CSC) is a joint effort between U.C. San Francisco and selected medical center(s) within Kaiser Permanente as part of the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Trials Network. This project…
Targeting Cardiovascular Events to Improve Patient Outcomes After Sepsis
Sepsis is the most common illness leading to hospitalization in the United States, affecting more than 1 million Americans each year. While short-term mortality has improved over prior decades, sepsis survivors face numerous post-hospital sequelae that negatively impact long-term morbidity…
Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity
Many genetic loci affect circulating lipid levels, but it remains unknown whether lifestyle factors, such as physical activity, modify these genetic effects. To identify lipid loci interacting with physical activity, we performed genome-wide analyses of circulating HDL cholesterol, LDL cholesterol,…
Associations of Accelerometer-Measured Sedentary Time and Physical Activity With Prospectively Assessed Cardiometabolic Risk Factors: The CARDIA Study
Background Isotemporal substitution examines the effect on health outcomes of replacing sedentary time with light-intensity physical activity or moderate-to-vigorous intensity physical activity; however, existing studies are limited by cross-sectional study designs. Methods and Results Participants were 1922 adults from the…
Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal
For patients with diabetes, many with multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, and may impact the frequency of in-person health care visits. To examine the impact of portal access…
Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study
Latinos face unique challenges engaging with their health care providers for risk management of cardiovascular disease (CVD). To better understand differences in how Latinos and non-Latino whites (NLWs) experience CVD care. We examined self-reported activation, engagement, confidence, and communication comparing…
Kidney function, proteinuria and breast arterial calcification in women without clinical cardiovascular disease: The MINERVA study
Breast arterial calcification (BAC) may be a predictor of cardiovascular events and is highly prevalent in persons with end-stage kidney disease. However, few studies to date have examined the association between mild-to-moderate kidney function and proteinuria with BAC. We prospectively…
The Association of Polycystic Ovary Syndrome and Gestational Hypertensive Disorders in a Diverse Community-Based Cohort
To examine the association of polycystic ovary syndrome (PCOS) and pregnancy-induced hypertension (PIH) within a large population of pregnant women in an integrated healthcare system. This retrospective study utilized a source cohort of 1023 women with PCOS and 1023 women…
Shake Rattle & Roll – Design and rationale for a pragmatic trial to improve blood pressure control among blacks with persistent hypertension
In Kaiser Permanente Northern California (KPNC), members had similar access to care and a very high overall rate of hypertension control. However, blacks had poorer blood pressure (BP) control than whites. The Shake Rattle & Roll (SRR) trial aimed to…
Insulin resistance since early adulthood and appendicular lean mass in middle-aged adults without diabetes: 20 years of the CARDIA study
To determine the association between 20-year trajectories in insulin resistance (IR) since young adulthood and appendicular lean mass (ALM) at middle-age in adults without diabetes. A prospective cohort study was designed among young and middle-aged US men (n?=?925) and women…
Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals
We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals. We conducted a retrospective cohort study within Kaiser…
Comparison of Cross-Sex Hormone Therapies in Relation to Risks of Vascular Events – DUPLICATED DO NOT ACTIVATE
The risk of acute thrombotic events such as venous thromboembolism (VTE) and ischemic stroke in transgender women receiving hormone therapy was addressed in our longitudinal Study of Transition, Outcomes and Gender (STRONG). STRONG is a cohort of transgender people enrolled…
Lung Function in Young Adults and Risk of Cardiovascular Events Over 29 Years: The CARDIA Study
Background Diminished peak lung function in young adulthood is a risk factor for future chronic obstructive pulmonary disease. The association between lung disease and cardiovascular disease later in life is well documented. Whether peak lung function measured in young adulthood…
Is Time From Last Hospitalization for Heart Failure to Placement of a Primary Prevention Implantable Cardioverter-Defibrillator Associated With Patient Outcomes?
Landmark studies have demonstrated the safety and efficacy of implantable cardioverter-defibrillators (ICDs) in selected stable ambulatory patients with heart failure (HF) with a reduced ejection fraction receiving optimal medical therapy. It is not known whether a recent hospitalization for HF…
Particulate Air Pollution, Cardiovascular Events, and Susceptibility Factors (PACES)
This is a retrospective cohort study of 5 million adult members of Kaiser Permanente Northern California during 2000 to 2012, linked to state-of-the-art estimates of exposure to PM2.5 (particulate matter less than 2.5 micrometers in diameter) generated at 1km x…
Healthy Lifestyle During the Midlife Is Prospectively Associated With Less Subclinical Carotid Atherosclerosis: The Study of Women’s Health Across the Nation
Background Measures of subclinical atherosclerosis are predictors of future cardiovascular outcomes as well as of physical and cognitive functioning. The menopausal transition is associated with accelerated progression of atherosclerosis in women. The prospective association between a healthy lifestyle during the…
Tele-Triage Outcomes For Patients With Chest Pain: Comparing Physicians And Registered Nurses
We took advantage of a change in protocol in an integrated delivery system's telephone consultation service-routing callers complaining of chest pain to physicians instead of registered nurses, whenever feasible-to explore whether tele-triage outcomes differed by staffing type. Comparing outcomes of…
Cardiovascular Events after New-Onset Atrial Fibrillation in Adults with CKD: Results from the Chronic Renal Insufficiency Cohort (CRIC) Study
Atrial fibrillation (AF), the most common sustained arrhythmia in CKD, is associated with poor clinical outcomes in both patients without CKD and patients with dialysis-treated ESRD. However, less is known about AF-associated outcomes in patients with CKD who do not…
Risk of cardiovascular disease in women with BRCA1 and BRCA2 mutations
Estimate the prevalence of cardiovascular disease risk factors and endpoints in women with BRCA mutations. Women, age 40 and older, with BRCA mutations identified in Kaiser Permanente Northern California completed a questionnaire and underwent a lipid and fasting glucose panel.…
Multimorbidity Burden and Adverse Outcomes in a Community-Based Cohort of Adults with Heart Failure
To assess multimorbidity burden and its association with clinical outcomes in adults with heart failure (HF) according to sex, age, and HF type. Retrospective cohort study. Five healthcare delivery systems across the United States. Adults with HF (N=114,553). We characterized…
Population-Based Pharmacogenomic Assessment of QT Prolongation
Cardiotoxicity of commonly prescribed medications, typically assessed by electrocardiographic features such as prolongation of the QT interval, has regulatory effects and is associated with potentially fatal outcomes. This project aims to advance understanding of the genetic basis for drug cardiotoxicity…
Association of Breast Arterial Calcification Presence and Gradation with the Ankle-Brachial Index among Postmenopausal Women
To examine the association of breast arterial calcification (BAC) with the ankle brachial index (ABI), a sensitive metric of peripheral arterial disease (PAD), among postmenopausal women. Background: BAC is an emerging risk marker of cardiovascular disease (CVD). MINERVA (MultIethNic study…
Statins for Primary Prevention in Older Adults-Moving Toward Evidence-Based Decision-Making
To determine the efficacy and safety of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in older adults, especially those aged 80 and older and with multimorbidity. The National Institute on Aging and the National Heart, Lung and…
The Utility and Cross-Validation of a Composite Physical Activity Score in Relation to Cardiovascular Health Indicators: Coronary Artery Risk Development in Young Adults
Single-method assessment of physical activity (PA) has limitations. The utility and cross-validation of a composite PA score that includes reported and accelerometer-derived PA data has not been evaluated. Participants attending the Year 20 exam were randomly assigned to the derivation…
Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation
Stroke rates in patients with nonvalvular atrial fibrillation (AF) who are not receiving anticoagulant therapy vary widely across published studies; the resulting effect on the net clinical benefit of anticoagulation in AF is unknown. To determine the effect of variation…
Early therapeutic persistence on dabigatran versus warfarin therapy in patients with atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry
Anticoagulation is highly effective for the prevention of stroke in patients with atrial fibrillation (AF) but it is dependent on patients continuing therapy. While studies have demonstrated suboptimal therapeutic persistence on warfarin, few have studied persistence rates with non vitamin…
Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation
Chronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF. We…
Examining Vaccine Effectiveness of Flublok Relative to Standard Dose Inactivated Influenza Vaccine Among Kaiser Permanente Northern California Members Aged 18-64 Years
This study employs a cluster randomization design to examine the vaccine effectiveness of Flublok relative to that of other flu vaccines used at Kaiser Permanente Northern California over two influenza seasons (2018 to 2019 and 2019 to 2020), in Kaiser…
Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity
Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes, and medical management, including lifestyle changes, may not be successful at lowering risk. To investigate the relationship between bariatric surgery and incident macrovascular (coronary…
Fasting Glucose Variability in Young Adulthood and Cognitive Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
To determine whether intraindividual variability in fasting glucose (FG) below the threshold of diabetes is associated with cognitive function in middle adulthood beyond increasing FG. We studied 3,307 CARDIA (Coronary Artery Risk Development Study in Young Adults) participants (age range…
Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF
Background Chronic kidney disease ( CKD ) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control. Methods and Results Patients enrolled in ORBIT AF (Outcomes Registry for…
Long-Term Outcomes of Adults With Heart Failure by Left Ventricular Systolic Function Status
Patients with heart failure (HF) and preserved (HFpEF) or borderline preserved ejection fraction (HFbEF) outnumber patients with HF and reduced ejection fraction (HFrEF), but limited data exist on outcomes in community-based populations of these patients. We examined clinical outcomes in…
Reassessing the Role of Surrogate End Points in Drug Development for Heart Failure
With few notable exceptions, drug development for heart failure (HF) has become progressively more challenging, and there remain no definitively proven therapies for patients with acute HF or HF with preserved ejection fraction. Inspection of temporal trends suggests an increasing…
Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care: A Matched Cohort Study
Bariatric surgery improves glycemic control in patients with type 2 diabetes mellitus (T2DM), but less is known about microvascular outcomes. To investigate the relationship between bariatric surgery and incident microvascular complications of T2DM. Retrospective matched cohort study from 2005 to…
Characterization of Statin Low-Density Lipoprotein Cholesterol Dose-Response Using Electronic Health Records in a Large Population-Based Cohort
Low-density lipoprotein cholesterol (LDL-C) response to statin therapy has not been fully elucidated in real-world populations. The primary objective of this study was to characterize statin LDL-C dose-response and its heritability in a large, multiethnic population of statin users. We…
Language barriers and LDL-C/SBP control among Latinos with diabetes
Language barriers in healthcare are associated with worse glycemic control among Latino patients with limited English proficiency and diabetes. We examined the association of patient-physician language concordance with lipid (low-density lipoprotein cholesterol [LDL-C]) and systolic blood pressure (SBP) control. Retrospective…
Risk of Incident Atherosclerotic Cardiovascular Disease Events by Achieved Atherogenic Lipid Levels Among 62,428 Statin-Treated Individuals With Diabetes Mellitus
The relevance of low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) goals for primary prevention of atherosclerotic cardiovascular disease (ASCVD) among patients with diabetes was assessed. This retrospective cohort study included patients with type 2 diabetes, age 21 to…
Breastfeeding and later maternal risk of hypertension and cardiovascular disease – The role of overall and abdominal obesity
In this study, we examined how any, full, and partial breastfeeding durations were associated with maternal risk of hypertension and cardiovascular disease (CVD), and how prepregnancy body mass index (BMI) and waist circumference 7 years postpartum influenced these associations. A total…
Evolution of Echocardiographic Measures of Cardiac Disease From CKD to ESRD and Risk of All-Cause Mortality: Findings From the CRIC Study
Abnormal cardiac structure and function are common in chronic kidney disease (CKD) and end-stage renal disease (ESRD) and linked with mortality and heart failure. We examined changes in echocardiographic measures during the transition from CKD to ESRD and their associations…
Prognostic Significance of Nuisance Bleeding in Anticoagulated Patients with Atrial Fibrillation
Bleeding is commonly cited as a reason for stopping oral anticoagulants (OACs). Whether minor bleeding events (nuisance bleeding, NB) in patients with atrial fibrillation on OACs are associated with OAC discontinuation, major bleeding, and stroke/systemic embolism (SSE) is unknown. Within…
Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA2DS2-VASc Scores: Findings From the ORBIT-AF I and II Registries
Background Current American College of Cardiology/American Heart Association guidelines suggest that for patients with atrial fibrillation who are at low risk for stroke (CHA2DS2VASc=1) (or women with CHA2DS2VASc=2) a variety of treatment strategies may be considered. However, in clinical practice,…
Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study
Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use. To examine the incidence of these events in a cohort of transgender persons. Electronic medical record-based cohort study of transgender members of integrated…
Liraglutide and weight loss among patients with advanced heart failure and a reduced ejection fraction: insights from the FIGHT trial.
AIMS: Obesity is present in up to 45% of patients with heart failure (HF). Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor antagonist, facilitates weight loss in obese patients. The efficacy of liraglutide as a weight loss agent among patients with HF…
Natural History of Patients Postacute Coronary Syndrome Based on Heart Failure Status.
The natural history of patients hospitalized for acute coronary syndrome (ACS) with pre-existing versus (vs) de novo heart failure (HF) has not been previously reported over an extended duration of follow-up. The IMPROVE-IT trial enrolled 18,144 patients hospitalized for ACS…
Exome Chip Analysis Identifies Low-Frequency and Rare Variants in MRPL38 for White Matter Hyperintensities on Brain Magnetic Resonance Imaging
Background and Purpose- White matter hyperintensities (WMH) on brain magnetic resonance imaging are typical signs of cerebral small vessel disease and may indicate various preclinical, age-related neurological disorders, such as stroke. Though WMH are highly heritable, known common variants explain…
TRANSFORM-HF (ToRsemide compArisoN with furoSemide FOR Management of Heart Failure) Study
Patients with heart failure will be randomized 1:1 to either oral torsemide or oral furosemide prior to hospital discharge. The primary endpoint will be all-cause mortality over the follow-up period. Secondary endpoints are hospitalizations, quality of life, and depression.
Optimal Anticoagulation Strategies for Acute Atrial Fibrillation
The purpose of this project is to assess the variation and impact of oral anticoagulant prescribing in the emergency department in order to inform development of interventions to improve acute atrial fibrillation and flutter management. A longitudinal database will be…
Improving Stroke Prevention for High-risk Atrial Fibrillation by Discharge Redesign Using Electronic Clinical Decision Support
This is a retrospective cohort study to describe the effect of adding direct oral anticoagulants to the Kaiser Permanente formulary on overall rates of oral anticoagulant initiation at the time of discharge for emergency department and inpatients with high-risk non-valvular…
Long-Term Outcome in Unruptured Brain Arteriovenous Malformation Patients
This study has three aims: 1) To identify predictors of hemorrhage and poor outcome in the untreated course of unruptured brain arteriovenous malformation patients, 2) To identify predictors of hemorrhage and poor outcome in the treated course of unruptured brain…
Optimizing Management and Outcomes for Patients with Valvular Heart Disease
This project aims to characterize the management and outcomes of valvular heart disease for patients within Kaiser Permanente Northern California. It will include evaluation of surveillance patterns for moderate and severe valve disease, assessment of clinical outcomes in those with…
Cumulative Incidence of Hypertension by 55 Years of Age in Blacks and Whites: The CARDIA Study
Blacks have higher blood pressure levels compared with whites beginning in childhood. Few data are available on racial differences in the incidence of hypertension from young adulthood through middle age. We calculated the cumulative incidence of hypertension from age 18…
Occupational cognitive complexity in earlier adulthood is associated with brain structure and cognitive health in midlife: The CARDIA study
In line with cognitive reserve theory, higher occupational cognitive complexity is associated with reduced cognitive decline in older adulthood. How and when occupational cognitive complexity first exerts protective effects during the life span remains unclear. We investigated associations between occupational…
Contemporary Burden and Correlates of Symptomatic Paroxysmal Supraventricular Tachycardia
Contemporary data about symptomatic paroxysmal supraventricular tachycardia (PSVT) epidemiology are limited. We characterized prevalence and correlates of symptomatic PSVT within a large healthcare delivery system and estimated national PSVT burden. We identified adults with an encounter for potential PSVT between…
Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents
: media-1vid110.1542/5778442247001PEDS-VA_2017-4085Video Abstract BACKGROUND AND OBJECTIVES: Shorter sleep duration is associated with childhood obesity. Few studies measure sleep quantity and quality objectively or examine cardiometabolic biomarkers other than obesity. This cross-sectional study of 829 adolescents derived sleep duration, efficiency and…
Association of Burden of Atrial Fibrillation With Risk of Ischemic Stroke in Adults With Paroxysmal Atrial Fibrillation: The KP-RHYTHM Study
Atrial fibrillation is a potent risk factor for stroke, but whether the burden of atrial fibrillation in patients with paroxysmal atrial fibrillation independently influences the risk of thromboembolism remains controversial. To determine if the burden of atrial fibrillation characterized using…
Blood Pressure Patterns and Subsequent Coronary Artery Calcification in Women Who Delivered Preterm Births
Women who delivered preterm infants have excess cardiovascular disease, but vascular pathways linking these conditions are not understood. We considered that higher blood pressure over 25 years among women with preterm delivery may be associated with coronary artery calcification (CAC).…
Manuscript title: Can survival bias explain the age attenuation of racial inequalities in stroke incidence? A simulation study
In middle age, stroke incidence is higher among black than white Americans. For unknown reasons, this inequality decreases and reverses with age. We conducted simulations to evaluate whether selective survival could account for observed age patterning of black-white stroke inequalities.…
Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System
Heart disease and stroke remain among the leading causes of death nationally. We examined whether differences in recent trends in heart disease, stroke, and total mortality exist in the United States and Kaiser Permanente Northern California (KPNC), a large integrated…
Outpatient Management of Emergency Department Patients With Acute Pulmonary Embolism: Variation, Patient Characteristics, and Outcomes
Outpatient management of emergency department (ED) patients with acute pulmonary embolism is uncommon. We seek to evaluate the facility-level variation of outpatient pulmonary embolism management and to describe patient characteristics and outcomes associated with home discharge. The Management of Acute…
Cumulative blood pressure from early adulthood to middle age is associated with left atrial remodelling and subclinical dysfunction assessed by three-dimensional echocardiography: a prospective post hoc analysis from the coronary artery risk development in young adults study
To evaluate the association of cumulative blood pressure (BP) from young adulthood to middle age with left atrial (LA) structure/function as assessed by three-dimensional echocardiography (3DE) in a large longitudinal bi-racial population study. We conducted a prospective post hoc analysis…
Contemporary rates and predictors of fast progression of chronic kidney disease in adults with and without diabetes mellitus
Chronic kidney disease (CKD) is highly prevalent but identification of patients at high risk for fast CKD progression before reaching end-stage renal disease in the short-term has been challenging. Whether factors associated with fast progression vary by diabetes status is…
Respiratory Symptoms in Young Adults and Future Lung Disease: The CARDIA Lung Study
There are limited data on factors in young adulthood that predict future lung disease. To determine the relationship between respiratory symptoms, loss of lung health, and incident respiratory disease in a population-based study of young adults. We examined prospective data…
10-year changes in accelerometer-based physical activity and sedentary time during midlife: CARDIA Study
To describe 10-year changes in accelerometer-determined physical activity (PA) and sedentary time in a midlife cohort, within and by race/sex groups. Coronary Artery Risk Development in Young Adults participants (n = 962) who wore the accelerometer with valid wear (≥4…
Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
The high mortality and cardiovascular disease (CVD) burden in patients with end-stage renal disease (ESRD) is well-documented. Recent literature suggests that acute kidney injury is also associated with CVD. It is unknown whether patients with incident ESRD due to dialysis-requiring…
Adherence to Cardio-protective Medications Prescribed for Secondary Prevention after an Acute Coronary Syndrome Hospitalization Compared to Usual Care
Secondary prevention after an acute coronary syndrome (ACS) hospitalization is critical to prevent additional morbidity and mortality. While poor adherence to prescribed cardio-protective medications is a known problem;1;2 it is unknown whether an ACS event might motivate patients to achieve…
Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop
Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a…
Social relationships, inflammation markers, and breast cancer incidence in the Women’s Health Initiative
Previous research has reported associations between social relationships and carcinogenesis. Inflammation is a potential mediator of these associations. To clarify these links for one tumor site, we examined associations between social relationships, circulating inflammation markers, and breast cancer incidence. Among…
Improved Cardiovascular Risk Factors Control Associated with a Large-Scale Population Management Program Among Diabetes Patients
Optimal cardiovascular risk factors control among individuals with diabetes remains a challenge. We evaluated changes in glucose, lipid, and blood pressure control among diabetes patients after implementation of a large-scale population management program, known as Preventing Heart Attacks and Strokes…
Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study
Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. Analyses focused on 79,176 AYA patients diagnosed with 14 first…
Comparison of Two Generations of ActiGraph Accelerometers: The CARDIA Study
This study aimed to examine the comparability of the ActiGraph 7164 and wGT3X-BT wear time, count-based estimates, and average time per day in physical activity of different intensities. We studied 87 Coronary Artery Risk Development in Young Adults (CARDIA) participants…
Optimism, Pessimism, Cynical Hostility, and Biomarkers of Metabolic Function in the Women’s Health Initiative
Psychological attitudes reflecting expectations about the future (optimism, pessimism) and people (cynical hostility) independently predict incident cardiovascular disease and possibly diabetes, but underlying biologic pathways are incompletely understood. Herein we examined the cross-sectional relationship between optimism, pessimism, and cynicism and…
Variation and Barriers in Cardiac Imaging Tests for Suspected Coronary Heart Disease in Kaiser Permanente Northern California
This study has three overall goals: 1) to evaluate regional practice patterns and variation for myocardial perfusion imaging (MPI), computed tomography angiography (CTA), and Stress Echo (SE) in adults with suspected coronary heart disease; 2) to evaluate patient, physician and…
High-resolution mapping of traffic related air pollution with Google street view cars and incidence of cardiovascular events within neighborhoods in Oakland, CA
Some studies have linked long-term exposure to traffic related air pollutants (TRAP) with adverse cardiovascular health outcomes; however, previous studies have not linked highly variable concentrations of TRAP measured at street-level within neighborhoods to cardiovascular health outcomes. Long-term pollutant concentrations…
Add-On Antihypertensive Medications to Angiotensin-Aldosterone System Blockers in Diabetes: A Comparative Effectiveness Study
In individuals with diabetes, the comparative effectiveness of add-on antihypertensive medications added to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker on the risk of significant kidney events is unknown. We used an observational, multicenter cohort of 21,897 individuals…
Weighted Multi-marker Genetic Risk Scores for Incident Coronary Heart Disease among Individuals of African, Latino and East-Asian Ancestry
We examined the clinical utility of two multi-locus genetic risk scores (GRSs) previously validated in Europeans among persons of African (AFR; n = 2,089), Latino (LAT; n = 4,349) and East-Asian (EA; n = 4,804) ancestry. We used data from the GERA cohort (30-79 years old,…
Recent abacavir use increases risk for Types 1 and 2 myocardial infarctions among adults with HIV
There is persistent confusion as to whether abacavir (ABC) increases the risk of myocardial infarction (MI), and whether such risk differs by type 1 (T1MI) or 2 (T2MI) MI in adults with HIV. Incident MIs in North American Cohort Collaboration…
Lifetime Marijuana Use and Subclinical Atherosclerosis: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Unlike tobacco, the effect of marijuana smoke on subclinical atherosclerosis, a surrogate measure for cardiovascular disease, is not known. This study aimed to determine the association between lifetime exposure to marijuana and measures of subclinical atherosclerosis in mid-life. We used…
Cardiometabolic risk factors and survival after breast cancer in the Women’s Health Initiative
Few studies have examined the relationship between cardiometabolic risk factors linked to metabolic syndrome and mortality among women with breast cancer. We used the Women's Health Initiative to evaluate the relationship between cardiometabolic risk factors, including waist circumference (WC), blood…
Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study
Anxiety and depression are associated with worse outcomes in several cardiovascular conditions, but it is unclear whether they affect outcomes in atrial fibrillation (AF). In a large diverse population of adults with AF, we evaluated the association of diagnosed anxiety…
Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry
Mineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. In order to better understand MRA use and subsequent outcomes, we performed…
Sudden Death After Hospitalization for Heart Failure With Reduced Ejection Fraction (from the EVEREST Trial).
Patients with chronic heart failure with reduced ejection fraction (HFrEF) benefit from medical and device therapies targeting sudden cardiac death (SCD). Contemporary estimates of SCD risk after hospitalization for heart failure are limited. We describe the incidence, timing, and clinical…
A recursive partitioning approach to investigating correlates of self-rated health: The CARDIA Study
Self-rated health (SRH) is an independent predictor of mortality; studies have investigated correlates of SRH to explain this predictive capability. However, the interplay of a broad array of factors that influence health status may not be adequately captured with parametric…
Risk factors for progression of coronary artery calcification in patients with chronic kidney disease: The CRIC study
Coronary artery calcification (CAC) is common among patients with chronic kidney disease (CKD) and predicts the risk for cardiovascular disease (CVD). We examined the associations of novel risk factors with CAC progression among patients with CKD. Among 1123 CKD patients…
Pre-pregnancy endothelial dysfunction and birth outcomes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Endothelial dysfunction is a form of subclinical cardiovascular disease that may be involved in preterm birth and small-for-gestational-age deliveries. However, concentrations of biomarkers of endothelial dysfunction before pregnancy have rarely been measured. We hypothesized that higher levels of biomarkers of…
Self-Reported Marijuana Use Over 25 Years and Abdominal Adiposity: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
We investigated the association between cumulative lifetime and current marijuana use with total abdominal adipose tissue (AT), visceral AT, subcutaneous AT, intermuscular AT, and mean liver attenuation (LA) at mid-life. Longitudinal and cross-sectional secondary data analysis of participants in the…
Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter-Defibrillators in the Cardiovascular Research Network
Primary prevention implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients with left ventricular systolic dysfunction by delivering therapies (antitachycardia pacing or shocks) to terminate potentially lethal arrhythmias; inappropriate therapies also occur. We assessed device therapies among adults receiving primary prevention…
Air Pollutants and Cardiovascular Risk: Investigating Thresholds with Pooled Cohorts and Electronic Health Records
This study will pool data from a set of well-established cohorts in the United States, each with appropriate outcome, residential history, and individual-level covariate detail, to study low-threshold exposures to criteria air pollutants and cardiovascular disease risk. A secondary aim…
How Fast is Fast Enough? Assessing Door-to-Needle Times and Outcomes of Stroke Patients Receiving Acute Thrombolysis Therapy Under the Kaiser Permanente Northern California Stroke EXPRESS Program
With stroke treatment, there is a general belief that "time is brain." However, there has been no published data examining specifically the association between door-to-needle times for acute treatment with intravenous alteplase in stroke patients and 90-day outcomes. In 2016,…
Pre-Pregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis.
PURPOSE: To assess the associations of pre-pregnancy cardiorespiratory fitness, moderate-to vigorous-intensity physical activity (MVPA), and time spent watching television with subsequent development of gestational diabetes mellitus (GDM).METHODS: Participants were 1,333 women enrolled in the Coronary Artery Risk Development in Young…
Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial.
OBJECTIVES: As the largest acute heart failure (AHF) trial conducted to date, the global ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial database presented an opportunity to systematically describe the relationship among time of hospital…
A large electronic-health-record-based genome-wide study of serum lipids
A genome-wide association study (GWAS) of 94,674 ancestrally diverse Kaiser Permanente members using 478,866 longitudinal electronic health record (EHR)-derived measurements for untreated serum lipid levels empowered multiple new findings: 121 new SNP associations (46 primary, 15 conditional, and 60 in meta-analysis…
Where are they now? Retention strategies over 25 years in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
In 1991, we described the recruitment and goals for a cohort of young adults. At the time, little was known about long-term retention of young, healthy and mobile adults or minorities. We present retention strategies and rates over 25 years,…
Thromboprophylaxis for Patients with High-risk Atrial Fibrillation and Flutter Discharged from the Emergency Department
Many patients with atrial fibrillation or atrial flutter (AF/FL) who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED).…
Associations of overweight/obesity and socioeconomic status with hypertension prevalence across racial and ethnic groups
Racial/ethnic disparities in the prevalence of diagnosed hypertension are persistent but may be partially explained by racial/ethnic differences in weight category and neighborhood socioeconomic status. The authors compared hypertension prevalence rates among 4 060 585 adults with overweight or obesity across 10…
Contemporary Procedural Complications, Hospitalizations, and Emergency Visits After Catheter Ablation for Atrial Fibrillation
Contemporary data on complications and resource utilization after atrial fibrillation (AF) ablation are limited. We evaluated rates and risk factors for procedural complication, rehospitalization, and emergency department visits after AF ablation. We identified all adult patients who underwent isolated AF…
Prospective surveillance pilot of rivaroxaban safety within the US Food and Drug Administration Sentinel System
The US Food and Drug Administration's Sentinel system developed tools for sequential surveillance. In patients with non-valvular atrial fibrillation, we sequentially compared outcomes for new users of rivaroxaban versus warfarin, employing propensity score matching and Cox regression. A total of…
The role of angiotensin receptor-neprilysin inhibitors in cardiovascular disease-existing evidence, knowledge gaps, and future directions.
Although traditional renin-angiotensin system antagonists including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have revolutionized the treatment of cardiovascular disease (CVD), the pivotal PARADIGM-HF trial demonstrated that sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), was superior to an angiotensin-converting enzyme inhibitor…
Performance of Coronary Risk Scores Among Patients With Chest Pain in the Emergency Department
Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (
Long-term Outcomes Associated With Implantable Cardioverter Defibrillator in Adults With Chronic Kidney Disease
Chronic kidney disease (CKD) is common in adults with heart failure and is associated with an increased risk of sudden cardiac death. Randomized trials of participants without CKD have demonstrated that implantable cardioverter defibrillators (ICDs) decrease the risk of arrhythmic…
Predictors of Post-discharge Mortality Among Patients Hospitalized for Acute Heart Failure.
Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation.…
Sedentary Behaviors and Cardiometabolic Risk, an Isotemporal Substitution Analysis
Evidence suggests that time spent engaging in sedentary behaviors is associated with a greater risk of adverse cardiometabolic outcomes. We investigated the cross-sectional associations of 6 unique sedentary tasks (watching television, using the computer, completing paperwork, reading, talking on the…
Expanded algorithm for managing patients with acute decompensated heart failure.
Heart failure is a complex disease process, the manifestation of various cardiac and noncardiac abnormalities. General treatment approaches for heart failure have remained the same over the past decades despite the advent of novel therapies and monitoring modalities. In the…
Rationale and design of the comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode (PIONEER-HF) trial.
OBJECTIVE: The objective is to assess the safety, tolerability, and efficacy of sacubitril/valsartan compared with enalapril in patients with heart failure (HF) with a reduced ejection fraction (EF) stabilized during hospitalization for acute decompensated HF.BACKGROUND: Sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin…
Network and Infrastructure Support for Development of Interdisciplinary Aging Research
For adults aged 40 to 75 years, randomized trials provide conclusive evidence that statins reduce the risk of initial and secondary cardiovascular disease (CVD) events. However, there is limited evidence that statins reduce CVD events in individuals over the age…
An Observational Study of Cardiovascular Risks Associated with Rheumatoid Arthritis Therapies: A Comparison of Two Analytical Approaches
Comparative safety studies typically use hierarchical treatment categories that lump monotherapy and combination therapy. The consequence of this approach on study results is not clear. For example, studies of tumor necrosis factor inhibitors usually lump users regardless of whether they…
A cohort study of maternal cardiometabolic risk factors and primary cesarean delivery in an integrated health system
Maternal cardiometabolic risk factors (i.e., hyperglycemia, pre-existing hypertension and high body mass index) impact fetal growth and risk of having a cesarean delivery. However, the independent and joint contribution of maternal cardiometabolic risk factors to primary cesarean section is unclear.…
Novel genetic associations for blood pressure identified via gene-alcohol interaction in up to 570K individuals across multiple ancestries
Heavy alcohol consumption is an established risk factor for hypertension; the mechanism by which alcohol consumption impact blood pressure (BP) regulation remains unknown. We hypothesized that a genome-wide association study accounting for gene-alcohol consumption interaction for BP might identify additional…
Associations between ACE-Inhibitors, Angiotensin Receptor Blockers, and Lean Body Mass in Community Dwelling Older Women
Studies suggest that ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) may preserve skeletal muscle with aging. We evaluated longitudinal differences in lean body mass (LBM) among women diagnosed with hypertension and classified as ACE-I/ARB users and nonusers among Women's Health…
Changes in Biomarker Profile and Left Ventricular Hypertrophy Regression: Results from the Frequent Hemodialysis Network Trials
Regression of left ventricular hypertrophy (LVH) is feasible with more frequent hemodialysis (HD). We aimed to ascertain pathways associated with regression of left ventricular mass (LVM) in patients enrolled in the Frequent HD Network (FHN) trials. This was a post…
Patient-reported adherence to statin therapy, barriers to adherence, and perceptions of cardiovascular risk
Patient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy. We examined these factors and their associations with adherence. We conducted telephone interviews among…
Real-World Effectiveness of a Medically Supervised Weight Management Program in a Large Integrated Health Care Delivery System: Five-Year Outcomes
There are insufficient data on the long-term, nonsurgical, nonpharmacologic treatment of obesity. To determine changes in weight over 5 years in participants enrolled between April 1, 2007, and December 31, 2014, in a medically supervised weight management program at Kaiser…
Serum cholesterol trajectories in the 10 years prior to lymphoma diagnosis
Many studies suggest a role for cholesterol in cancer development. Serum cholesterol levels have been observed to be low in newly diagnosed lymphoma cases. The objective of these analyses was to examine the time-varying relationship of cholesterol with lymphomagenesis in…
Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System
Faster treatment with intravenous alteplase in acute ischemic stroke is associated with better outcomes. Starting in 2015, Kaiser Permanente Northern California redesigned its acute stroke workflow across all 21 Kaiser Permanente Northern California stroke centers to (1) follow a single…
MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease: cohort recruitment and baseline characteristics
MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease (MINERVA) was designed to answer the question of whether a novel continuous breast arterial calcification (BAC) mass score improves cardiovascular risk stratification among asymptomatic postmenopausal women. This article describes recruitment…
Prospective Postmarketing Surveillance of Acute Myocardial Infarction in New Users of Saxagliptin: A Population-Based Study
The cardiovascular safety of saxagliptin, a dipeptidyl-peptidase 4 inhibitor, compared with other antihyperglycemic treatments is not well understood. We prospectively examined the association between saxagliptin use and acute myocardial infarction (AMI). We identified patients aged ≥18 years, starting from the…
Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study
While poor performance during a maximal graded exercise test (GXT) predicts cardiovascular events and premature mortality, the potential clinical importance of non-participation in a GXT, either for medical or non-medical reasons, is currently unknown. Data are from 4086 and 3547…
Use of iDXA spine scans to evaluate total and visceral abdominal fat
Abdominal fat may be a better predictor than body mass index (BMI) for risk of metabolically-related diseases, such as diabetes, cardiovascular disease, and some cancers. We sought to validate the percent fat reported on dual energy X-ray absorptiometry (DXA) regional…
Outcomes of Dabigatran and Warfarin for Atrial Fibrillation in Contemporary Practice: A Retrospective Cohort Study
Dabigatran (150 mg twice daily) has been associated with lower rates of stroke than warfarin in trials of atrial fibrillation, but large-scale evaluations in clinical practice are limited. To compare incidence of stroke, bleeding, and myocardial infarction in patients receiving…
Population-based study of ischemic stroke risk after trauma in children and young adults
To quantify the incidence, timing, and risk of ischemic stroke after trauma in a population-based young cohort. We electronically identified trauma patients (
CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management
Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting…
Short-Term Outcomes and Factors Associated With Adverse Events Among Adults Discharged From the Emergency Department After Treatment for Acute Heart Failure
Although 80% of patients with heart failure seen in the emergency department (ED) are admitted, less is known about short-term outcomes and demand for services among discharged patients. We examined adult members of a large integrated delivery system who visited…
Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer
To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. We leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United…
Contemporary rates and correlates of statin use and adherence in nondiabetic adults with cardiovascular risk factors: The KP CHAMP study
Statin therapy is highly efficacious in the prevention of fatal and nonfatal atherosclerotic events in persons at increased cardiovascular risk. However, its long-term effectiveness in practice depends on a high level of medication adherence by patients. We identified nondiabetic adults…
Understanding the relation between socioeconomic position and inflammation in post-menopausal women: education, income and occupational prestige
The role of occupational prestige, a direct measure of the perceived status of job and job holder, in inflammation is unknown. To contribute to understanding the pathways by which socioeconomic position (SEP) is associated with inflammation, we aimed to estimate…
Visit-to-Visit Blood Pressure Variability in Young Adulthood and Hippocampal Volume and Integrity at Middle Age: The CARDIA Study (Coronary Artery Risk Development in Young Adults)
The aims of this study are to assess the relationships of visit-to-visit blood pressure (BP) variability in young adulthood to hippocampal volume and integrity at middle age. We used data over 8 examinations spanning 25 years collected in the CARDIA…
Predicting Readmission After Stroke Study (PRESS)
Hospital readmissions are a tremendous burden on patients, their families, and the health care system. In 2008, the Centers for Medicare and Medicaid Services began publicly reporting hospital-level, risk-standardized, 30-day readmission and mortality rates for acute myocardial infarction and heart…
Posttraumatic stress disorder onset and inflammatory and endothelial function biomarkers in women
BACKGROUND: Research has linked posttraumatic stress disorder (PTSD) with higher circulating levels of inflammatory and endothelial function (EF) biomarkers, and effects may be bidirectional. We conducted the first investigation of new-onset PTSD and changes in inflammatory and EF biomarkers.METHODS: Data…
Comparison of Inappropriate Shocks and Other Health Outcomes Between Single- and Dual-Chamber Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter-Defibrillators
In US clinical practice, many patients who undergo placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death receive dual-chamber devices. The superiority of dual-chamber over single-chamber devices in reducing the risk of inappropriate ICD shocks in…
Hispanic Chronic Renal Insufficiency Cohort (HCRIC) Study
This is a renewal of an ongoing ancillary study to the Chronic Renal Insufficiency Cohort (CRIC) Study to examine whether rates of loss of kidney function and subclinical and clinical cardiovascular disease varies among Hispanics versus other race/ethnic groups, after…