Inflammation and sudden cardiac death in a community-based population of older adults: The Cardiovascular Health Study

Heart Rhythm ◽  
2013 ◽  
Vol 10 (10) ◽  
pp. 1425-1432 ◽  
Author(s):  
Ayman A. Hussein ◽  
John S. Gottdiener ◽  
Traci M. Bartz ◽  
Nona Sotoodehnia ◽  
Christopher DeFilippi ◽  
...  
Keyword(s):  
Older Adults ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Community Based

Abstract 30: Global Electrical Heterogeneity on Electrocardiogram is Associated with Sudden Cardiac Death After Adjustment for Ejection Fraction

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Larisa G Tereshchenko ◽  
Jonathan Waks ◽  
Mary Biggs ◽  
Colleen Sitlani ◽  
Muammar Kabir ◽  
...  
Keyword(s):  
Older Adults ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Cardiovascular Health ◽  
Cox Regression ◽  
Middle Age ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Conduction Delay ◽  
Delay Model

Introduction: Electrocardiographic (ECG) measures of myocardial global electrical heterogeneity (GEH) are associated with sudden cardiac death (SCD) in middle-age adults. Hypothesis: We hypothesized that time-updated ECG GEH measures are associated with SCD in elderly adults after LVEF adjustment. Methods: We analyzed data from 2 prospective cohorts: The Atherosclerosis Risk in Communities (ARIC, n=15,366; mean age 54.1±5.8 y; 44.6% male; 73.2% white) and the Cardiovascular Health Study (CHS, n=5,016; mean age 72.8±5.6 y; 43.1% male; 95.3% white). Mean spatial QRS-T angle, azimuth, elevation, and magnitude of spatial ventricular gradient (SVG), and sum absolute QRST integral (SAI QRST) were calculated from digital 12-lead ECGs and analyzed as baseline variables in ARIC and as time-updated longitudinal variables in CHS (measured yearly at 10 consecutive visits). The primary outcome was adjudicated SCD. Cox regression models were constructed: Model 1 adjusted for age, sex and race. Model 2 further adjusted for cardiovascular disease, beta-blocker use, creatinine, BMI, hypertension, diabetes, smoking, total cholesterol, HDL, triglycerides, physical activity and alcohol use. Model 3 included Model 2 variables and heart rate, QTc, LV hypertrophy and bundle branch block or intra-ventricular conduction delay. Model 4 in CHS included all Model 3 variables plus baseline LVEF and time-updated incident HF and coronary heart disease. Results: During median 13-14 y of follow-up SCD incidence was 1.51 (95%CI 1.35-1.69) per 1,000 person-yrs in ARIC, and 2.78 (95%CI 2.41-3.21) per 1,000 person-yrs in CHS. In both cohorts (Table) QRS-T angle, SVG and SAI QRST were associated with SCD. Among older adults (CHS), longitudinal SAI QRST, QRS-T angle and SVG magnitude were associated with SCD independent of LVEF. Conclusions: Baseline and longitudinal GEH ECG parameters are independently associated with SCD in middle-age and older adults, respectively. In older adults, GEH ECG parameters provide information on SCD risk beyond LVEF.

Abstract P122: Plasma Fatty Acid Binding Protein 4 is Associated with the Incidence of Sudden Cardiac Death in Non-Diabetic Adults in the Cardiovascular Health Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Luc Djousse ◽  
Marlena Maziarz ◽  
Mary L Biggs ◽  
Joachim H Ix ◽  
Jorge R Kizer ◽  
...  
Keyword(s):  
Older Adults ◽  
Fatty Acid ◽  
Cardiac Death ◽  
Fatty Acid Binding Protein ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Fatty Acid Binding ◽  
Acid Binding Protein ◽  
Diabetes Status

Background: Fatty acid binding protein 4 (FABP4) is an adipokine that plays a role in lipid transport. Previous studies have reported that FABP4 may increase the risk of diabetes and exert negative inotropy on the myocardium. It is unknown whether plasma FABP4 is associated with the risk of sudden cardiac death (SCD). Objective: To test the hypothesis that plasma FABP4 is associated with a higher incidence of SCD in older adults and determine if diabetes status modifies this association. Methods: We prospectively analyzed data on 4,564 men and women aged 65+ years from the Cardiovascular Health Study. FABP4 was measured at baseline using ELISA and SCD events were adjudicated through review of medical records (inter-reviewer agreement of 88% and kappa of 0.74). We used Cox proportional hazards model to examine the association between FABP4 and SCD. Results: During a median follow up of 11.8 years, 146 new cases of SCD occurred. In a multivariable model adjusting for age, sex, race, clinic, education, glomerular filtration rate based on cystatin C, high-sensitive C-reactive protein, leisure time physical activity, hormone replacement therapy, alcohol intake, self-reported general health status, smoking, prevalent coronary heart disease, and prevalent heart failure, each higher standard deviation (SD) of plasma FABP4 was associated with a non-significant 14% (95% CI: -5% to 37%) higher risk of SCD. When stratified by prevalent diabetes status, FABP4 was associated with a higher risk of SCD in non-diabetic participants, [HR per SD of FABP4: 1.37 (95% CI: 1.11-1.67)] but not in diabetic participants [HR per SD of FABP4: 0.77 (95% CI: 0.52-1.15)], p for diabetes-FABP4 interaction was 0.026. Conclusion: A single measure of plasma FABP4 obtained later in life was associated with a higher risk of SCD among older adults without diabetes but not among those with diabetes. If confirmed in other studies, these data may point to novel mechanisms and opportunities for SCD prevention.

scholarly journals Longitudinal Measures of Trimethylamine N-oxide and Incident Atherosclerotic Cardiovascular Disease Events in Older Adults: The Cardiovascular Health Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1434-1434
Author(s):  
Yujin Lee ◽  
Zeneng Wang ◽  
Heidi Lai ◽  
Marcia de Oliveira Otto ◽  
Rozenn Lemaitre ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Renal Function ◽  
Cystatin C ◽  
Impaired Renal Function ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Atherosclerotic Cardiovascular Disease ◽  
Community Based

Abstract Objectives Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite of dietary choline, L-carnitine and phosphatidylcholine-rich animal foods. Based on experimental studies and cohorts with prevalent disease, elevated TMAO may increase risk of atherosclerotic cardiovascular disease (ASCVD). TMAO is also renally cleared and may interact with and causally contribute to renal dysfunction and elevated cystatin-C. Yet, the associations of serial TMAO levels with incident ASCVD in a community-based prospective cohort, and the potential mediating and modifying role of renal function, are not established. Methods We investigated the associations of serial measures of plasma TMAO, assessed at baseline and 7 years post baseline, with incident ASCVD among 4144 older adults in the Cardiovascular Health Study (CHS). TMAO was measured using stable isotope dilution LC/MS/MS (lab CV <6%). Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, sudden cardiac death, or other atherosclerotic death) was centrally adjudicated using medical records. Risk was assessed by multivariable Cox proportional hazards regression including time-varying demographics, lifestyle factors, medical history, and laboratory and dietary variables. We assessed potential mediating effects and interaction by renal function estimated by cystatin-C. Results During a median 15 years follow-up, 1757 ASCVD events occurred. After multivariable adjustment, TMAO was associated with a higher risk of ASCVD, with an extreme quintile HR (95% CI) of 1.22 (1.04, 1.44), P-trend = 0.01. This relationship appeared further mediated or confounded by estimated glomerular filtration rate (eGFR): adjusting for cystatin-C-based eGFR, the HR (95% CI) was 1.06 (0.98–1.25). Significant interaction was also observed by renal function (P-interaction < 0.001), with TMAO associated with higher risk of ASCVD among individuals with impaired renal function (eGFR ≤ 60) [1.63 (1.03–2.59)], but not normal baseline renal function (eGFR > 60) [1.15 (0.96–1.37)], even with further adjustment for continuous eGFR. Conclusions In this large community-based cohort of older US adults, higher serial measures of TMAO were associated with an elevated risk of ASCVD, in particular among those with impaired renal function. Funding Sources NIH, NHLBI.

scholarly journals N-terminal pro-B-type natriuretic peptide is associated with sudden cardiac death risk: the Cardiovascular Health Study

Heart Rhythm ◽  
2011 ◽  
Vol 8 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Kristen K. Patton ◽  
Nona Sotoodehnia ◽  
Christopher DeFilippi ◽  
David S. Siscovick ◽  
John S. Gottdiener ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Natriuretic Peptide ◽  
Cardiac Death ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Death Risk ◽  
Sudden Cardiac Death Risk

Abstract P027: Time-updated Premature Ventricular Contractions on 12-lead ECG Are Associated With the Risk of Sudden Cardiac Death: Atherosclerosis Risk in Communities Study and Cardiovascular Health Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Abhishek Maan ◽  
David M German ◽  
Aron Bender ◽  
Srini V Mukundan ◽  
Colleen Sitlani ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Cardiovascular Health ◽  
Competing Risk ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Premature Ventricular Contractions ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

Introduction: The association between premature ventricular contractions (PVCs) and Sudden Cardiac Death (SCD) remains controversial. Hypothesis: We hypothesized that PVCs are associated with SCD. Methods: Presence of PVCs was detected on 12-lead ECG recorded at baseline or any of 4 follow-up visits in 15,667 participants (pts) (mean age: 54.2 + 5.8 Yrs; 55% female; 73% Whites) of the Atherosclerosis Risk in Communities (ARIC) study. For validation cohort, we included baseline and 9 follow-up visits ECG data in 5,846 pts (mean age: 72.8+ 5.6 yrs; 57.7% female, 84.2% whites) from Cardiovascular Health Study (CHS). Competing risk analyses models were constructed to test the association between time-updated PVCs and SCD risk. Model 1 was adjusted for age, sex, race and study center. Model 2 in addition was adjusted for time-updated coronary heart disease, heart failure, atrial fibrillation, stroke, and hypertension. Results: In ARIC pts, across all study visits, PVCs were observed in 2.6% of the ECGs; 99.7% of pts were PVC-free at least once; 8.8% of pts had PVC at least once. 97.7% of pts without PVCs remained PVC-free at the next visit; 19.1% of pts with detected PVC had PVC at the next visit; 2.4% of pts who were PVC-free on previous ECG, transitioned to having PVC on subsequent visit ECG. In CHS, across all 10 yearly study visits, on average, PVC was observed on 4.85% of ECG recordings; 99.4% of participants were PVC-free at least once; 21.9% of pts had PVC at least once. 96.4% of PVC-free pts remained free from PVC at the next visit. 30.6% of pts with detected PVC on a given ECG had PVC at the next visit. 3.6% of pts who did not have PVC on previous ECG, transitioned to having PVC at the next visit. 69.4% of pts with PVC on a given ECG transitioned to being PVC-free next year. In adjusted competing risk analysis PVC was associated with SCD, but not with non-sudden cardiac death or non-cardiac death (Table). Conclusions: Time-updated presence of PVC on a short 10-sec resting 12-lead ECG is associated with SCD.

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