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  • Online Resource  (8)
  • Ovid Technologies (Wolters Kluwer Health)  (8)
  • Appiah, Duke  (8)
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  • Online Resource  (8)
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  • Ovid Technologies (Wolters Kluwer Health)  (8)
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  • 1
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 4 ( 2023-4), p. 393-400
    Abstract: Maternal age at last birth of child is increasing in the United States, and it has been reported to influence future chronic diseases. In this study of nationally-representative sample of postmenopausal women, there was no conclusive association between maternal age at last birth of child and cardiovascular disease mortality later in life. Objective Maternal age at last birth (ALB) of child is increasing in the United States, and it has been reported to influence future chronic diseases. However, the relationship of ALB and cardiovascular disease (CVD) events later in life has not been widely studied. We evaluated the association of ALB with CVD mortality. Methods Data were from 7,971 parous postmenopausal women older than 45 years who participated in the US National Health and Nutritional Examination Survey from 1999 to 2018 and had mortality follow-up data through to December 31, 2019. ALB was self-reported, whereas CVD mortality was assessed using International Classification of Diseases codes. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results The mean age of participants was 63 ± 9.8 years, with 9.5% being non-Hispanic Black, 9.7% being Hispanic women, and 21% reporting ALB ≥35 years. During a median follow-up of 8.1 years, 443 participants died from CVD. In age-adjusted models, CVD mortality was elevated for women with ALB of 〈 25 years (HR, 1.68; 95% CI, 1.23-2.29) and ALB of ≥35 years (HR, 1.37; 95% CI, 1.00-1.88). However, after additional adjustment for race and ethnicity, foreign born, education, marital status, poverty income ratio, parity, smoking status, age at menarche, oral contraceptive pills use and family history of myocardial infarction, these estimates were attenuated resulting in no association between ALB and CVD mortality. Conclusions In this study of nationally representative sample of postmenopausal women, there was no conclusive association between maternal ALB and CVD mortality later in life.
    Type of Medium: Online Resource
    ISSN: 1072-3714
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2071114-1
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  • 2
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. suppl_1 ( 2016-03)
    Abstract: Introduction: The association of surgical and natural menopause (SM and NM, respectively) with CVD outcomes is controversial. We assessed the hypothesis that CVD risk factor levels antecedent to menopause explain differences in future left ventricular (LV) structure and function parameters rather than type of menopause. Methods: We studied 825 premenopausal women (49% black) from the CARDIA study in 1990-1991 (baseline, mean age: 32 years) who later reached menopause by 2010-2011 and had echocardiographs at these two time points. Results: During 20 years of follow up, 508 women reached NM while 317 underwent SM (34% with bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have higher mean values of systolic blood pressure, body mass index as well as lower mean HDL cholesterol, physical activity, parity and years of education. With the exception of race, no statistically significant differences were found by ovarian status among women with SM. In 1990-1991, no differences in LV structure and function were found between women who later reach NM or SM. In 2010-2011, women with SM had significantly higher LV mass, LV mass/volume ratio, E/e’ ratio, and impaired longitudinal and circumferential strain than women with NM (Table 1). No significant differences in these measures were found among SM by ovarian status. Controlling for baseline echocardiographic parameters, demographics, BMI, physical activity, parity, smoking, systolic blood pressure and age at menarche in linear regression models attenuated these differences between groups (Table 1). Further adjustment for age at menopause and hormone therapy use did not change these results. Conclusion: In this study, presurgical CVD risk factors among women with SM attenuated the adverse postsurgical measures of LV structure and function found among such women. These data suggest that premenopausal CVD risk factors rather than gynecologic surgery predispose women with SM to elevated future CVD risk.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1466401-X
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  • 3
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 5 ( 2022-03-25), p. 564-572
    Abstract: The association between menopause and incident cardiovascular disease (CVD) is controversial. We evaluated the relationships of estrogen deficiency (ovarian reproductive aging) assessed by age at natural menopause (ANM), chronological aging, and antecedent CVD risk factors (biological aging) with left ventricular (LV) structure and function among women transitioning from pre- to postmenopause. Methods: We studied 771 premenopausal women (37% Black) from the Coronary Artery Risk Development in Young Adults Study with echocardiographic data in 1990 to 1991 (mean age: 32 y) who later reached natural menopause by 2015 to 2016 and had repeated echocardiographic measurements. Linear regression models were used to evaluate the association of ANM with parameters of LV structure and function. Results: Mean ANM was 50 (± 3.8) years and the average time from ANM to the last echocardiograph was 7 years. In cross-sectional analyses, a 1-year increase in ANM was significantly associated with lower postmenopausal LV mass (LVM), LVM indexed to body surface area, LV mass-to-volume ratio, and relative wall thickness. In age-adjusted longitudinal analyses, higher ANM was inversely associated with pre- to postmenopausal changes in LVM (β = –0.97; 95% CI: –1.81 to –0.13, P  = 0.024) and LVM indexed (β = –0.48; 95% CI: –0.89 to –0.07, P  = 0.021). Controlling for baseline LV structure parameters and traditional CVD risk factors attenuated these associations. Further adjustment for hormone therapy uses did not alter these results. Conclusion: In this study, premenopausal CVD risk factors attenuated the association of ANM with changes in LV structure parameters. These data suggest that premenopausal CVD risk factors may predispose women to elevated future CVD risk more than ovarian aging.
    Type of Medium: Online Resource
    ISSN: 1530-0374
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2071114-1
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  • 4
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 24, No. 11 ( 2017-11), p. 1269-1276
    Abstract: To evaluate the association between surgical menopause (SM) versus natural menopause (NM) in relation to later left ventricular (LV) structure and function, while taking into account the LV parameters and other cardiovascular disease risk factor (CVDRF) levels that predate the menopausal transition. Methods: We studied 825 premenopausal women from the Coronary Artery Risk Development in Young Adults study in 1990 to 1991 (baseline, mean age 32 years) who later reached menopause by 2010 to 2011 and had echocardiograms at these two time points. Results: During 20 years of follow-up, 508 women reached NM, whereas 317 underwent SM (34% had bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have greater parity, and higher mean values of systolic blood pressure, body mass index, and also lower mean high-density lipoprotein cholesterol and physical activity than women who reached NM. No significant differences in LV structure/function were found between groups. In 2010 to 2011, SM women had significantly higher LV mass, LV mass/volume ratio, E/e’ ratio, and impaired longitudinal and circumferential strain than NM women. SM women with bilateral oophorectomy had adverse LV measures than women with hysterectomy with ovarian conservation. Controlling for baseline echocardiographic parameters and CVDRF in linear regression models eliminated these differences between groups. Further adjustment for age at menopause/surgery and hormone therapy use did not change these results. Conclusion: In this study, the adverse LV structure and function observed among women with SM compared with NM were explained by their unfavorable presurgical CVDRF profiles, suggesting that premenopausal CVDRF rather than gynecologic surgery predispose SM women to elevated future cardiovascular disease risk.
    Type of Medium: Online Resource
    ISSN: 1072-3714 , 1530-0374
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2071114-1
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  • 5
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 27, No. 6 ( 2020-03-02), p. 658-667
    Type of Medium: Online Resource
    ISSN: 1530-0374
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2071114-1
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  • 6
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. Suppl_1 ( 2022-03)
    Abstract: Background: While endogenous estrogen deficiency in men due to inactivating mutations of the aromatase gene results in profound metabolic dysfunction, evidence for the association of estradiol with cardiovascular disease (CVD) in men overall is inconsistent, with most studies performed among older men or patients with CVD. We investigated the association of total estradiol (E2) or free estradiol (FE2) and CVD mortality in a nationally representative sample of US men. Hypothesis: Low levels of E2 or FE2 will be associated with elevated risk of CVD mortality. Methods: Data on 954 men without CVD, cancer, diabetes and not on androgen therapy or taking anabolic steroids who participated in Phase 1 (1988 to 1991) of the third National Health and Nutrition Examination Survey and for whom E2 was measured, and were followed for mortality through to December 31, 2015 were included. Fasting serum levels of E2 were measured using competitive electrochemiluminescence immunoassays. Free estradiol was estimated from estradiol, sex hormone binding globulin, and albumin. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: The average age of participants at baseline was 35.7 (Standard deviation (SD) ±11.6) years with 11% and 6% of them reporting Black and Hispanic race and ethnicity, respectively. During a median follow-up of 25.2 years, 40 CVD deaths were recorded, with the cumulative incidence greater among men with low E2 or FE2 (Figure). Controlling for baseline age, race/ethnicity, education, systolic blood pressure, body mass index, physical activity, smoking status, alcohol intake, HDL cholesterol, c-reactive protein and total testosterone levels, a 1 log SD decrease in E2 (HR: 2.38, 95%CI: 1.11-5.00) or FE2 (HR: 1.96, 95%CI: 1.03-3.70) was associated with elevated CVD mortality. Conclusions: In this nationally representative sample of U.S young and middle-aged men, low levels of total estradiol or free estradiol were associated with elevated risk for CVD mortality.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 7
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Background: The association between variability in body mass index (BMI) in early adulthood and cardiac structure and function in midlife has not been previously examined. Methods: We examined 2371 Coronary Artery Risk Development in Young Adults (CARDIA) participants who had BMI assessments across 25-years (CARDIA exam year 0 [1985-1986], 2 [1987-1989] , 5 [1990-1991], 7 [1992-1993] , 10 [1995-1996], 15 [2000-2001] , 20 [2005-2006], and 25 [2010-2011] ) as well as echocardiography data at the year-25 exam (2010-2011). BMI variability was assessed by standard deviation (SD) across 25 years. Adjusted multivariable linear regression models were used to assess the association between echocardiography variables (dependent variable) and SD of BMI (independent variable). Model 1 was adjusted for standard cardiac risk factors (age, sex, race, education, blood pressure, anti-hypertension medication use, smoking, fasting plasma glucose, alcohol consumption, physical activity, HDL and total cholesterol. Model 2 was additionally adjusted for mean BMI. Results: Among participants included in the analysis, mean [SD] age at the year 25 exam [2010-2011] was 50.4 [3.6] years; 44.5% were men; and 41.3% were black). In model 1, greater SD of BMI was associated with greater left ventricular mass (β 5.18g, p 〈 0.001), left ventricular global longitudinal strain 0.08, p=0.01, and left atrial volume (β 1.60ml, p 〈 0.001). Additional adjustment for mean BMI, attenuated associations (p 〉 .05 for all). Greater SD of BMI was associated with worse diastolic function (E/é) (β 0.11, p 〈 0.001). Observed association between BMI variability and E/é persisted even after accounting for mean BMI (β 0.08, p=0.01). Conclusions: Greater body weight variability in young adulthood was associated with modest unfavorable midlife alterations in diastolic function.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
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  • 8
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 76, No. 2 ( 2020-08), p. 404-409
    Abstract: Recent evidence links long-term (visit-to-visit) blood pressure (BP) variability to the risk of cardiovascular disease, independent of mean BP levels. Potential associations between long-term BP variability and cardiovascular disease risk may be reflected in early life course alterations in coronary artery calcium (CAC) and carotid intima-media thickness. We evaluated 2482 CARDIA study (Coronary Artery Risk Development in Young Adults) participants (mean [SD] age at the year 20 exam [2005–2006] was 45.4 [3.6] years, 43.2% men, and 41.3% black). We included participants with BP assessments across 20-years (year 0, 2, 5, 7, 10, 15, 20 exams) and carotid intima-media thickness and CAC data at the year 20 exam. BP variability was assessed using variability independent of the mean and SD. Adjusted multivariable linear or logistic regression models (as appropriate) were used to assess associations between long-term BP variability measures and carotid intima-media thickness. and CAC (ln [CAC+1] and prevalent CAC). Long-term systolic BP variability independent of the mean (per 1 SD) was positively associated with carotid intima-media thickness (β=10 μm, SE=3, P =0.002). Similarly, long-term diastolic BP variability independent of the mean was associated with carotid intima-media thickness (β=10 μm, SE (3), P =0.001). Long-term BP variability was not associated with either ln [CAC+1] or prevalent CAC. Long-term systolic and diastolic BP variability acr oss early adulthood was positively associated with modest adverse midlife alterations in carotid intima-media thickness but not to CAC. Our findings provide further insights into pathophysiologic mechanisms that link long-term BP variability to cardiovascular disease.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2094210-2
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