Yash R. Patel

Adherence to healthy lifestyle factors and risk of death in men with diabetes mellitus: The Physicians' Health Study

BACKGROUND & AIMSnThe relationship between healthy lifestyle factors and mortality in people with type 2 diabetes is unclear. The purpose of this study was to examine whether healthy lifestyle factors are associated with mortality in people with type 2 diabetes.nnnMETHODSnWe prospectively studied 1163 men with type 2 diabetes from the Physicians Health Study. Lifestyle factors consisted of currently not smoking, moderate drinking (1-2 drinks/day), vigorous exercise (1+/week), BMIxa0<xa025xa0kg/m2, and being in the top 2 quintiles of the alternate healthy eating index-2010 (AHEI-2010). Multivariate Cox regression models were used to estimate hazard ratios (95% confidence intervals) of mortality.nnnRESULTSnAt baseline, average age was 69 years and mean follow up was 9 years. About 22% of study participants had ≤1 healthy lifestyle factor, 37% had two, 29% had three, and 12% had four or more healthy lifestyle factors. An inverse relationship was found between the number of lifestyle factors and total mortality. Compared with participants who had ≤1 healthy lifestyle factor, the risk of death was 42% (95% CI; 19%-58%) lower for those with two healthy lifestyle factors, 41% (95% CI; 18%-58%) lower for those with three, and 44% (95% CI; 12%-64%) lower for those with 4 or more healthy lifestyle factors.nnnCONCLUSIONnAdherence to modifiable healthy lifestyle factors is associated with a lower risk of death among adult men with type 2 diabetes. Our study emphasizes the importance of educating individuals with diabetes to adhere to healthy lifestyle factors.

Coffee consumption and calcified atherosclerotic plaques in the coronary arteries: The NHLBI Family Heart Study

BACKGROUND & AIMSnWhile a recent meta-analysis of prospective studies reported that coffee consumption is associated with a lower risk of cardiovascular disease mortality, limited and inconsistent data are available on the relation of coffee intake with subclinical disease. Thus, the aim of the present study was to see the association of coffee consumption with the prevalence of atherosclerotic plaque in the coronary arteries in NHLBI Family Heart Study.nnnMETHODSnIn a cross-sectional design, we studied 1929 participants of the NHLBI Family Heart Study without known coronary heart disease. Coffee consumption was assessed by a semi-quantitative food frequency questionnaire and coronary-artery calcium (CAC) was measured by cardiac computed tomography. We defined prevalent CAC as an Agatston score of ≥100 and used generalized estimating equations to calculate prevalence ratios of CAC as well as a sensitivity analysis at a range of cutpoints for CAC.nnnRESULTSnMean age was 56.7 years and 59% of the study subjects were female. In adjusted analysis for age, sex, BMI, smoking, alcohol, physical activity, field center, and energy intake, prevalence ratio (95% CI) for CAC was 1.0 (reference), 0.92 (0.57-1.49), 1.34 (0.86-2.08), 1.30 (0.84-2.02), and 0.99 (0.60-1.64) for coffee consumption of almost never, <1/day, 1/day, 2-3/day, and ≥4 cups/day, respectively. In a sensitivity analysis, there was no evidence of association between coffee consumption and prevalent CAC when CAC cut points of 0, 50, 150, 200, and 300 were used.nnnCONCLUSIONSnThese data do not provide evidence for an association between coffee consumption and prevalent CAC in adult men and women.

Walking and Calcified Atherosclerotic Plaque in the Coronary Arteries

Objective— Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification. Approach and Results— In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ⩽3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35–0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52–0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36–0.81) for >15 to 22.5 Met-h/wk, (P trend=0.01). The walking–CAC relationship remained significant for those with body mass index ≥25 (P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking–aortic calcification association was not significant. Conclusions— Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.Objective— Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification.nnApproach and Results— In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ≤3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35–0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52–0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36–0.81) for >15 to 22.5 Met-h/wk, ( P trend=0.01). The walking–CAC relationship remained significant for those with body mass index ≥25 ( P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking–aortic calcification association was not significant.nnConclusions— Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.nn# Highlights {#article-title-39}

Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction

Background The purpose of this study was to evaluate the relationship between serum sodium at the time of diagnosis and long term clinical outcomes in a large national cohort of patients with heart failure with preserved ejection fraction. Methods and Results We studied 25 440 patients with heart failure with preserved ejection fraction treated at Veterans Affairs medical centers across the United States between 2002 and 2012. Serum sodium at the time of heart failure diagnosis was analyzed as a continuous variable and in categories as follows: low (115.00–134.99 mmol/L), low‐normal (135.00–137.99 mmol/L), referent group (138.00–140.99 mmol/L), high normal (141.00–143.99 mmol/L), and high (144.00–160.00 mmol/L). Multivariable Cox regression and negative binomial regression were performed to estimate hazard ratios (95% confidence interval [CI]) and incidence density ratios (95% CI) for the associations of serum sodium with mortality and hospitalizations (heart failure and all‐cause), respectively. The average age of patients was 70.8 years, 96.2% were male, and 14% were black. Compared with the referent group, low, low‐normal, and high sodium values were associated with 36% (95% CI, 28%–44%), 6% (95% CI, 1%–12%), and 9% (95% CI, 1%–17%) higher risk of all‐cause mortality, respectively. Low and low‐normal serum sodium were associated with 48% (95% CI, 10%–100%) and 38% (95% CI, 8%–77%) higher risk of number of days of heart failure hospitalizations per year, and with 44% (95% CI, 32%–56%) and 18% (95% CI, 10%–27%) higher risk of number of days of all‐cause hospitalizations per year, respectively. Conclusions Both elevated and reduced serum sodium, including values currently considered within normal range, are associated with adverse outcomes in patients with heart failure with preserved ejection fraction.

Development and validation of a heart failure with preserved ejection fraction cohort using electronic medical records

BackgroundHeart failure (HF) with preserved ejection fraction (HFpEF) comprises nearly half of prevalent HF, yet is challenging to curate in a large database of electronic medical records (EMR) since it requires both accurate HF diagnosis and left ventricular ejection fraction (EF) values to be consistently ≥50%.MethodsWe used the national Veterans Affairs EMR to curate a cohort of HFpEF patients from 2002 to 2014. EF values were extracted from clinical documents utilizing natural language processing and an iterative approach was used to refine the algorithm for verification of clinical HFpEF. The final algorithm utilized the following inclusion criteria: any International Classification of Diseases-9 (ICD-9) code of HF (428.xx); all recorded EF ≥50%; and either B-type natriuretic peptide (BNP) or aminoterminal pro-BNP (NT-proBNP) values recorded OR diuretic use within one month of diagnosis of HF. Validation of the algorithm was performed by 3 independent reviewers doing manual chart review of 100 HFpEF cases and 100 controls.ResultsWe established a HFpEF cohort of 80,248 patients (out of a total 1,155,376 patients with the ICD-9 diagnosis of HF). Mean age was 72xa0years; 96% were males and 12% were African-Americans. Validation analysis of the HFpEF algorithm had a sensitivity of 88%, specificity of 96%, positive predictive value of 96%, and a negative predictive value of 87% to identify HFpEF cases.ConclusionWe developed a sensitive, highly specific algorithm for detecting HFpEF in a large national database. This approach may be applicable to other large EMR databases to identify HFpEF patients.

Efficacy of spinal cord stimulation as an adjunct therapy for chronic refractory angina pectoris

INTRODUCTIONnPatients with chronic refractory angina whose symptoms are not controlled with conventional therapies have a poor quality of life. Adjunctive therapies, such as spinal cord stimulation (SCS) may be considered in these cases. We sought to examine whether SCS is associated with changes in exercise capacity and angina severity in these patients.nnnMETHODSnWe searched Pubmed, Medline and other databases until December 2015. Two reviewers independently extracted data and assessed risk of bias. Exercise capacity included exercise duration and rate pressure product, determined via an exercise test. Angina severity included daily angina frequency and nitrate consumption.nnnRESULTSnA total of 518 participants (1048.25 person-years of follow-up), from 14 studies met our inclusion criteria. The mean age was 66.8years and 68.5% were men. SCS implant duration ranged from 3weeks to 5years (median: 6months). Using random effects meta-analysis, we found that SCS was associated with a higher exercise duration (1.90min, 95% CI 1.71, 2.06) and lower angina severity, 1.55 less daily angina episodes, (95% CI -1.75, -1.33), 1.54 less daily nitrates consumed, (95% CI -1.81, -1.26), and a 22 points higher SF-36 angina frequency score (95% CI 10.76, 32.81; p<0.0001) on follow-up. The change in rate pressure product was not significant.nnnCONCLUSIONnThis meta-analysis suggests that SCS, as an adjunct therapy to medical management, may be associated with a longer exercise duration and lower angina frequency and nitrate consumption in patients with chronic refractory angina pectoris who are not candidates for percutaneous intervention or revascularization.

FRIED FOOD CONSUMPTION IS ASSOCIATED WITH A HIGHER RISK OF CARDIOVASCULAR MORTALITY IN THE PHYSICIANS’ HEALTH STUDY

Consumption of fried foods is highly prevalent worldwide. Despite reports of a positive association between fried food consumption (FFC) and risk of coronary heart disease (CHD), heart failure, hypertension, type 2 diabetes, and obesity, only limited data exist on its relation with mortality from

Walking and Calcified Atherosclerotic Plaque in the Coronary Arteries The National Heart, Lung, and Blood Institute Family Heart Study

Objective— Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification. Approach and Results— In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ⩽3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35–0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52–0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36–0.81) for >15 to 22.5 Met-h/wk, (P trend=0.01). The walking–CAC relationship remained significant for those with body mass index ≥25 (P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking–aortic calcification association was not significant. Conclusions— Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.Objective— Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification.nnApproach and Results— In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ≤3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35–0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52–0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36–0.81) for >15 to 22.5 Met-h/wk, ( P trend=0.01). The walking–CAC relationship remained significant for those with body mass index ≥25 ( P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking–aortic calcification association was not significant.nnConclusions— Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.nn# Highlights {#article-title-39}

Walking and Calcified Atherosclerotic Plaque in the Coronary ArteriesHighlights

Objective— Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification. Approach and Results— In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ⩽3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35–0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52–0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36–0.81) for >15 to 22.5 Met-h/wk, (P trend=0.01). The walking–CAC relationship remained significant for those with body mass index ≥25 (P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking–aortic calcification association was not significant. Conclusions— Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.Objective— Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification.nnApproach and Results— In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ≤3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35–0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52–0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36–0.81) for >15 to 22.5 Met-h/wk, ( P trend=0.01). The walking–CAC relationship remained significant for those with body mass index ≥25 ( P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking–aortic calcification association was not significant.nnConclusions— Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.nn# Highlights {#article-title-39}