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Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease: The ISCHEMIA Trial

Nguyen, Dan D; Spertus, John A; Alexander, Karen P; Newman, Jonathan D; Dodson, John A; Jones, Philip G; Stevens, Susanna R; O'Brien, Sean M; Gamma, Reto; Perna, Gian P; Garg, Pallav; Vitola, João V; Chow, Benjamin J W; Vertes, Andras; White, Harvey D; Smanio, Paola E P; Senior, Roxy; Held, Claes; Li, Jianghao; Boden, William E; Mark, Daniel B; Reynolds, Harmony R; Bangalore, Sripal; Chan, Paul S; Stone, Gregg W; Arnold, Suzanne V; Maron, David J; Hochman, Judith S
BACKGROUND:Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown. OBJECTIVES/OBJECTIVE:The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. METHODS:One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure. RESULTS: = 0.29). CONCLUSIONS:Older patients with chronic coronary disease and moderate or severe ischemia had consistent improvement in angina frequency but less improvement in angina-related health status with invasive management compared with younger patients. Invasive management was not associated with improved clinical outcomes in older or younger patients. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
PMID: 37100486
ISSN: 1558-3597
CID: 5465192

Abstract 441: Relationship Between Diabetes, Glucose Control, And Vascular Health: Findings From The American Heart Association Cardiometabolic Health Strategically Focused Research Network [Meeting Abstract]

Garshick, Michael; Barrett, Tessa A; Jindal, Manila; Newman, Jonathan D; Fadzan, Maja; Bredefeld, Cindy; Levy, Natalie; Akinlonu, Adedoyin; Heguy, Adriana; Drenkova, Schlamp, Florencia; Giannarelli, Chiara; Fisher, Edward A; Goldberg, Ira J; Berger, Jeffrey
ORIGINAL:0017100
ISSN: 1524-4636
CID: 5578852

Corrigendum to "Vascular endothelium as a target for perfluroalkyl substances (PFAs)" [Environ. Res. 212 (2022) 1-4/11339]

Wittkopp, Sharine; Wu, Fen; Windheim, Joseph; Robinson, Morgan; Kannan, Kurunthachalam; Katz, Stuart D; Chen, Yu; Newman, Jonathan D; [Levy, Natalie]
PMID: 36805490
ISSN: 1096-0953
CID: 5428782

Cause-Specific Mortality in Patients With Advanced Chronic Kidney Disease in the ISCHEMIA-CKD Trial

Sidhu, Mandeep S; Alexander, Karen P; Huang, Zhen; Mathew, Roy O; Newman, Jonathan D; O'Brien, Sean M; Pellikka, Patricia A; Lyubarova, Radmila; Bockeria, Olga; Briguori, Carlo; Kretov, Evgeny L; Mazurek, Tomasz; Orso, Francesco; Roik, Marek F; Sajeev, Chakkanalil; Shutov, Evgeny V; Rockhold, Frank W; Borrego, David; Balter, Stephen; Stone, Gregg W; Chaitman, Bernard R; Goodman, Shaun G; Fleg, Jerome L; Reynolds, Harmony R; Maron, David J; Hochman, Judith S; Bangalore, Sripal
BACKGROUND:In ISCHEMIA-CKD, 777 patients with advanced chronic kidney disease and chronic coronary disease had similar all-cause mortality with either an initial invasive or conservative strategy (27.2% vs 27.8%, respectively). OBJECTIVES/OBJECTIVE:This prespecified secondary analysis from ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease) was conducted to determine whether an initial invasive strategy compared with a conservative strategy decreased the incidence of cardiovascular (CV) vs non-CV causes of death. METHODS:Three-year cumulative incidences were calculated for the adjudicated cause of death. Overall and cause-specific death by treatment strategy were analyzed using Cox models adjusted for baseline covariates. The association between cause of death, risk factors, and treatment strategy were identified. RESULTS:A total of 192 of the 777 participants died during follow-up, including 94 (12.1%) of a CV cause, 59 (7.6%) of a non-CV cause, and 39 (5.0%) of an undetermined cause. The 3-year cumulative rates of CV death were similar between the invasive and conservative strategies (14.6% vs 12.6%, respectively; HR: 1.13, 95% CI: 0.75-1.70). Non-CV death rates were also similar between the invasive and conservative arms (8.4% and 8.2%, respectively; HR: 1.25; 95% CI: 0.75-2.09). Sudden cardiac death (46.8% of CV deaths) and infection (54.2% of non-CV deaths) were the most common cause-specific deaths and did not vary by treatment strategy. CONCLUSIONS:In ISCHEMIA-CKD, CV death was more common than non-CV or undetermined death during the 3-year follow-up. The randomized treatment assignment did not affect the cause-specific incidences of death in participants with advanced CKD and moderate or severe myocardial ischemia. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease [ISCHEMIA-CKD]; NCT01985360).
PMID: 36697158
ISSN: 1876-7605
CID: 5410812

Survival After Invasive or Conservative Management of Stable Coronary Disease

Hochman, Judith S; Anthopolos, Rebecca; Reynolds, Harmony R; Bangalore, Sripal; Xu, Yifan; O'Brien, Sean M; Mavromichalis, Stavroula; Chang, Michelle; Contreras, Aira; Rosenberg, Yves; Kirby, Ruth; Bhargava, Balram; Senior, Roxy; Banfield, Ann; Goodman, Shaun G; Lopes, Renato D; Pracon, Radoslaw; López-Sendón, José; Maggioni, Aldo Pietro; Newman, Jonathan D; Berger, Jeffrey S; Sidhu, Mandeep S; White, Harvey D; Troxel, Andrea B; Harrington, Robert A; Boden, William E; Stone, Gregg W; Mark, Daniel B; Spertus, John A; Maron, David J
PMID: 36335918
ISSN: 1524-4539
CID: 5356892

The Environment and High Blood Pressure

Chapter by: Newman, Jonathan D.; Brook, Robert D.
in: Hypertension: A Companion to Braunwald's Heart Disease by
[S.l.] : Elsevier, 2023
pp. 101-105
ISBN: 9780323931731
CID: 5615732

Associations of a polygenic risk score with coronary artery disease phenotypes in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial [Letter]

Newman, Jonathan D; Douglas, Pamela S; Zhbannikov, Ilya; Ferencik, Maros; Foldyna, Borek; Hoffmann, Udo; Shah, Svati H; Ginsburg, Geoffrey S; Lu, Michael T; Voora, Deepak
A polygenic risk score (PGS) is associated with obstructive coronary artery disease (CAD) independent of traditional risk factors. Coronary computed tomography angiography (CTA) can characterize coronary plaques, including features of highrisk CAD. However, it is unknown if a PGS is associated with obstructive CAD and high-risk CAD phenotypes in patients with symptoms suggestive of CAD.
PMCID:9336199
PMID: 35605652
ISSN: 1097-6744
CID: 5283832

Association of Medication Adherence With Health Outcomes in the ISCHEMIA Trial

Garcia, R Angel; Spertus, John A; Benton, Mary C; Jones, Philip G; Mark, Daniel B; Newman, Jonathan D; Bangalore, Sripal; Boden, William E; Stone, Gregg W; Reynolds, Harmony R; Hochman, Judith S; Maron, David J
BACKGROUND:The ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial randomized participants with chronic coronary disease (CCD) to guideline-directed medical therapy with or without angiography and revascularization. The study examined the association of nonadherence with health status outcomes. OBJECTIVES/OBJECTIVE:The study sought to compare 12-month health status outcomes of adherent and nonadherent participants with CCD with an a priori hypothesis that nonadherent patients would have better health status if randomized to invasive management. METHODS:Self-reported medication-taking behavior was assessed at randomization with a modified 4-item Morisky-Green-Levine Adherence Scale, and participants were classified as adherent or nonadherent. Twelve-month health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ-7) summary score (SS), which ranges from 0 to 100 (higher score = better). The association of adherence with outcomes was evaluated using Bayesian proportional odds models, including an interaction by study arm (conservative vs invasive). RESULTS:Among 4,480 randomized participants, 1,245 (27.8%) were nonadherent at baseline. Nonadherent participants had worse baseline SAQ-7 SS in both conservative (72.9 ± 19.3 vs 75.6 ± 18.4) and invasive (71.0 ± 19.8 vs 74.2 ± 18.7) arms. In adjusted analyses, adherence was associated with higher 12-month SAQ-7 SS in both treatment groups (mean difference in SAQ-7 SS with conservative treatment = 1.6 [95% credible interval: 0.3-2.9] vs with invasive management = 1.9 [95% credible interval: 0.8-3.1]), with no interaction by treatment. CONCLUSIONS:More than 1 in 4 participants reported medication nonadherence, which was associated with worse health status in both conservative and invasive treatment strategies at baseline and 12 months. Strategies to improve medication adherence are needed to improve health status outcomes in CCD, regardless of treatment strategy. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
PMID: 35981820
ISSN: 1558-3597
CID: 5300212

Management of dyslipidemia and atherosclerotic cardiovascular risk in prediabetes

Neves, João Sérgio; Newman, Connie; Bostrom, John A; Buysschaert, Martin; Newman, Jonathan D; Medina, José Luiz; Goldberg, Ira J; Bergman, Michael
Prediabetes affects at least 1 in 3 adults in the U.S. and 1 in 5 in Europe. Although guidelines advocate aggressive management of lipid parameters in diabetes, most guidelines do not address treatment of dyslipidemia in prediabetes despite the increased atherosclerotic cardiovascular disease (ASCVD) risk. Several criteria are used to diagnose prediabetes: impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and HbA1c of 5.7-6.4%. Individuals with prediabetes have a greater risk of diabetes, a higher prevalence of dyslipidemia with a more atherogenic lipid profile and an increased risk of ASCVD. In addition to calculating ASCVD risk using traditional methods, an OGTT may further stratify risk. Those with 1-hour plasma glucose ≥8.6 mmol/L (155 mg/dL) and/or 2-hour ≥7.8 mmol/L (140 mg/dL) (IGT) have a greater risk of ASCVD. Diet and lifestyle modification are fundamental in prediabetes. Statins, ezetimibe and PCSK9 inhibitors are recommended in people requiring pharmacotherapy. Although high-intensity statins may increase risk of diabetes, this is acceptable because of the greater reduction of ASCVD. The LDL-C goal in prediabetes should be individualized. In those with IGT and/or elevated 1-hour plasma glucose, the same intensive approach to dyslipidemia as recommended for diabetes should be considered, particularly if other ASCVD risk factors are present.
PMID: 35787415
ISSN: 1872-8227
CID: 5280182

Portable air cleaner use and biomarkers of inflammation: A systematic review and meta-analysis

Wittkopp, Sharine; Walzer, Dalia; Thorpe, Lorna; Roberts, Timothy; Xia, Yuhe; Gordon, Terry; Thurston, George; Brook, Robert; Newman, Jonathan D.
Fine particulate matter air pollution (PM2.5) is a major contributor to cardiovascular morbidity and mortality, potentially via increased inflammation. PM2.5 exposure increases inflammatory biomarkers linked to cardiovascular disease, including CRP, IL-6 and TNFα. Portable air cleaners (PACs) reduce individual PM2.5 exposure but evidence is limited regarding whether PACs also reduce inflammatory biomarkers. We performed a systematic review and meta-analysis of trials evaluating the use of PACs to reduce PM2.5 exposure and inflammatory biomarker concentrations. We identified English-language articles of randomized sham-controlled trials evaluating high efficiency particulate air filters in non-smoking, residential settings measuring serum CRP, IL-6 and TNFα before and after active versus sham filtration, and performed meta-analysis on the extracted modeled percent change in biomarker concentration across studies. Of 487 articles identified, we analyzed 14 studies enrolling 778 participants that met inclusion criteria. These studies showed PACs reduced PM2.5 by 61.5 % on average. Of the 14 included studies, 10 reported CRP concentrations in 570 participants; these showed active PAC use was associated with 7 % lower CRP (95 % CI: −14 % to 0.0 %, p = 0.05). Nine studies of IL-6, with 379 participants, showed active PAC use was associated with 13 % lower IL-6 (95 % CI: [−23 %, −3 %], p = 0.009). Six studies, with 269 participants, reported TNF-α and demonstrated no statistical evidence of difference between active and sham PAC use. Portable air cleaners that reduce PM2.5 exposure can decrease concentrations of inflammatory biomarkers associated with cardiovascular disease. Additional studies are needed to evaluate clinical outcomes and other biomarkers.
SCOPUS:85153860881
ISSN: 2666-6022
CID: 5499742