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Clinical course of adults with co-occurring hypertrophic cardiomyopathy and hypertension: A scoping review

Arabadjian, Milla; Montgomery, Sophie; Pleasure, Mitchell; Nicolas, Barnaby; Collins, Maxine; Reuter, Maria; Massera, Daniele; Shimbo, Daichi; Sherrid, Mark V
INTRODUCTION/UNASSIGNED:Hypertension affects approximately 50 % of patients with hypertrophic cardiomyopathy (HCM) but clinical course in adults with co-occurring HCM and hypertension is underexplored. Management may be challenging as routine anti-hypertensive medications may worsen obstructive HCM, the most common HCM phenotype. In this scoping review, we sought to synthesize the available literature related to clinical course and outcomes in adults with both conditions and to highlight knowledge gaps to inform future research directions. METHODS/UNASSIGNED:We searched 5 electronic databases (PubMed, CINAHL, Scopus, Embase, Web of Science) to identify peer-reviewed articles, 2011-2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) guideline. RESULTS/UNASSIGNED:Eleven articles met eligibility. Adults with both conditions were older and had higher rates of obesity and diabetes than adults with HCM alone. Results related to functional class and arrhythmia were equivocal in cross-sectional studies. Only 1 article investigated changes in medical therapy among adults with both conditions. Hypertension was a predictor of worse functional class, but was not associated with all-cause mortality, heart failure-related mortality, or sudden-death. No data was found that related to common hypertension-related outcomes, including renal disease progression, nor patient-reported outcomes, including quality of life. CONCLUSIONS/UNASSIGNED:Our results highlight areas for future research to improve understanding of co-occurring HCM and hypertension. These include a need for tailored approaches to medical management to optimize outcomes, evaluation of symptom burden and quality of life, and investigation of hypertension-related outcomes, like renal disease and ischemic stroke, to inform cardiovascular risk mitigation strategies.
PMID: 38510995
ISSN: 2666-6022
CID: 5640672

Clinical course and outcomes in adults with co-occurring hypertrophic cardiomyopathy and hypertension: a scoping review protocol

Arabadjian, Milla; Nicolas, Barnaby; Montgomery, Sophie; Pleasure, Mitchell; Collins, Maxine; Reuter, Maria; Massera, Daniele; Shimbo, Daichi; Sherrid, Mark
INTRODUCTION:Hypertension affects 40%-60% of adults with hypertrophic cardiomyopathy (HCM), the most common inherited cardiac condition. It can be a diagnostic confounder for HCM, contributing to delayed diagnosis. Clinically, treatment of co-occurring hypertension and HCM poses challenges as first-line and second-line antihypertensive medications are often contraindicated in HCM. The clinical course in adults with hypertension and HCM is also not well understood, and studies examining patient outcomes in this population are equivocal. In this paper, we aim to outline the protocol of a scoping review, a type of literature review, to systematically synthesise existing knowledge on adults with co-occurring HCM and hypertension, highlighting knowledge and evidence gaps, and identifying future research directions to optimise outcomes in this population. METHODS AND ANALYSIS:This review is guided by Arksey and O'Malley's conceptual framework on conducting scoping reviews. We will search five electronic databases (PubMed, CINAHL, Scopus, Embase and Web of Science) and reference lists of publications to identify eligible articles focusing on medical therapy, clinical course or outcomes in adults with HCM and hypertension, between 2011 and 2023. Our search strategy and presentation of results will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review guideline. First, two independent reviewers will screen articles, by title and abstract, followed by a full-text screen to identify eligible articles. Relevant data will be extracted and synthesised. ETHICS AND DISSEMINATION:Ethical approval is not required for this review as it is a secondary data collection of published articles and does not involve human subject participation. We will present results of this review at relevant professional conferences and patient-centred educational events. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER:
PMID: 37463810
ISSN: 2044-6055
CID: 5535662

Role of Resilience in the Psychological Recovery of Women With Acute Myocardial Infarction

Arabadjian, Milla; Duberstein, Zoe T; Sperber, Sarah H; Kaur, Kiranjot; Kalinowski, Jolaade; Xia, Yuhe; Hausvater, Anaïs; O'Hare, Olivia; Smilowitz, Nathaniel R; Dickson, Victoria Vaughan; Zhong, Hua; Berger, Jeffrey S; Hochman, Judith S; Reynolds, Harmony R; Spruill, Tanya M
Background Psychological well-being is important among individuals with myocardial infarction (MI) given the clear links between stress, depression, and adverse cardiovascular outcomes. Stress and depressive disorders are more prevalent in women than men after MI. Resilience may protect against stress and depressive disorders after a traumatic event. Longitudinal data are lacking in populations post MI. We examined the role of resilience in the psychological recovery of women post MI, over time. Methods and Results We analyzed a sample from a longitudinal observational multicenter study (United States, Canada) of women post MI, between 2016 and 2020. Perceived stress (Perceived Stress Scale-4 [PSS-4]) and depressive symptoms (Patient Health Questionnaire-2 [PHQ-2]) were assessed at baseline (time of MI) and 2 months post MI. Demographics, clinical characteristics, and resilience (Brief Resilience Scale [BRS]) were collected at baseline. Low and normal/high resilience groups were established as per published cutoffs (BRS scores <3 or ≥3). Mixed-effects modeling was used to examine associations between resilience and psychological recovery over 2 months. The sample included 449 women, mean (SD) age, 62.2 (13.2) years, of whom 61.1% identified as non-Hispanic White, 18.5% as non-Hispanic Black, and 15.4% as Hispanic/Latina. Twenty-three percent had low resilience. The low resilience group had significantly higher PSS-4 and PHQ-2 scores than the normal/high resilience group at all time points. In adjusted models, both groups showed a decrease in PSS-4 scores over time. Conclusions In a diverse cohort of women post MI, higher resilience is associated with better psychological recovery over time. Future work should focus on developing strategies to strengthen resilience and improve psychological well-being for women with MI. Registration URL:; Unique identifier: NCT02905357.
PMID: 37026542
ISSN: 2047-9980
CID: 5463912

Barbershop-Facilitated Community-to-Clinic Linkage Implementation Program: Rationale and Protocol for a Novel Program to Prevent Hypertension Among Black Men

Ravenell, Joseph; Green, Tanisha; Arabadjian, Milla; Schoenthaler, Antoinette; Ogedegbe, Olugbenga
BACKGROUND:Black men in the United States have higher hypertension (HTN) prevalence than other groups, largely due to adverse social determinants of health, including poor healthcare access. The Community-to-Clinic Linkage Implementation Program (CLIP) is effective for HTN screening in Black-owned barbershops. However, its effect on HTN prevention among Black men is untested. Here, we describe the rationale and study protocol for the development and testing of a barbershop facilitation (BF) strategy, with trained Community Health Workers, to implement and scale CLIP for HTN prevention in Black men. METHODS:The study is part of the American Heart Association (AHA)-funded RESTORE (Addressing Social Determinants to Prevent Hypertension) Health Equity Research Network. The study is tri-phasic: (i) pre-implementation-qualitative examination of factors affecting adoption of CLIP and development of BF strategy, (ii) implementation-cluster randomized control trial to test the effectiveness of CLIP with and without BF. We will partner with 20 barbershops and enroll 420 Black men with elevated blood pressure (BP)/Stage 1 HTN (2017 ACC/AHA HTN guidelines). Outcomes include reduction in BP, rate of CLIP adoption and linkage to care, and incidence of Stage 2 HTN. The study time frame is 12 months, (iii) post-implementation-we will evaluate program sustainability (6 months post-trial conclusion) and cost-effectiveness (up to 10 years). CONCLUSIONS:This study harnesses community-based resources to address HTN prevention in Black men, who are more adversely impacted by HTN than other groups. It has major policy relevance for health departments and other stakeholders to address HTN prevention in Black communities. CLINICALTRIALS.GOV IDENTIFIER/BACKGROUND:NCT05447962.
PMID: 37061797
ISSN: 1941-7225
CID: 5464332

Measurement of stress amongst working adults with cardiovascular disease

Dickson, Victoria Vaughan; Zhanay, Jessie; Leon, Alejandra; Scott, Lela; Arabadjian, Milla
AIMS/OBJECTIVE:Cardiovascular disease (CVD) is a leading cause of increased disability from work worldwide. Chronic stress including work-related stressors influences cardiovascular health. The purpose of this study was to assess stress levels amongst workers with CVD. The specific aims were to: (i) evaluate associations of the biological marker-hair cortisol concentration (HCC) with perceived stress and (ii) examine associations of HCC and perceived stress with sociodemographic factors and work-related factors. METHODS AND RESULTS/RESULTS:This cross-sectional descriptive study (n = 75) of employed adults (≥ 21 age) with CVD assessed perceived stress, work-related factors including workplace support, job control, job strain, and work-life balance using valid and reliable instruments. Hair cortisol concentration was measured using collected hair samples. Data analyses included descriptive statistics, correlational, and ANOVA analysis. The sample was 64% female; 80% are White, 8% African American, 4% Asian, and 8% Hispanic; mean 12 years with CVD diagnosis. Hair cortisol concentration was significantly correlated with workplace support by co-workers (r = -0.328, P = 0.012), supervisors (r = -0.260, P = 0.05), and skill discretion (-0.297, r = 0.047) but not perceived stress. Those with better work-life balance had lower HCC (F = 3.077, P = 0.054) and lower perceived stress (F = 10.320, P < 0.01). CONCLUSIONS:Although this sample of working adults with CVD reported high levels of perceived stress; only work-related factors were significantly associated with HCC. These results suggest that there are work-related stressors that cut across jobs and workplaces that may contribute to chronic stress in working adults. Healthcare providers across clinical and occupational settings have an important role in addressing work-related stress in working adults with CVD.
PMID: 35404401
ISSN: 1873-1953
CID: 5207042

Quality of life and physical functioning in black and white adults with hypertrophic cardiomyopathy

Arabadjian, Milla; Yu, Gary; Vorderstrasse, Allison; Sherrid, Mark V; Dickson, Victoria Vaughan
BACKGROUND:Hypertrophic cardiomyopathy (HCM) is a common and clinically heterogeneous inherited cardiac disease. Quality of life (QOL) and physical functioning are important clinically but are underexplored in diverse populations with HCM. OBJECTIVES/OBJECTIVE:To examine predictors for and compare QOL and physical functioning in Black and White adults with HCM. METHODS:We analyzed a sub-sample from a longitudinal prospective study on HCM. Eligibility criteria included self-identified Black and White adults (≥18 years) with clinical HCM. QOL was measured with the Minnesota Living with Heart Failure Questionnaire (MLWHF);physical functioning included age-adjusted exercise capacity and NYHA class. Covariates included HCM structural characteristics and common comorbidities. We analyzed data from 434 individuals, 57 (13.1%) of whom self-identified as Black/African American. RESULTS:In this sample, the Black cohort had higher MLWHF scores, 31.2 (27.2) v. 23.9 (22.1), p=0.042, signifying worse QOL, but there were no intergroup differences when QOL was dichotomized. Mean metabolic equivalents (METs) on symptom-limited stress testing were similar, though the Black cohort was younger, 54.6 (13.4) v.62.5 (14.8) years, p=0.001. No one from the Black cohort achieved an "excellent-for-age" exercise capacity, and 64.1% had a "below-average-for-age" exercise capacity vs 47% in the White cohort, though this was not statistically significant, p=0.058. There was no difference between groups in advanced NYHA class. Female gender was associated with worse QOL and physical functioning irrespective of covariates. CONCLUSIONS:This study is a starting point that underscores the need for a more comprehensive examination of well-being and physical functioning in Black populations with HCM.
PMID: 35901604
ISSN: 1527-3288
CID: 5276812

Disease Expression and Outcomes in Black and White Adults With Hypertrophic Cardiomyopathy

Arabadjian, Milla E; Yu, Gary; Sherrid, Mark V; Dickson, Victoria Vaughan
Background There is limited research on hypertrophic cardiomyopathy (HCM), which is the most common inherited cardiac disorder, in diverse populations, including Black individuals. Current literature lacks comprehensive data on HCM disease expression, comorbidities, and outcomes in this historically disadvantaged group. The purpose of this study was to examine structural HCM characteristics, comorbidities, and outcomes in a Black and White cohort with HCM. Methods and Results The study was a subgroup analysis from a longitudinal, prospective study on HCM, with supplemental chart review. The sample included adults (≥18 years) with a clinical diagnosis of HCM, who self-identified as Black/African American or White. The study sample comprised 434 individuals; 57 (13.1%) were Black, and 180 (41.5%) were women. Black patients were younger than White patients, 54.6 (13.4) versus 62.5 (14.8) years, P=0.001. Black patients were more likely to have sub-basal and diffuse hypertrophy, 22 (38.6%) versus 56 (14.9%), P<0.001, 6 (10.5%) versus 15 (4%), P=0.017, mid-LV obstruction, 7 (12.3%) versus 21 (5.5%), P=0.025, and cardiac fibrosis ≥15%, 10 (22.2%) versus 19 (8.8%), P=0.009, than White patients. Black patients were more likely to experience appropriate implantable cardioverter defibrillator interventions, 5 (38.5) versus 5 (6.8), P<0.001 and were more likely to have ≥2 sudden death risk factors. Comorbidities were largely similar between groups, though more Black participants had Class II obesity, 12 (21.8) versus 30 (8.1), P<0.001. Both groups had similar rates of genetic testing usage. Conclusions This study underscores the need for continued research of HCM in Black populations, including tailored approaches to diagnosis and precise evaluation of cardiac anatomy.
PMID: 34431363
ISSN: 2047-9980
CID: 5011112

An Integrated Review of Hypertrophic Cardiomyopathy in Black Populations: Underrecognized and Understudied

Arabadjian, Milla; McCarthy, Margaret; Dickson, Victoria Vaughan
BACKGROUND:Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder globally, affecting 0.2% to 0.5% of individuals. Existing clinical HCM guidelines do not address diverse populations, specifically minority groups who often experience health disparities. OBJECTIVE:The aim of this study was to describe the state of the science of HCM in black populations. METHODS:This integrated review guided by Whittemore and Knafl's methodology included literature search of multiple databases, data evaluation, and analysis. Publications between 2000 and 2020 were included if they addressed HCM cardiac anatomic manifestations, disease course, symptoms, quality of life, or outcomes in black populations. RESULTS:Six articles met the inclusion criteria. Overall, blacks are underrepresented in HCM research. Certain HCM structural phenotypes are more commonly exhibited in blacks, and physiology drives HCM treatment. Sudden death events and all-cause mortality do not differ between blacks and whites with HCM. Fewer blacks with HCM undergo genetic testing than whites with HCM. The lack of diversity in general genomic databases has resulted in reclassification of several genetic variants identified as more common in blacks. CONCLUSIONS:Blacks are underrepresented in HCM research, even those focused on elucidating HCM manifestations, disease course, and outcomes in black populations. This may be due in part to HCM research that is largely generated from specialty centers that can require patients to navigate complex healthcare systems to reach expert HCM care. Longitudinal studies with large samples of blacks with HCM are necessary to elucidate how HCM affects this population.
PMID: 33565785
ISSN: 1550-5049
CID: 4853932

Measurement of Stress Among Working Adults with Coronary Heart Disease (CHD) presented by [Meeting Abstract]

Dickson, Victoria S. Vaughan; Arabadjian, Milla; Leon, Alejandra; Zhanay, Jessie
ISSN: 0029-6562
CID: 4919152

Hypertrophic cardiomyopathy in a Black cohort - phenotypic characteristics, outcomes, and symptom experience

Arabadjian, Milla
Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, affecting between 0.2% to 0.5% of the US population. Clinical HCM guidelines do not address diverse populations and there are gaps in the existing literature on Blacks with HCM, a traditionally underserved group. Objective: The purpose of this dissertation was to compare a Black and White cohort with HCM and describe HCM genotype and phenotype, symptom experience, including quality of life, functional capacity and provider assigned functional class (NYHA class), and outcomes differences between groups; to examine the relationship between HCM phenotype, comorbidities, and outcomes; to examine the relationship between functional capacity, HCM structural phenotype, outcomes and co-morbidities.Methods: Secondary analysis of an existing HCM dataset. Results: Blacks comprised 13% of the study sample of 434. Follow - up was a mean 2.2(SD 1.2) years. Both groups had similar magnitude of left ventricular hypertrophy but significant differences in distribution of hypertrophy. Blacks had more cardiac fibrosis. Both groups had similar number of co-morbid conditions, and obesity and hypertension were prevalent across groups. There was overall low mortality in both groups, though Blacks had more aborted sudden death events. While Blacks and Whites had similar functional class and quality of life scores, Blacks had a lower functional capacity. There was no significant association between race, HCM phenotype, symptom experience, and outcomes. Conclusions: Blacks were underrepresented in this sample, consistent with the existing HCM literature. Research with larger samples of Blacks with HCM, especially those who get HCM care in the community, is necessary to allow generalizability of results and to elucidate targets for intervention to reduce health disparities. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
ISSN: 0419-4217
CID: 4914242