Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study

The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease

Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study

Background: Prior studies have shown insulin resistance is associated with reduced cardiac autonomic function measured at rest, but few studies have determined whether insulin resistance is associated with reduced cardiac autonomic function measured during daily activities. Methods: We examined older adults without diabetes with 48-h ambulatory electrocardiography (n = 759) in an ancillary study of the Atherosclerosis Risk in Communities Study. Insulin resistance, the exposure, was defined by quartiles for three indexes: 1) the homeostatic model assessment of insulin resistance (HOMA-IR), 2) the triglyceride and glucose index (TyG), and 3) the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Low heart rate variability, the outcome, was defined by <25th percentile for four measures: 1) standard deviation of normal-to-normal R-R intervals (SDNN), a measure of total variability; 2) root mean square of successive differences in normal-to-normal R-R intervals (RMSSD), a measure of vagal activity; 3) low frequency spectral component (LF), a measure of sympathetic and vagal activity; and 4) high frequency spectral component (HF), a measure of vagal activity. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals weighted for sampling/non-response, adjusted for age at ancillary visit, sex, and race/study-site. Insulin resistance quartiles 4, 3, and 2 were compared to quartile 1; high indexes refer to quartile 4 versus quartile 1. Results: The average age was 78 years, 66% (n = 497) were women, and 58% (n = 438) were African American. Estimates of association were not robust at all levels of HOMA-IR, TyG, and TG/HDL-C, but suggest that high indexes were associated consistently with indicators of vagal activity. High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low RMSSD (OR: 1.68 (1.00, 2.81), OR: 2.03 (1.21, 3.39), and OR: 1.73 (1.01, 2.91), respectively). High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low HF (OR: 1.90 (1.14, 3.18), OR: 1.98 (1.21, 3.25), and OR: 1.76 (1.07, 2.90), respectively). Conclusions: In older adults without diabetes, insulin resistance was associated with reduced cardiac autonomic function - specifically and consistently for indicators of vagal activity - measured during daily activities. Primary prevention of insulin resistance may reduce the related risk of cardiac autonomic dysfunction

Mortality Outcomes Surveillance, Part I: Ascertaining Decedents

Mortality Outcomes Surveillance, Part I: Ascertaining Decedents summarizes the data stemming from the protocol used to (1) trace sample members and then (2) screen, match, and score all decedents in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Mortality Outcomes Surveillance, Part II: Adjudicating Causes of Death & In-Hospital Cardiovascular Outcomes summarizes data stemming from the protocol used to (3) assemble and abstract decedent cohort histories, obituaries, death certificates, healthcare provider questionnaires, coroner/medical examiner autopsy reports, next-of-kin interviews, and hospital records; and then (4) review, classify, and adjudicate all deaths and in-hospital cardiovascular outcomes ≤ 1 month before dates of death

Peripheral Artery Disease Prevalence and Incidence Estimated From Both Outpatient and Inpatient Settings Among Medicare Fee‐for‐Service Beneficiaries in the Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND: Outpatient ascertainment of peripheral artery disease (PAD) is rarely considered in the measurement of PAD clinical burden; therefore, the clinical burden of PAD likely has been underestimated while contributing to a decreased awareness of PAD in comparison to other circulatory system disorders. METHODS AND RESULTS: The purpose of this study was to estimate the age-standardized annual period prevalence and incidence of PAD in the outpatient and inpatient settings using data from the Atherosclerosis Risk in Communities (ARIC) study linked with Centers for Medicare and Medicaid Services claims. The majority (>70%) of all PAD encounters occurred in the outpatient setting. The weighted mean age-standardized prevalence and incidence of outpatient PAD was 11.8% (95% CI 11.5-12.1) and 22.4 per 1000 person-years (95% CI 20.8-24.0), respectively. Black patients had higher weighted mean age-standardized prevalence (15.6%; 95% CI 14.6-16.4) compared with white patients (11.4%; 95% CI 11.1-11.7). Black women had the highest weighted mean age-standardized prevalence (16.9%; 95% CI 16.0-17.8). Black patients also had a higher incidence rate of PAD (31.3 per 1000 person-years; 95% CI 27.3-35.4) compared with white patients (25.4 per 1000 person-years; 95% CI 23.5-27.3). PAD prevalence and incidence did not differ by sex alone. CONCLUSIONS: This study provides comprehensive estimates of PAD in the inpatient and outpatient settings where the majority of PAD burden was found. PAD is an important circulatory system disorder similar in prevalence to stroke and coronary heart disease

Incident Heart Failure Is Associated with Lower Whole-Grain Intake and Greater High-Fat Dairy and Egg Intake in the Atherosclerosis Risk in Communities (ARIC) Study

Prospective studies evaluating associations between food intake and risk of heart failure (HF) in diverse populations are needed

Mortality Outcomes Surveillance, Part I: Ascertaining Decedents (2021 Update)

Mortality Outcomes Surveillance, Part I: Ascertaining Decedents (2021 Update) summarizes the data stemming from the protocol used to (1) trace sample members and then (2) screen, match, and score all decedents in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Mortality Outcomes Surveillance, Part II: Adjudicating Causes of Death & In-Hospital Cardiovascular Outcomes summarizes data stemming from the protocol used to (3) assemble and abstract decedent cohort histories, obituaries, death certificates, healthcare provider questionnaires, coroner/medical examiner autopsy reports, next-of-kin interviews, and hospital records; and then (4) review, classify, and adjudicate all deaths and in-hospital cardiovascular outcomes ≤ 1 month before dates of death

Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation

Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear

A Model for Developing, Evaluating, and Disseminating Best Practices in Education and Training: NC TraCS Education Development and Evaluation Model

With the shift towards team-based translational science came recognition that existing strategies for training individual investigators and retaining them in the biomedical workforce would be inadequate. To support this shift, it is important to: develop innovative strategies to educate and train diverse members of research teams; evaluate those programs; and disseminate best practices broadly. We have developed a four-phase model to facilitate the development, evaluation, and widespread dissemination of innovative strategies to train the biomedical research workforce. Phase I (Innovate) involves small scale trials of programs to address perceived training needs or new methods of delivery. Phase II (Incubate) refines and evaluates promising Phase I activities on a larger scale. Phase III (Translate) seeks to replicate initial successes either locally (Phase IIIa) or with other interested institutions (Phase IIIb). Phase IV (Disseminate) assesses whether identified local best practices can have success on a broader scale. We present specific examples from our own experience that demonstrate the utility of this model, and then conclude with opportunities and challenges related to the education and training of this workforce

Circulating levels of liver enzymes and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities cohort

Elevated levels of circulating liver enzymes have been associated with increased risk of cardiovascular disease. Their possible association with atrial fibrillation (AF) has received little attention

Characteristics and Outcomes of Patients With Acute Decompensated Heart Failure Developing After Hospital Admission

There are limited data on ADHF that develops after hospital admission. This study sought to compare patient characteristics, comorbidities, mortality, and length of stay by timing of acute decompensated heart failure (ADHF) onset. The surveillance component of the Atherosclerosis Risk in Communities Study (2005–2011) sampled, abstracted, and adjudicated hospitalizations with select ICD-9-CM discharge codes from 4 U.S. communities among those aged 55 years and older. We included 5,602 validated ADHF hospitalizations further classified as pre- or post-admission onset. Vital status was assessed up to 1 year since admission. We estimated multivariable-adjusted associations of in-hospital mortality, 28-day case fatality, and 365-day case fatality with timing of ADHF onset (post-versus pre-admission). All analyses were weighted to account for the stratified sampling design. Of 25,862 weighted ADHF hospitalizations, 7% had post-admission onset of ADHF. Patients with post-admission ADHF were more likely to be older, white, and female. The most common primary discharge diagnosis codes for those with post-admission ADHF included diseases of the circulatory or digestive systems or infectious diseases. Short-term mortality among post-admission ADHF was almost 3 times that of pre-admission ADHF (in-hospital mortality: odds ratio: 2.7, 95% confidence interval: 1.9–3.9; 28-day case fatality: odds ratio: 2.6, 95% confidence interval: 1.8–3.7). The average hospital stay was almost twice as long among post-admission as pre-admission ADHF (9.6 vs. 5.0 days). In conclusion, post-admission onset of ADHF is characterized by differences in comorbidities and worse short-term prognosis, and opportunities for reducing post-admission ADHF occurrence and associated risks need to be studied