Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Muntner P[original query] |
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Atherosclerotic cardiovascular disease events among adults with high predicted risk without established risk factors
Kong N , Sakhuja S , Colantonio LD , Levitan EB , Lloyd-Jones DM , Cushman M , Muntner P , Polonsky TS . Am J Prev Cardiol 2024 17 100612 Objective: Age is the strongest contributor to 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk. Some older adults have a predicted ASCVD risk ≥7.5 %, without established risk factors. We sought to compare ASCVD incidence among adults with predicted ASCVD risk ≥7.5 %, with and without established ASCVD risk factors, to adults with predicted risk <7.5 %. Methods: We analyzed data from REasons for Geographic and Racial Differences in Stroke study participants, 45–79 years old, without ASCVD or diabetes, not taking statins and with low-density lipoprotein cholesterol 70–189 mg/dL. Participants were categorized into 3 groups based on their 10-year predicted ASCVD risk and presence of established risk factors: <7.5 %, ≥7.5 % with established risk factors and ≥7.5 % without established risk factors. Established risk factors included smoking, systolic blood pressure ≥130 mmHg or antihypertensive medication use, total cholesterol ≥200 mg/dL, or high-density lipoprotein cholesterol <50 mg/dL for women (<40 mg/dL for men). Participants were followed for ASCVD events. Results: Among 11,115 participants, 911 incident ASCVD events occurred over a median of 11.1 years. ASCVD incidence rates were 3.6, 12.8, and 9.8 per 1,000 person-years for participants with predicted risk <7.5 %, predicted risk ≥7.5 % with established risk factors and predicted risk ≥7.5 % without established risk factors, respectively. Compared to adults with predicted risk <7.5 %, hazard ratios for incident ASCVD in participants with risk ≥7.5 % with and without established risk factors were 3.58 (95 %CI 3.03 – 4.21) and 2.72 (95 %CI 1.91–3.88), respectively. Conclusions: Adults with a 10-year predicted ASCVD risk ≥7.5 % but without established risk factors had a high ASCVD incidence. © 2023 |
Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to control hypertension
Commodore-Mensah Y , Loustalot F , Himmelfarb CD , Desvigne-Nickens P , Sachdev V , Bibbins-Domingo K , Clauser SB , Cohen DJ , Egan BM , Fendrick AM , Ferdinand KC , Goodman C , Graham GN , Jaffe MG , Krumholz HM , Levy PD , Mays GP , McNellis R , Muntner P , Ogedegbe G , Milani RV , Polgreen LA , Reisman L , Sanchez EJ , Sperling LS , Wall HK , Whitten L , Wright JT , Wright JS , Fine LJ . Am J Hypertens 2022 35 (3) 232-243 Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999-2000 to 48.5% in 2007-2008, it remained stable through 2013-2014 and declined to 43.7% in 2017-2018. To address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. Also, the group sought to identify opportunities to reverse the adverse trend and further improve hypertension control. The workshop immediately preceded the Surgeon General's Call to Action to Control Hypertension, which recognized a stagnation in progress with hypertension control. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities. The broad set of "big ideas" was comprised of various activities that may improve hypertension control, including: interventions to engage patients, promotion of self-measured BP monitoring with clinical support, supporting team-based care, implementing telehealth, enhancing community-clinical linkages, advancing precision population health, developing tailored public health messaging, simplifying hypertension treatment, using process and outcomes quality metrics to foster accountability and efficiency, improving access to high-quality health care, addressing social determinants of health, supporting cardiovascular public health and research, and lowering financial barriers to hypertension control. |
Comparison of three devices for 24-hour ambulatory blood pressure monitoring in a nonclinical environment through a randomized trial
Nwankwo T , Coleman King SM , Ostchega Y , Zhang G , Loustalot F , Gillespie C , Chang TE , Begley EB , George MG , Shimbo D , Schwartz JE , Muntner P , Kronish IM , Hong Y , Merritt R . Am J Hypertens 2020 33 (11) 1021-1029 BACKGROUND: The U.S. Preventive Services Task Force recommends the use of 24-hour ambulatory blood pressure monitoring (ABPM) as part of screening and diagnosis of hypertension. The optimal ABPM device for population-based surveys is unknown. OBJECTIVE: Among three ABPM devices, we compared the proportion of valid BP readings, mean awake and asleep BP readings, differences between awake ABPM readings and initial standardized BP readings, and sleep experience. RESULTS: The proportions of valid blood pressure readings were not different among the three devices ( p > 0.45). Mean awake and asleep systolic BP were significantly higher for STO device (WA vs. STO vs. SL: 126.65 mmHg, 138.09 mmHg, 127.44 mmHg; 114.34 mmHg, 120.34 mmHg, 113.13 mmHg; p <0.0001 for both). The difference between the initial average standardized mercury systolic BP readings and the ABPM mean awake systolic BP was larger for STO device (WA vs. STO. vs. SL: -5.26 mmHg, -16.24 mmHg, -5.36 mmHg; p <0.0001); diastolic BP mean differences were ~ -6 mmHg for all three devices ( p =0.6). Approximately 55% of participants reported that the devices interfered with sleep; however, there were no sleep differences across the devices (p >0.4 for all). CONCLUSION: Most of the participants met the threshold of 70% valid readings over 24 hours. Sleep disturbance was common but did not interfere with completion of measurement in most of the participants. |
Blood pressure assessment in adults in clinical practice and clinic-based research: JACC Scientific Expert Panel
Muntner P , Einhorn PT , Cushman WC , Whelton PK , Bello NA , Drawz PE , Green BB , Jones DW , Juraschek SP , Margolis KL , Miller ER3rd , Navar AM , Ostchega Y , Rakotz MK , Rosner B , Schwartz JE , Shimbo D , Stergiou GS , Townsend RR , Williamson JD , Wright JTJr , Appel LJ , National Heart Lung Blood Institute Working Group . J Am Coll Cardiol 2019 73 (3) 317-335 The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities. |
Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association
Benjamin EJ , Virani SS , Callaway CW , Chamberlain AM , Chang AR , Cheng S , Chiuve SE , Cushman M , Delling FN , Deo R , de Ferranti SD , Ferguson JF , Fornage M , Gillespie C , Isasi CR , Jiménez MC , Jordan LC , Judd SE , Lackland D , Lichtman JH , Lisabeth L , Liu S , Longenecker CT , Lutsey PL , Mackey JS , Matchar DB , Matsushita K , Mussolino ME , Nasir K , O'Flaherty M , Palaniappan LP , Pandey A , Pandey DK , Reeves MJ , Ritchey MD , Rodriguez CJ , Roth GA , Rosamond WD , Sampson UKA , Satou GM , Shah SH , Spartano NL , Tirschwell DL , Tsao CW , Voeks JH , Willey JZ , Wilkins JT , Wu JH , Alger HM , Wong SS , Muntner P . Circulation 2018 137 (12) e67-e492 Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA’s My Life Check - Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. Cardiovascular disease (CVD) and stroke produce immense health and economic burdens in the United States and globally. The Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease [CHD], heart failure [HF], valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2007, the annual versions of the Statistical Update have been cited >20 000 times in the literature. From January to July 2017 alone, the 2017 Statistical Update was accessed >106 500 times. |
Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association
Benjamin EJ , Blaha MJ , Chiuve SE , Cushman M , Das SR , Deo R , de Ferranti SD , Floyd J , Fornage M , Gillespie C , Isasi CR , Jiménez MC , Jordan LC , Judd SE , Lackland D , Lichtman JH , Lisabeth L , Liu S , Longenecker CT , Mackey RH , Matsushita K , Mozaffarian D , Mussolino ME , Nasir K , Neumar RW , Palaniappan L , Pandey DK , Thiagarajan RR , Reeves MJ , Ritchey M , Rodriguez CJ , Roth GA , Rosamond WD , Sasson C , Towfighi A , Tsao CW , Turner MB , Virani SS , Voeks JH , Willey JZ , Wilkins JT , Wu JH , Alger HM , Wong SS , Muntner P . Circulation 2017 135 (10) e146-e603 Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the factors in the AHA’s Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity [PA], diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. Cardiovascular disease (CVD) and stroke produce immense health and economic burdens in the United States and globally. The Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure (HF), valvular disease, venous disease, and peripheral arterial disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2006, the annual versions of the Statistical Update have been cited >20 000 times in the literature. In 2015 alone, the various Statistical Updates were cited ≈4000 times. |
Research needs to improve hypertension treatment and control in African Americans
Whelton PK , Einhorn PT , Muntner P , Appel LJ , Cushman WC , Diez Roux AV , Ferdinand KC , Rahman M , Taylor HA , Ard J , Arnett DK , Carter BL , Davis BR , Freedman BI , Cooper LA , Cooper R , Desvigne-Nickens P , Gavini N , Go AS , Hyman DJ , Kimmel PL , Margolis KL , Miller ER 3rd , Mills KT , Mensah GA , Navar AM , Ogedegbe G , Rakotz MK , Thomas G , Tobin JN , Wright JT , Yoon SS , Cutler JA . Hypertension 2016 Additional targeted research and customized training programs could spearhead strategies for elimination of the disparities in prevalence and control of high BP between African Americans and the remainder of the US general population. | This report presents findings of an ad hoc working group assembled by the National Heart, Lung, and Blood Institute (NHLBI) to assess research needs to improve prevention, treatment and control of hypertension among African Americans. Non-Hispanic Blacks (African American and Black will be used for US and international studies, respectively) tend to have an earlier onset, higher prevalence, and disproportionately high risk of complications for hypertension compared to non-Hispanic Whites and Mexican Americans.1 |
Life's Simple 7 and risk of incident stroke: the Reasons for Geographic And Racial Differences in Stroke study
Kulshreshtha A , Vaccarino V , Judd SE , Howard VJ , McClellan WM , Muntner P , Hong Y , Safford MM , Goyal A , Cushman M . Stroke 2013 44 (7) 1909-14 BACKGROUND AND PURPOSE: The American Heart Association developed Life's Simple 7 (LS7) as a metric defining cardiovascular health. We investigated the association between LS7 and incident stroke in black and white Americans. METHODS: The Reasons for Geographic And Racial Differences in Stroke (REGARDS) is a national population-based cohort of 30,239 blacks and whites, aged ≥45 years, sampled from the US population from 2003 to 2007. Data were collected by telephone, self-administered questionnaires, and an in-home examination. Incident strokes were identified through biannual participant contact followed by adjudication of medical records. Levels of the LS7 components (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet) were each coded as poor (0 point), intermediate (1 point), or ideal (2 points) health. An overall LS7 score was categorized as inadequate (0-4), average (5-9), or optimum (10-14) cardiovascular health. RESULTS: Among 22,914 subjects with LS7 data and no previous cardiovascular disease, there were 432 incident strokes over 4.9 years of follow-up. After adjusting for demographics, socioeconomic status, and region of residence, each better health category of the LS7 score was associated with a 25% lower risk of stroke (hazard ratios, 0.75; 95% confidence interval, 0.63-0.90). The association was similar for blacks and whites (interaction P value=0.55). A 1-point higher LS7 score was associated with an 8% lower risk of stroke (hazard ratios, 0.92; 95% confidence interval, 0.88-0.95). CONCLUSIONS: In both blacks and whites, better cardiovascular health, on the basis of the LS7 score, is associated with lower risk of stroke, and a small difference in scores was an important stroke determinant. |
Reduction in cadmium exposure in the United States population, 1988-2008: the contribution of declining smoking rates
Tellez-Plaza M , Navas-Acien A , Caldwell KL , Menke A , Muntner P , Guallar E . Environ Health Perspect 2012 120 (2) 204-9 BACKGROUUND: Public health policies such as tobacco control, air pollution reduction, and hazardous waste remediation may have reduced cadmium exposure among U.S. adults. However, trends in urine cadmium, a marker of cumulative cadmium exposure, have not been evaluated. OBJECTIVES: We estimated the trends in urine cadmium concentrations in U.S. adults using data from the National Health and Nutrition Examination Surveys (NHANES) from 1988 to 2008. We also evaluated the impact of changes in the distribution of available cadmium determinants (age, sex, race, education, body mass index, smoking, and occupation) at the population level to explain cadmium trends. METHODS: The study population included 19,759 adults ≥ 20 years of age with measures of urine cadmium and cadmium determinants. RESULTS: Age-adjusted geometric means of urine cadmium concentrations were 0.36, 0.35, 0.27, 0.27, 0.28, 0.25, and 0.26 microg/g creatinine in 1988-1991, 1991-1994, 1999-2000, 2001-2002, 2003-2004, 2005-2006, and 2007-2008, respectively. The age, sex, and race/ethnicity-adjusted percent reduction in urine cadmium geometric means comparing 1999-2002 and 2003-2008 with 1988-1994 were 27.8% (95% confidence interval: 22.3%, 32.9%) and 34.3% (29.9%, 38.4%), respectively (p-trend < 0.001), with reductions in all participant subgroups investigated. In never smokers, reductions in serum cotinine accounted for 15.6% of the observed reduction. In ever smokers, changes in smoking cessation, and cumulative and recent dose accounted for 17.1% of the observed reduction. CONCLUSIONS: Urine cadmium concentrations decreased markedly between 1988 and 2008. Declining smoking rates and changes in exposure to tobacco smoke may have played an important role in the decline of urine cadmium concentrations, benefiting both smokers and nonsmokers. Cadmium has been associated to several health outcomes in NHANES 1999-2008. Consequently, despite the observed decline, further reduction in cadmium exposure is needed. |
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