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Facing
Off Against
The Johns Hopkins
Ciccarone Center
for the Prevention
of Heart Disease
Heart
Disease
Annual Update
2015
staff and fellows
The staff members and fellows of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease include:
TOP ROW Thura Abd, MD, MPH; Haitham Ahmed, MD, MPH; Mahmoud Al Rifai, MD, MPH; Amer Aladin, MD;
Dominique Ashen, PhD, CRNP; Kevin Billups, MD; Michael J. Blaha, MD, MPH
SECOND ROW Roger S. Blumenthal, MD; Miguel Caínzos-Achirica, MD, MPH; Zeina Dardari, MS; Chintan Desai, MD, MPH;
Kamil Faridi, MD; David Feldman, BS; Roberta Florido, MD
THIRD ROW Gary Gerstenblith, MD, MHS; Ty Gluckman, MD; Sherita Golden, MD, MHS; Cathy Handy, MD, MPH;
Rupert Hung, BA; Steven Jones, MD; Parag H. Joshi, MD, MHS
FOURTH ROW Stephen Juraschek, MD, PhD; Ali Keramati, MD; Seth S. Martin, MD, MHS; Lena Mathews, MD;
J. Bill McEvoy, MBBCh, MHS; Rebeccah McKibben, MD, MPH; Erin Michos, MD, MHS
FIFTH ROW P. Elliott Miller, MD; Khurram Nasir, MD, MPH; Chiadi Ndumele, MD, MHS; Chike Nwabuo, MD, MPH;
Jaideep Patel, MD; Wendy Post, MD, MS; Renato Quispe, MD
SIXTH ROW Elizabeth Ratchford, MD; Nishant Shah, MD; Rajesh Tota-Maharaj, MD; Peter Toth, MD; Bruno Urrea, MD;
Brett Wanamaker, MD; Seamus Whelton, MD, MPH
from
the
message director
Celebrating Another Busy and Productive Year
at The Ciccarone Center
H
ard as it is to believe, the Johns Hopkins Ciccarone
Center for the Prevention of Heart Disease is
concluding its 26th year in operation.
Each year our faculty, fellows, residents, and
staff get more productive, and this was our
most impressive one yet. Permit me to cite just
a few examples of why this was so.
In 2013, Irene Pollin made a generous and
transformational donation of $10 million to
support our research and education initiatives.
I became the inaugural Kenneth Jay Pollin
Professor of Cardiology, and J. Bill McEvoy, Seth
Martin, and Parag Joshi were chosen as the first set of
Pollin Cardiovascular Prevention Fellows. Since then, all
three fellows have received valuable masters-level training in
the Bloomberg School of Health, and this has led to even
stronger collaborations with the Welch Center for
Prevention, Epidemiology, and Clinical Research, led by
Drs. Larry Appel, Joe Coresh, and Liz Selvin.
Drs. Martin and McEvoy have joined the faculty as members
of the Ciccarone Center, and Dr. Joshi has returned to his
hometown of Dallas, Texas, to join the excellent Preventive
Cardiology faculty at the Southwestern Medical Center at
the University of Texas. During this past year, Dr. Martin
received the Steven N. Blair Award for Excellence in
Physical Activity Research from the American Heart
Association’s (AHA) Council on Lifestyle and
Cardiometabolic Health. He also received the Anna H.
Stiles Award from the Bloomberg School in recognition of
outstanding achievements and innovative thesis research.
Additionally, he participated as a mobile health (mHealth)
scholar at the NIH 2015 Summer Institute on Mobile
Technology Research to Enhance Health, and he is leading
our mHealth clinical research efforts. Seth has become a
national thought leader on ways to refine and improve the
2013 Prevention Guidelines.
Over the past year, Dr. McEvoy led important research on
the role of a blood-based biomarker, high-sensitivity
troponin, and its role in predicting the future development
of hypertension and heart failure. Together with Drs.
Jaideep Patel and Khurram Nasir, Bill also led an
important project that found that, among people with a
family history of premature heart disease, only those with
an elevated coronary artery calcium (CAC) score were at
elevated risk of a future cardiovascular event, while carotid
artery thickness was not a good predictor. Bill, Khurram,
and Dr. Michael Blaha also led two impressive
publications on the relationship of cigarette smoking,
inflammation, and the development of subclinical
vascular disease and cardiovascular events, such
as stroke and heart attack.
Dr. Joshi will continue to serve as an adjunct
faculty member of the Ciccarone Center.
Together with Dr. Steven Jones, Parag
produced an innovative paper that looked at the
association of HDL-cholesterol subclasses and
the development of heart disease. He was a
finalist for the prestigious AHA Elizabeth Barrett-Connor
Research Award, with his presentation, “The Ten-Year
Prognostic Value of the Absence of Coronary Artery
Calcium.” Moreover, all three Pollin fellows have been
serving as mentors for the younger fellows, residents, and
students who work with us.
Our new Pollin Cardiovascular Prevention Fellows are
Drs. Haitham Ahmed and Seamus Whelton.
Both have strong interests in the importance of lifestyle
improvements to reduce the burden of cardiovascular
disease and strategies to improve cardiovascular risk
prediction through selective use of vascular imaging and
measurement of exercise capacity. Haitham led a well-cited
Mayo Clinic Proceedings paper looking at how one’s
performance on a treadmill stress test can predict 10-year
survival. Seamus led a clinical research paper looking at the
predictive role of resting heart and inflammatory markers
with Dr. Erin Michos, and he and Mike Blaha led a study
of predictors of long-term healthy arterial aging.
Dr. Blaha, the Ciccarone Center’s Clinical Research
Director, produced a series of high-profile publications,
with the help of medical student Rupert Hung and
internal medicine fellow Dr. Stephen Juraschek,
looking at the prognostic importance of increased
cardiorespiratory fitness. In Diabetes Care, they
demonstrated that higher fitness is associated with a much
lower risk of developing diabetes, regardless of baseline risk
factors. In Circulation, they reported that better fitness is
associated with a significantly lower chance of developing
atrial fibrillation. They also showed that higher fitness is
associated with a lower risk of developing hypertension.
Clearly, better lifestyle habits are the cornerstone of
prevention!
[ continued ]
from
the
message director
Drs. Blaha and Andrew DeFilippis published one of our
most impactful papers in the Annals of Internal Medicine that
showed that the current risk estimator tool employed in
the national prevention guidelines does indeed significantly
over-estimate the occurrence of future heart attacks and
strokes. Andrew, Mike, and Dr. Mahmoud Al Rifai are
also leading researchers in the AHA’s Tobacco
Regulation and Addiction Center (ATRAC),
which is an NIH-sponsored, five-year, FDAfunded project to regulate policy on tobacco
products related to cardiovascular toxicity.
Drs. Blaha and Nasir deserve tremendous
credit for playing pivotal roles in creating several
large, important clinical research databases.
Together with Drs. Eric Roberts and
Aaron Horne they also found that CAC
testing can potentially be cost-saving to the
health care system as a risk stratification tool.
Along with Dr. Rajesh Tota-Maharaj, Drs. Blaha and
Nasir published work that showed more diffuse CAC was
associated with a higher cardiovascular disease risk.
Dr. Michos, Associate Director for the Ciccarone Center,
was recently named an Associate Faculty of the Welch
Center for Prevention, Epidemiology, and Clinical Research.
This past year, she led several publications regarding vitamin
D deficiency and risk of heart attack, stroke, heart failure,
cognitive decline, and diabetes. She also published key
articles on the prognostic value of cardiac troponin in
persons with kidney disease, and the predictive value of
resting heart rate and lipoprotein measurements.
Dr. Chiadi Ndumele has led our group’s efforts at
improving employee cardiovascular health at Johns Hopkins
and he also published an important study in JACC Heart
Failure that found that obesity has an independent
relationship with myocardial injury, as reflected by the
biomarker high-sensitivity cardiac troponin-T (hs-cTnT).
Moreover, obesity and hs-cTnT provide complementary
prognostic information regarding the risk of heart failure.
He also led a portion of a Cardiometabolic Think Tank,
leading to a recent publication in JACC regarding the
development of a new care model for the metabolic
syndrome.
Dr. Wendy Post is the principal investigator of the
Hopkins Field Center for the Multi-Ethnic Study of
Atherosclerosis (MESA). She also holds two RO1 grants
from the NIH to study the effects of HIV on the heart.
Wendy published a paper in the Annals of Internal Medicine
that identified that men with HIV have a higher than
expected amount of noncalcified atherosclerosis in their
heart arteries. Her team has published multiple manuscripts
describing factors associated with heart disease in HIV.
Wendy and Dr. P. Elliott Miller described that HIV
infection is associated with remodeling of the coronary
arteries, which might contribute to increased risk for heart
attacks. Along with Osler house officer Dr. Becky
McKibben, Wendy identified that patients with HIV have
higher levels of inflammation in the blood that contributes
to a greater prevalence of coronary artery stenosis
(blockages) and also that patients with chronic
hepatitis C viral infection have more plaque in
the heart arteries than those without infection.
Dr. Jones leads a very productive research
group that continues to publish important
papers from the Very Large Database of Lipids
that he created and brought to the Ciccarone
Center. He and Dr. Seth Martin are
directing the Lipid Disorder Clinic of the
Ciccarone Center and have become national
experts in the use of the new PCSK9
inhibitors in persons with familial
hypercholesterolemia and/or statin intolerance. They are
carrying on the landmark work on lipoproteins and
atherosclerosis that was previously led by one of my
mentors, the late Dr. Peter O. Kwiterovich, Jr.
(pictured above).
I work with Dr. Mariell Jessup, past president of the
AHA, as co-chairperson of the committee that is updating
the hypertension, cholesterol management, and risk
assessment guidelines. I also serve as President of the
Greater Maryland Chapter of the AHA. Dr. Martin is ViceChair of the “Young Hearts” of the Maryland AHA Board,
and we have been very active on the state level and
nationally lobbying to restrict the availability of electronic
cigarettes and to reduce the consumption of sugarsweetened beverages. Johns Hopkins has been a strong
supporter of the AHA Heart Healthy kitchen, which has
taught many hundreds of local residents how to prepare
healthy but tasty meals.
We thank the many long-time supporters of the Ciccarone
Center, and we celebrate our many achievements with
them. The Ciccarone Center team, which was inspired by
the late, iconic Hopkins lacrosse coach Henry Ciccarone, is
truly filled with All-American talent in our battle against
heart disease and stroke.
Sincerely yours,
Roger S. Blumenthal, MD
Director
The Johns Hopkins Ciccarone Center
for the Prevention of Heart Disease
The Kenneth Jay Pollin Professor of Cardiology
Johns Hopkins Professor of Medicine and Epidemiology
news & highlights
This past year has been a
momentous one for the
Johns Hopkins Ciccarone
Center for the Prevention of
Heart Disease, in terms of
accomplishing our goals and
continuing our work in creating
excellent clinical care, educating
health care practitioners, and
studying better ways to prevent
heart disease. Following is a
brief overview of some of what
we achieved.
Congratulations to Haitham
Ahmed, MD, MPH, and Seamus
Whelton, MD, MPH, who were
appointed the 2015-2016 Pollin
Cardiovascular Prevention Fellows.
Both are outstanding postdoctoral
clinical research fellows, with
strong interest in the importance of
lifestyle improvements to reduce
the burden of cardiovascular
disease, and they will continue to
try to devise strategies to improve
cardiovascular risk prediction
through selective use of vascular
imaging and measurement of
exercise capacity.
In March, Dr. Ahmed made his TV
debut (in the New York area, at
least). Dr. Ahmed appeared in an
episode of the local CBS news
affiliate’s Dr. Max Gomez program,
“Life And Death Treadmill Test,”
discussing results of his research
on the FIT Project, published at the
same time in the journal Mayo
Clinic Proceedings.
It’s been a big year
for Erin Michos,
MD, MHS, our
Associate Director
of Preventive
Cardiology. She
was elected as a
Fellow of the American Heart
Association in November and
named an Associate Faculty of the
Welch Center for Prevention,
Epidemiology, and Clinical
Research. She also took over as
Course Director for “Clinical
Assessment of Cardiovascular
Disease,” which is taught to Masters
and PhD candidate students at the
Johns Hopkins Bloomberg School of
Public Health. And, beginning in
September 2015, she joined the
Cardiology Executive Leadership
team as the inaugural representative
of the Women’s Task Force for the
Division of Cardiology.
Helping Vets with Healthy Meals
Members of the Ciccarone Center
and a Maryland affiliate of the
American Heart Association (AHA)
learned firsthand the true meaning
of the phrase “sharing a meal.”
Seth Martin, MD, MHS, an assistant
professor of medicine at Johns
Hopkins, along with folks from
Members of AHA’s Young Hearts Board
AHA’s Young Hearts Board,
(from left, Sara Ensey, Amanda Bernheim,
Jasveen Kaur, Seth Martin, J.T. Farcosky, and
participated in a cooking class at
Nathan Barbo) donated the fruits of their
the AHA’s “Simple Cooking with
labor to the staff and residents at MCVET.
Heart Kitchen” in Baltimore.
They made two heart-healthy
dishes, an alfredo lasagna with broccoli and a cauliflower casserole. Then,
rather than devour their own creations, the group donated the food to
the staff and residents of the Maryland Center for Veterans Education and
Training. MCVET is a nonprofit designed to provide homeless veterans and
other veterans in need with comprehensive services that will enable them
to rejoin their communities.
All in a day’s work for the busy Martin, who also works with the AHA’s
Advocacy Coordinating Committee and serves as chair of the Young
Hearts Board.
“This is one of the many activities that our Ciccarone Center does with the
AHA,” Dr. Martin said.
Amanda Bernheim, Regional Office Manager for the AHA’s Mid-Atlantic
Affiliate, noted that everyone, not just the folks at MCVET, benefitted from
the activity.
“It is always fun getting together with everyone in a social setting, and even
more so when it is for a good cause,” she said, adding that “Chef Daniels
was confident that there would not be any leftovers.”
1
news & highlights
A landmark study
led by Khurram
Nasir, MD,
Michael Blaha,
MD, and other
members of the
Dr. Khurram Nasir
Ciccarone Center,
and published in the Journal of the
American College of Cardiology in
October, has been making
headlines. Articles and commentary
on the study, which offers evidence
supporting a different and novel
role for calcium (CAC) scores,
raising the possibility that about
half of people who are eligible to
take statins might now avoid taking
them and focus simply on lifestyle
habits, appeared in editions of the
New York Times and online at forbes.
com, medpagetoday.com, and
medicalxpress.com, to name a few.
The study is particularly
noteworthy because, under the
current guidelines, statins are either
recommended or may be
considered for almost two-thirds of
the U.S. adult population. “We
believe that the value of CAC testing
in the current era may be in limiting
the scope of statin therapy to more
selective use, rather than in
expanding it,” said Dr. Nasir.
2
In October 2015, Dr. Blaha was
accepted as a participant in the 2016
Junior Faculty Leadership Program
(JFLP) at Johns Hopkins. A
voluntary cohort program offered
by the Office of Faculty
Development, JFLP is designed to
provide School of Medicine faculty
members (at the level of Instructor
or Assistant Professor) with the
opportunity to build professional
and leadership skills and to think
proactively about their future roles
as leaders in academic medicine.
Mike also has been selected to serve
on the FDA’s Endocrinologic and
Metabolic Drug Advisory
Committee, and he worked on the
approval of the first two PCSK9
inhibitors. He was also selected as
co-chair of the Cross Cohort
Collaboration (CCC), which seeks to
combine and harmonize the
existing NHLBI cohorts to enable
analyses that were not possible
before.
The results of a new study led by
Wendy Post, MD, show that people
infected with the
hepatitis C virus are
at risk for more than
liver damage: the
infection may also
spell heart trouble.
The findings, published online July
27 in The Journal of Infectious Diseases,
emerged from a larger ongoing
study of men, many of whom were
infected with HIV and followed
over time to track risk of infection
and disease progression. A subset of
the participants had both HIV and
hepatitis C, two infections that often
occur together. Dr. Post says that, at
a minimum, patients with hepatitis
C—more than 2.7 million people in
the United States—would benefit
from an annual cardiac evaluation
that includes cholesterol and
glucose testing, a blood pressure
check, and assessment of lifestyle
habits.
In late 2015, Dr. Post was elected to
the American Society of Clinical
Investigation (ASCI), one of the
most prestigious honors. ASCI is an
honor society of physician-scientists
who translate findings in the
laboratory to the advancement of
clinical practice. Founded in 1908,
ASCI includes over 3,000 members
who are in the upper ranks of
academic medicine and industry.
We congratulate Dr. Post on this
fabulous achievement, certainly one
of the highlights of her career.
This past spring, the Ciccarone
Center teamed up with US News &
World Report to provide monthly
columns for the publication’s patient
advice blog written by our experts
on topics of heart health and
cardiovascular disease. The
columns are authored by a faculty
member and a postdoctoral fellow
and offer insight on ongoing issues
of interest in the field of cardiology.
This partnership gives us the
opportunity to reach a large lay
audience and educate readers by
providing independent, reliable
expertise on matters of the heart.
Some of the topics covered to date
include:
•The cardiovascular risk of
excessive exercise training
•Assessing risk for heart attacks
and strokes with coronary artery
calcium
•The statin dilemma: a primer for
patients
• Understanding good cholesterol
•CPR: separating fact from fiction
• Sitting disease and heart health
•Erectile dysfunction and
cardiovascular risk
The full list of articles can be found
at http://health.usnews.com/
health-news/patient-advice/articles.
Kudos to Ciccarone research fellow
Renato Quispe, MD, who
presented at the very
prestigious Eleventh
Annual
Northwestern
Cardiovascular
Young Investigators’
Forum, held October 15-18, 2015, in
Chicago. His presentation was
entitled, ”Inaccuracy of Friedewald‐
Estimation at Clinically Relevant
Very Low Levels of LDL‐
Cholesterol: The Very Large
Database of Lipids Study 1C.”
news & highlights
Also gaining
recognition at the
Young
Investigators’
Forum was
J. Bill McEvoy,
MBBCh, MHS,
whose groundbreaking research on
high-sensitivity troponin, a more
sensitive version of a blood test long
used to verify heart muscle damage
from heart attacks, received second
place at the annual event. Dr.
McEvoy also recently landed a
European CV research award—the
Raymond Shanahan Prize from the
National University of Ireland—for
his smoking-cessation work. Most
importantly, congratulations to Dr.
McEvoy for staying at the Ciccarone
Center as a faculty member at Johns
Hopkins!
In the bad news/good news
category, avid Dallas Cowboys fan
Parag H. Joshi,
MD, MHS,
recently left the
Ciccarone Center
(bad news for us!)
to become an
Assistant Professor
of Medicine in the division of
Cardiology at the University of
Texas Southwestern in Dallas
(good news for him!). Dr. Joshi,
who was a finalist for the Elizabeth
Barrett-Connor Research Award
for Young Investigators in Training
at the 2014 AHA Scientific Sessions,
will focus on preventive cardiology,
building on the training he
received under the Ciccarone
Center team. Fortunately, he will
serve as an adjunct Assistant
Professor with the Ciccarone
Center, which will allow continued
collaboration in many of our
research endeavors.
Richard S. Ross, MD, Groundbreaking
Cardiologist and Hopkins Dean
Richard S. Ross, MD, former dean
of the Johns Hopkins University
School of Medicine and a
renowned cardiologist who served
as president of the American
Heart Association, died August 11,
2015. He was 91 years of age.
Ross was dean of the Johns
Hopkins University School of
Medicine from 1975 to 1990.
Under his leadership, the school
doubled its space devoted to
research, consistently was among
the nation’s top recipients of
federal research funding, and undertook educational reforms and initiatives
that stimulated a continued flow of top-notch applicants to Johns Hopkins
while enhancing their diversity.
As director of Johns Hopkins Cardiology, Ross was among the researchers
who pioneered the use of several novel methods of examining and treating
heart conditions. Along with radiology director Russell Morgan, MD,
Ross introduced coronary cineangiography, a method for “taking the first
motion pictures of the heart,” Ross recalled in a 1992 interview.
Ross and fellow cardiologists Drs. Gottlieb Friesinger, J. Michael
Criley and O’Neal Humphries also were the first at Johns Hopkins
to produce coronary arteriograms, a technique of measuring myocardial
blood flow with dye injected selectively into the coronary arteries. Other
areas of Ross’ research included the relationship between coronary
anatomy and prognosis in coronary artery disease, and the evaluation of
surgical procedures for the treatment of coronary artery disease. He was
also instrumental in organizing a multicenter, prospective, randomized trial
to evaluate the use of coronary bypass surgery for emergency treatment
of unstable angina pectoris.
Before becoming dean, he served as president of the American Heart
Association in 1973–74 and as editor of modern editions of The Principles
and Practice of Medicine, written originally by William Osler, Johns
Hopkins’ first physician-in-chief. Ross received the American Heart
Association’s Gold Heart Award in 1976 and its James B. Herrick Award
for Outstanding Achievement in Clinical Cardiology in 1982. In 2005,
he received The Johns Hopkins University’s President’s Medal, an honor
reserved for people of distinguished achievement.
3
news & highlights
At the 2015 American Heart
Association Epidemiology
Conference, Roberta Florido, MD, a
cardiology fellow at Hopkins and a
Ciccarone Center member, presented
novel data, along with Dr. Chiadi
Ndumele, that showed patients with
low physical activity had higher
levels of chronic cardiac injury, as
manifested by a high sensitivity
assay for cardiac troponin. They are
continuing to study the relationship
between physical and other cardiac
findings in the Atherosclerosis Risk
in Communities (ARIC) study.
Congratulations to Seth Martin,
MD, MHS, for joining the
Ciccarone Center as an assistant
professor of medicine. Dr. Martin,
along with Ciccarone Center
alumnus Mohamed Elshazly, MD,
published a landmark paper in
Circulation this year comparing
patient-level discordance of total
cholesterol/high-density
lipoproteins to low-density
lipoproteins. He also recently
published data in the journal
Atherosclerosis showing no
association between serum leptin
levels and cardiovascular disease
in a multi-ethnic cohort of American
participants. This is important, since
prior studies had historically shown
an association in Caucasian men.
Overall, this seems to be an exciting
time for studying lipid
abnormalities, obesity, and
cardiovascular risk.
4
In June 2015, Dr. Elizabeth
Ratchford, who serves as the
Medical Director of the Vascular
Ultrasound Laboratory at our Green
Spring Station offices, became a
Trustee-at-Large for the Board of the
Society for Vascular Medicine. She
also joined the editorial board for
the journal Vascular Medicine and is
co-editor of its free online patient
resource.
Stanley L. Blumenthal,
MD, Cardiology Research
Awards
Since 2004, the annual Stanley L.
Blumenthal, MD, Preventive
Cardiology Research Awards have
been presented to the Hopkins
postdoctoral fellows, graduate
students, or housestaff submitting
the best abstracts to major research
meetings, such as the American
Heart Association or American
College of Cardiology Scientific
Sessions. These awards are
bestowed following the division’s
yearly cardiovascular research
retreat in May.
This year’s presentations and
awards ceremony was held in the
Koch Center Research Building in
Baltimore. As in years past, there
were combined oral presentations
for both basic science and clinical
science, and then separate awards
were given for the posters
presented in each category.
First place in the ORAL
COMPETITION went to
Anneline te Riele, who received
recognition for
“Exome Sequencing,
Functional Analysis,
and Super-resolution
Imaging Identify a
Pathogenic Role for
SCN5A Mutations in ARVD/C/.”
Seth Martin, MD, MHS, took
second place for his presentation,
“mActive: A Randomized Clinical
Trial of an Automated mHealth
Intervention for Physical Activity
Promotion.” The third place prize
was conferred on Yuejin Li for
“Cardiac Impacts of cTnI Ser199
Phosphorylation in Vivo.” Taishi
Nakamura took fourth place for
“PKG1-alpha Oxidation Fails to
Prevent Adverse Cardiac
Remodeling but Renders Itself
Capable of PDE5 Activation.”
First place in the POSTER
COMPETITION: BASIC
SCIENCE went to Worawan
Limpitikul for a
presentation entitled,
“Conservation of
Cardiac L-type Ca2+
Channels and Their
Modulation in
Drosophila: A Novel Genetically
Pliable Channelopathic Model.”
Mark Ranek was awarded second
prize for “Protein Kinase G
Phosphorylates CHIP to Protect
Against Myocardial Infarction.”
The third place winner was
Gunsik Cho for the presentaion on
“Generation of Adult Heart Muscle
from Human Pluripotent Stem
Cells.”
In the POSTER COMPETITION:
CLINICAL SCIENCE, Thorsten
Leucker, MD, PhD, took home first
place for his presentation,
“Improved Aortic Valve Area
Calculation Using a Novel Biplane
Echo Continuity Equation.” Second
prize went to Micaela Iantorno,
MD, for “A Novel, Non-invasive
MRI Evaluation of Nitric-oxide
Mediated Systemic and Coronary
Endothelial Function in a Single
MRI Acquisition.” Cathy Handy,
MD, MPH, won third place for her
presentation, “The Association of
Coronary Artery Calcium with
Non-cardiovascular Disease: The
Importance of ‘Biological Aging’
from the Multi-Ethnic Study of
Atherosclerosis.”
Congratulations to all the winners!
news & highlights
P.J. Schafer Cardiovascular
Research Award
The P.J. Schafer Cardiovascular
Research Award funds the efforts
of clinical investigators seeking a
better understanding of how to
diagnose premature heart disease
and prevent sudden cardiac death.
Previous recipients of this
prestigious award, which is given
to a junior faculty member, include
Drs. Erin Michos, Richard George,
Saman Nazarian, Rhondalyn
McLean, Oscar Cingolani, Chiadi
Ndumele, Michael Blaha, and
Allison Hays.
The 2015-2016 P.J. Schafer award
winners are Seth S. Martin, MD,
MHS, and J. William (“Bill”)
McEvoy, MBBch, MHS. They were
chosen for their research interest
and accomplishments in devising
strategies to better predict who is
actually at above-average risk for
cardiovascular disease and who is
really at very low risk. The award
will help Dr. Martin continue his
work with “big data,” including the
“mHealth trial,” which involves
digitally tracking physical activity
and using automated, personalized
text messaging to reinforce healthy
behavior in real-time. Dr. McEvoy
will continue to focus on refining
and personalizing cardiovascular
risk, testing novel biomarkers of
risk, and doing comparative
effectiveness research with a
special emphasis on hypertension
and atherosclerosis.
Dr. Martin received his Bachelor of
Science degree from Washington
and Lee University, graduating
summa cum laude and Phi Beta
Kappa. He went on to receive his
medical degree from the University
of Pennsylvania and completed his
internal medicine training at Duke
University.
(continued on page 6)
Tribute to David E. Bush, MD
By Roger S. Blumenthal, Edward P. Shapiro, and Nisha Chandra-Strobos
The cardiovascular community lost an outstanding
clinician, mentor, clinical researcher, and pioneer
with the passing of Dr. David Bush at age 63 on
September 3, 2015. David was a widely respected
and internationally recognized educator and an
expert in cardiac computed tomography (CT) and
coronary angiography.
David earned his medical degree at UCSF and moved to Baltimore in 1977 to
join the prestigious Osler Medical Residency where he became one of the
very few African-American house officers. He was selected by Dr. Myron
“Mike” Weisfeldt to do his cardiology fellowship training at Johns
Hopkins. He worked under the guidance of Dr. Bernadine Healy, with
whom he published a seminal paper in Circulation in 1988 describing the
cellular mechanisms of myocardial infarct expansion. He was recruited to the
faculty in Cardiology and became the first African-American Cardiology
faculty member at Johns Hopkins in 1983.
Over the next decade David became an expert in cardiac catheterization and
was named Director of the Cardiac Catheterization Lab at The Johns Hopkins
Bayview Medical Center. He studied endothelial function and brachial artery
vasoreactivity with Dr. Pamela Ouyang, and demonstrated that
endothelial function in some postmenopausal women could be improved with
estrogen therapy.
More recently he worked closely with Dr. Roy Ziegelstein; his basic
interest in the pathophysiology of disease shifted to the problem of post
MI depression and the negative prognosis that it imparts.
A decade ago, David and Dr. Edward Shapiro, developed a highly
acclaimed, multidisciplinary Cardiac CT Angiography CME course that
continues monthly. They have taught hundreds of cardiologists and radiologists
world-wide about the intricacies of this exciting technology. David was a
dynamic teacher and mentor and he displayed great enthusiasm for finding
new ways to better diagnose and manage atherosclerotic vascular disease.
David, in his own humble but persuasive way, helped address issues of
diversity and racial equality on the national front in academic medicine. He
was an active member of the Association of Black Cardiologists, was named
that organization’s member of the year in 1999 and later served on their
governing board. He served on multiple NIH study selections and important
committees for the AHA over the years.
We will all miss David’s collegiality, advice, friendship and radiance. He was a
great problem-solver, and for the past 32 years he was a shining example of
what a faculty member at Johns Hopkins should be. He had the unique ability
to balance research with clinical relevance and bring the bench to the bedside.
He redefined patient commitment; he was seeing patients up to three weeks
prior to his death. He was a highly sought-after clinician and his patients
adored him.
5
news & highlights
Dr. Martin then completed a
cardiology fellowship at the Johns
Hopkins University School of
Medicine. He was designated the
Henry R. Kravis & Marie-Josée
Cardiovascular Fellow and also
served as a Pollin Cardiovascular
Prevention Fellow. Dr. Martin was
awarded the Howard S. Silverman
Research Award for originality and
creativity in medical research.
Additionally, he was recognized as
an Up and Coming Future Star of
Cardiology by the American
College of Cardiology. During his
fellowship, Dr. Martin obtained a
Master of Health Science degree at
the Johns Hopkins Bloomberg
School of Public Health.
After completing the fellowship,
Dr. Martin joined the Johns
Hopkins Cardiology faculty and
now works on staff with the
Ciccarone Center for the Prevention
of Heart Disease. Dr. Martin has a
longstanding interest in preventive
cardiology, in particular
cardiovascular risk assessment,
lipidology, and mobile health
technology. Dr. Martin has
published more than 110 articles in
leading cardiology and medicine
journals, as well as 11 book
chapters, and serves as Associate
Editor for the American College of
Cardiology’s CardioSource
Dyslipidemia Clinical Community.
Dr. McEvoy is an Assistant
Professor of Medicine in the
Division of Cardiology and
Department of Medicine at the
Johns Hopkins University School
of Medicine. A 2004 graduate of the
National University of Ireland,
UCC School of Medicine, Dr.
McEvoy completed Intern and
Senior House Officer training in
medicine, and successfully
obtained Membership of the Royal
College of Physicians (MRCP) in
Ireland. Dr. McEvoy then
completed Registrar training in
Cardiology at the Mater
Misericordiae University Hospital
in Dublin, Ireland.
(continued on page 7)
More Than 200!
The Ciccarone Center publishes important original research articles, editorials, and review articles
in many of the world’s top cardiology, internal medicine, epidemiology, and endocrinology journals.
From October 2014 to September 2015, the Center showed amazing productivity, publishing more
than 200 articles of significant basic and clinical research findings, commentaries, and review
articles in many leading medical journals, including:
American Heart Journal (4)
American Journal of Cardiology (8)
American Journal of Epidemiology (2)
American Journal of Hypertension (1)
American Journal of Kidney Diseases (2)
Annals of Internal Medicine (5)
Arteriosclerosis, Thrombosis & Vascular Biology (4)
Atherosclerosis (25)
Circulation (9)
Circulation: Cardiovascular Imaging (3)
Circulation: CV Quality & Outcomes (3)
Circulation: Research (1)
Clinical Cardiology (5)
Coronary Artery Disease (3)
Diabetes Care (5)
European Heart Journal (2)
European Journal of Preventive Cardiology (2)
Heart (1)
6
Hypertension (4)
International Journal of Cardiology (5)
Journal of the American College of Cardiology (6)
JACC: Cardiovascular Imaging (5)
JACC: Heart Failure (2)
Journal of the American Heart Association (10)
Journal of the American Medical Association (2)
JAMA: Internal Medicine (1)
Journal of the American Society of Hypertension (1)
Journal of Clinical Endocrinology & Metabolism (2)
Journal of Clinical Lipidology (7)
Journal of Hypertension (2)
Mayo Clinic Proceedings (6)
PLOS ONE (2)
news & highlights
In 2008, Dr. McEvoy joined the
prestigious Osler Housestaff
training program at the Johns
Hopkins Department of Medicine
as the only international graduate
in his residency class. In 2011, he
matched to the Cardiology
fellowship at Johns Hopkins and
completed advanced training in
Cardiac Prevention, Cardiac
Imaging, and Cardiovascular
Epidemiology. He was an
inaugural Pollin Cardiovascular
Prevention Fellow and also served
as the Chief Cardiology Fellow in
2014.
Dr. McEvoy has numerous
undergraduate and post-graduate
awards in medical education and
research. He has a clinical interest
in the primary and secondary
prevention of heart disease, in both
critical care and outpatient care
settings. He sees adults who
require care for ailments across the
spectrum of general cardiology
and is passionate about providing
the highest standard of clinical care
for his patients.
Hopkins Cardiology is indebted to
Paul and Vivian Schafer and the
Board of the P.J. Schafer
Foundation for their hard work
and generous contributions in
support of cutting-edge research
geared to the prevention of sudden
cardiac death, which tragically took
the life of their son, P.J.
To make donations or sign up for
the P.J. Schafer golf tournament, go
to www.pjschafer.com.
Our Donors Make an Invaluable Difference
The impact of philanthropy is immeasurable. It enables
research, education and clinical care to advance beyond the
limitations of budgetary constraints and diminished federal
funding. We are truly grateful to our generous contributors.
They assist in our efforts and partner with us as we remain
at the forefront of scientific investigation and collaboration
in all areas of cardiovascular disease prevention.
While our space here is limited, please know our
thankfulness is not. Philanthropic support of any amount
has been greatly appreciated, but we’d like to take this
opportunity to thank the following donors for their
extraordinary investment in our clinical research and
activities over the past year:
Mr. and Mrs. Richard Amato
Mr. David L. Ansell
Mr. and Mrs. Larry Askew
Mr. and Mrs. Leonard J. Attman
Mr. Edgar I. Calin
Mr. and Mrs. Edward Casel
Mr. and Mrs. Mark K. Fischer
Mr. David L. Greif II
Mrs. Virginia F. Gomprecht
Ms. Joyce C. Koons
Mr. and Mrs. Jerome Leibowitz
Mr. and Mrs. Michael L. Lenkin
Mr. and Mrs. Hal Magruder
Mr. and Mrs. Jonathan L. Marcus
Mrs. Margaret J. McMichael
Mr. Daniel D. Moore, Jr.
Mr. James Pacquin
Mr. and Mrs. Nicholas G. Paleologos
Mr. and Mrs. Joseph Popovich, Jr.
Mr. Andrew Samet
Mr. and Mrs. Terry Schadoff
Mr. and Mrs. Thad Shelly
Mr. and Mrs. Donald J. Shepard
Mr. and Mrs. Carter C. Shepherd
Mr. and Mrs. Robert Taylor
Mr. and Mrs. Dennis W. Townsend
Caprice M. Uhlhorn, PhD
Mr. Daniel Wagner
Irv and Ginger Gomprecht
7
simple as
Preventing Cardiovascular Events Based on the 2013 Prevention Guidelines
The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease has identified a simple and effective
way to predict and prevent cardiovascular disease. Our “ABCDE” method — which stands for Assessment of risk,
Antiplatelet therapy; Blood pressure management; Cholesterol management, Cigarette/tobacco cessation; Diet and
weight management, Diabetes prevention and treatment; and Exercise — organizes the national guidelines into a
comprehensive plan for managing prevention. This tool is intended to provide a brief set of instructions for people
who may be at risk to discuss with their doctors.
Assessing Your CVD
Risk
An adult can estimate
his or her risk of heart
attack or stroke over the next 10
years by using the atherosclerotic
cardiovascular disease (ASCVD) risk
calculator: http://clincalc.com/
Cardiology/ASCVD/PooledCohort.
aspx.
An Aspirin a Day
A small dose of aspirin (81 mg) daily
may lower the risk of a heart attack
and stroke. In many patients who
have had a heart attack or have
heart stents, adding another
antiplatelet medicine, such as
clopidogrel, to daily aspirin can add
additional benefit. Aspirin is
generally recommended for people
with 1) an ASCVD risk estimate
>10% (if not at high risk for
bleeding); 2) those who have known
atherosclerosis; and 3) diabetes
(if at least 40 years of age).
Blood Pressure —
Go Low
High blood pressure is a
significant cause of heart
attack, stroke, kidney disease, and
dementia. Hypertension is defined
as a blood pressure of >140/90.
Recent clinical trial data indicates
that a person over age 50 with a
cardiac risk factor should likely
strive for a systolic blood pressure of
<130. Lifestyle interventions,
including regular aerobic exercise,
eating a diet low in salt and high in
fruits and vegetables, losing excess
weight, and reducing alcohol intake,
all lower blood pressure.
8
Cholesterol Therapy
a Must
Cholesterol gradually
builds up on the walls of
arteries over time, leading to
cholesterol plaques or
atherosclerosis. Healthier dietary
habits and increased exercise remain
the two best ways to improve
cholesterol but often a statin and/or
other medication is employed to
lower cardiovascular risk.
Cigarette/Tobacco Cessation
Tobacco use increases the risk of
heart attack and stroke and is linked
to multiple types of cancers. If you
smoke, make every concerted effort
to stop. Develop a plan to quit and
set a quit date. Resources are
available to help you stop smoking,
including nicotine replacement
therapies and prescription
medications. Contact
1-800-QUIT-NOW.
Diabetes Prevention
and Treatment
Both diabetes and prediabetes can lead to
heart disease, stroke, kidney failure,
blindness, and amputations. You can
help diagnose both conditions by
checking your hemoglobin A1c
(HbA1c) levels. A measured HbA1c
of 5.7-6.4% represents pre-diabetes,
while a level of 6.5% or more
represents diabetes. Weight loss and
improvements in diet and exercise
help prevent the development of
diabetes. If you are a diabetic, you
may need medications, such as
metformin or insulin, for optimal
diabetes control.
Diet and Weight Management
A healthy diet should be rich in
fruits, vegetables, and whole grains,
along with low-fat dairy products,
poultry, fish, legumes, and nuts.
Sweets, sugar-sweetened beverages,
red meat, and simple carbohydrates
found in white breads, pastas, and
white rice should be minimized.
Weight is measured using the body
mass index, or BMI. Normal BMI is
18-24.9 kg/m2; 25-29.9 kg/m2 is
considered overweight; and
> 30 kg/m2 indicates obesity. For
excess weight, making even small
changes in diet and exercise can aid
in weight loss. The new guidelines
suggest losing at least 5% of body
weight via a low calorie diet
combined with an increase in
physical activity.
Exercise Is Key
Exercise helps us lose
weight, stay healthy,
and feel better. A good
exercise program consists of aerobic
activity, strength training, and
flexibility exercise. Guidelines
recommend 3-4 sessions a week,
lasting on average 30-40 minutes
per session, involving moderate- to
vigorous-intensity physical activity.
Reduce sitting time and aim for
>10,000 steps/day of walking.
Take control of your ABCs!
For more information, call the
Johns Hopkins Ciccarone
Center for the Prevention of
Heart Disease at 410-955-7376.
www.hopkinsmedicine.org/
heart
Personalized prevention advice is the trademark of the Ciccarone Center.
is
the
what ciccarone center?
Since 1990, the mission of
the Ciccarone Center for the
Prevention of Heart Disease has
been three-fold:
•To create excellent clinical care
for people at risk of developing
heart disease
•To educate health care
practitioners about how to
better identify and care for
patients at risk of developing
heart disease
•To establish rigorous research
programs to study better
prevention of heart disease
Relentless pursuit of these goals
over the past two decades has led
to the creation of one of the fastest
growing clinical and research
programs at Johns Hopkins, which
is highly regarded for its innovative
and effective approaches to
cardiovascular disease prevention
and treatment.
Clinical Care
The trademark of the Ciccarone
Center is its comprehensive
approach, which involves both
global assessment and aggressive
management of multiple risk
factors (not just single risk factors,
such as high blood pressure or
high cholesterol) contributing to
the development and progression
of atherosclerosis. Our clinical
center is dedicated to:
•The detection and management
of individuals at risk for
accelerated atherosclerosis
(primary prevention) to prevent
or delay the onset of
cardiovascular disease, and
•The management of patients
with established vascular
disease (secondary prevention)
to reduce recurrent
cardiovascular events and
decrease mortality.
Education
Our educational efforts are aimed
at the medical community and the
general public. The Ciccarone
Center also serves as a model for
teaching the art of prevention of
cardiovascular disease to fellows,
residents, and students at the Johns
Hopkins School of Medicine and
the Bloomberg School of Public
Health.
Our physicians and nurse
practitioner are also lecturers for
medical and nursing students and
physicians at Hopkins and at
national meetings. Hopkins
Medicine also organizes meetings
to address educational issues for
the public.
Research
As part of Johns Hopkins, the
Ciccarone Center for the Prevention
of Heart Disease is committed to
conducting cutting-edge research
on atherosclerosis and risk factors
for heart disease. We conduct
research on two levels:
• Clinical research studies of
cardiovascular disease involving
informed, consenting adults,
and
• Basic research and experiments
to decipher the molecular
reactions leading to
atherosclerotic vascular disease.
A Personalized,
Comprehensive
Approach
The Ciccarone Center specializes in
managing adults who are at high
risk for future cardiovascular
disease because of the presence of
multiple cardiac risk factors (such
as hypertension, dyslipidemia,
diabetes, smoking, sedentary
lifestyle, or overweight status) or a
history of known cardiovascular or
peripheral arterial disease.
The Ciccarone Center’s
personalized, comprehensive
approach to lifestyle and medical
management can slow the
progression of cardiovascular
disease and decrease one’s future
risk of a heart attack, stroke, bypass
surgery, angioplasty, or stenting.
We also sponsor research that
includes both clinical trials and
basic molecular studies.
Several groups of patients have
been of particular interest to the
Ciccarone Center:
•Women and ethnic minorities
•Patients with metabolic
disorders, in particular inherited
dyslipidemias, the metabolic
syndrome, and diabetes
•Patients with accelerated
atherosclerosis
•Persons with a family history of
coronary heart disease or stroke
•Persons with recurrent chest
pain but no established
cardiovascular disease
•Persons who have been
intolerant of standard
cholesterol or blood pressure
medications
9
is
the
what ciccarone center?
State-of-the-Art Testing
We are especially interested in
individuals who develop
cardiovascular disease before the
age of 65. We have special expertise
in the screening and management
of asymptomatic family members of
persons with premature
atherosclerotic disease. Our team
may selectively employ state-of-theart testing to help identify factors
contributing to heart disease
clustering in families.
For an individual patient, we may
use the latest assessment
techniques to measure lipoproteins
(total cholesterol, high-density
lipoprotein-cholesterol [HDL-C],
LDL-C, and triglyceride levels) and
apolipoproteins (Lp[a],
apolipoprotein B) as well as
nontraditional risk factors, such as
high-sensitivity C-reactive protein
(hsCRP), and measurements of
lipoprotein size and number.
However, for many individuals
these emerging risk factors are
often not needed to optimize their
management in a cost-effective
manner.
Advanced Diagnostic
Tools
Among asymptomatic adults with
no history of cardiovascular
disease, we may use a 64-slice or a
320-slice multidetector computed
tomography (MDCT) scan of the
chest to measure the amount of
coronary artery calcification. The
presence of elevated coronary
artery calcification (e.g. > 75th
percentile for one’s age and gender)
or thickened carotid arteries is a
sign of accelerated atherosclerosis
for one’s age and may lead to more
aggressive attempts at
comprehensive risk factor changes
through both medical management
and lifestyle modification.
Occasionally, a cardiac CT
angiogram may also be indicated in
patients with atypical chest pain
and inconclusive stress test results.
After an initial comprehensive
evaluation, we can inform a patient
whether his/her management
might be changed by some of the
more sophisticated laboratory and
diagnostic testing that we can
provide.
Improving Lifestyle
Habits
Dominique Ashen, PhD, CRNP, a
nurse practitioner who specializes
in helping people improve their
lifestyle habits,
assists patients
with behavior
changes such as:
•Following
healthier diets
•Maintaining a
prudent body weight
• Smoking cessation
•Maintaining a regular aerobic
program
• Coping better with stress
We also refer patients to the Johns
Hopkins Clinical Exercise Center
as well as to the state-of-the-art
Maryland Athletic Club (MAC)
Healthy Start program to optimize
their lifestyle habits. We encourage
all individuals with known
cardiovascular disease, peripheral
arterial disease, diabetes, or
congestive heart failure to
participate in a supervised exercise
program.
Our Mission
We have built the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease with the following
goals in mind:
1. Provide a center dedicated to clinical patient care and the global assessment of risk factors for
cardiovascular disease, which enables patients to receive:
•the latest information on the prevention of atherosclerotic vascular disease,
•comprehensive management of risk factors for cardiovascular disease, and
•high-quality care that is integrated into the other health promotional resources of Johns Hopkins.
2. Create a center at Johns Hopkins for the education of health care providers in the area of prevention
of cardiovascular disease. Teaching by our physicians and nurse practitioner broadly targets Hopkins
nurses, medical students, fellows, and physicians as well as the community at large.
3. Foster cardiovascular research, including both clinical trials and translational research.
10
publications
research
A listing of the publications by
the staff of the Johns Hopkins
Ciccarone Center for the
Prevention of Heart Disease,
from October 2014 through
September 2015.
1. Abd TT, Hayek S, Cheng JW, Samuels OB,
Wittstein IS, Lerakis S. Incidence and clinical
characteristics of takotsubo cardiomyopathy postaneurysmal subarachnoid hemorrhage.
International Journal of Cardiology. 2014 Oct
20;176(3):1362-4.
2. Abd TT, George RT.
Association of coronary
plaque burden with
fractional flow reserve:
should we keep attempting
to derive physiology from
anatomy? Cardiovascular
Diagnosis and Therapy.
2015 Feb;5(1):67-70.
Dr. Thura Abd
Summary: This study
evaluates the performance of
an emerging coronary computed tomography
angiography-derived anatomical measure “percent
aggregate plaque volume” to improve the detection
of hemodynamic significant stenosis as compared
with invasive fractional flow reserve.
3. Christenson ES, Ahmed HM, Durand CM.
Pasteurella multocida infection in solid organ
transplantation. The Lancet, Infectious Diseases.
2015 Feb;15(2):235-40.
Summary: This article reviews the clinical
features, epidemiology, and treatment of P.
multocida, which is known to use domesticated or
wild animals as potential carriers of this disease,
with a focus on these features in patients who are
immunosuppressed.
4. Desai D, Ahmed HM, Michos ED. Preventing
cardiovascular disease in patients with diabetes: use
of aspirin for primary prevention. Current
Cardiology Reports. 2015 Mar;17(3):566.
Summary: This article reviews the literature for
the most up-to-date studies evaluating aspirin
therapy for primary prevention of atherosclerotic
cardiovascular disease (ASCVD) in patients with
diabetes.
5. Brawner CA, Ahmed HM. Predicting
cardiovascular events…How FIT is our crystal
ball? Atherosclerosis. 2015; Aug;241(2):741-2.
Summary: The authors summarize the available
data about using cardiorespiratory fitness in
cardiovascular risk assessment and treatment
decisions.
6. Ahmed HM, Al-Mallah MH, McEvoy JW,
Nasir K, Blumenthal RS, Jones SR, Brawner
CA, Keteyian SJ, Blaha MJ. Maximal exercise
testing variables and 10-year survival: fitness score
derivation from the FIT Project. Mayo Clinic
Proceedings. 2015 Mar;90(3):346-55.
Summary: The FIT Treadmill Score is easily
attainable from any standard exercise test and
translates basic treadmill performance measures
into a fitness-related mortality risk score. This will
be validated in external populations.
7. Cruz D, Ahmed H, Gandapur Y, Abraham MR.
Propionibacterium acnes: a treatable cause of
constrictive pericarditis. Case Reports in Medicine.
2015;2015:193272.
Summary: This case and review illustrate the
importance of considering Propionibacterium acnes
as a cause of idiopathic pericardial effusion and
effusive constrictive disease.
8. Same RV, Feldman DI, Shah N, Martin SS,
Al Rifai M, Blaha MJ, Ahmed HM. The
relationship between sedentary behavior and
cardiovascular risk. Current Cardiovascular Risk
Reports. Forthcoming 2015.
9. Blumenthal RS, Ahmed HM. Risk prediction
using coronary artery calcium in younger
populations — Theory or valid practice? Journal of
the American College of Cardiology:
Cardiovascular Imaging. Forthcoming 2015.
10. Aladin AI, Whelton SP, Al-Mallah MH, Blaha
MJ, Keteyian SJ, Juraschek SP, Rubin J, Brawner
CA, Michos ED. Relation of resting heart rate to
risk for all-cause mortality by gender after
considering exercise capacity (the Henry Ford
exercise testing project). American Journal of
Cardiology. 2014 Dec 1;114(11):1701-6.
Summary: After adjustment for fitness, elevated
resting heart rate (RHR) is an independent risk
factor for all-cause mortality in men but not
women, suggesting gender differences in the utility
of RHR for risk stratification.
11. Aladin AI, Al Rifai M, Rasool SH, Keteyian
SJ, Brawner CA, Michos ED, Blaha MJ, AlMallah MH, Keteyian SJ, McEvoy JW. The
association of resting heart rate and incident
hypertension: The Henry Ford hospital exercise
testing (FIT) project. American Journal of
Hypertension. 2015 Jun 25. pii: hpv095.
Summary: Elevated resting heart rate is an
independent risk factor for incident hypertension,
particularly in younger persons. Whether lifestyle
modification or other strategies to reduce resting
heart rate can prevent hypertension in high-risk
individuals warrants further study.
12. Alluri K, Joshi PH, Henry TS, Blumenthal
RS, Nasir K, Blaha MJ. Scoring of coronary
artery calcium scans: history, assumptions, current
limitations, and future directions. Atherosclerosis.
2015 Mar;239(1):109-17.
Summary: The authors discuss the methodology
of each scoring system, describing how each makes
important indirect assumptions in the way they
account (or do not account) for calcium density,
location of calcium, spatial distribution of calcium,
and microcalcification/emerging calcium that might
limit their predictive power.
13. Alluri K, McEvoy JW, Dardari ZA, Jones
SR, Nasir K, Blankstein R, Rivera JJ, Agatston
AA, Kaufman JD, Budoff MJ, Blumenthal RS,
Blaha MJ. Distribution and burden of newly
detected coronary artery calcium: Results from the
Multi-Ethnic Study of Atherosclerosis. Journal of
Cardiovascular Computed Tomography. 2015 JulAug;9(4):337-344.
Summary: We characterized the anatomic
distribution and burden of newly detectable CAC
over 10-year follow-up. New-onset CAC most
commonly involves just 1 vessel, occurs in the left
anterior descending artery, and has low CAC
burden and can be detected at an early stage when
aggressive preventive strategies may provide
benefit.
Irene Pollin: A Pioneer and Inspiration
In 2013, we were the fortunate recipients of an
extremely generous $10 million donation from Irene
Pollin that has served as a transformational grant for
our education and research initiatives. As part of that
magnificent gift, Dr. Roger Blumenthal became
the inaugural Kenneth Jay Pollin Professor of Cardiology,
and several outstanding postdoctoral clinical research fellows are selected
as Pollin Cardiovascular Prevention Fellows each year to further their
development as academic medicine leaders in preventive cardiology.
In addition to being a generous benefactor, Irene Pollin has long been a
pioneer and inspiration to all of us in her ability to empower people to learn
more about their own risk of heart disease and stroke and to take meaningful
steps to lower that risk. We have tried to learn from and emulate her
innovative cardiovascular screening and education approach.
11
publications
research
14. Al Rifai M, Cainzos-Achirica M, Blaha MJ.
Establishing the warranty of a coronary artery
calcium score of zero. Atherosclerosis. 2015 Jan;
238(1):1-3.
Summary: The duration of a very low risk period
for an ASCVD event associated with the absence
of CAC depends on the number of associated
cardiac risk factors.
15. Al Rifai M, McEvoy JW, Nasir K, Rumberger
J, Feldman D, Budoff MJ, Blaha MJ. Traditional
cardiovascular disease risk factors associated with
one-year all-cause mortality among those with
coronary artery calcium scores ≥ 400.
Atherosclerosis. 2015 Jun 5;241(2):495-497.
Summary: Smoking and diabetes are strongly
associated with one-year mortality among persons
with extensive CAC, suggesting that these risk
factors serve as triggers of acute events.
16. Al Rifai M,
Silverman MG, Nasir
K, Budoff MJ,
Blankstein R, Szklo M,
Katz R, Blumenthal RS,
Blaha MJ. The
association of
nonalcoholic fatty liver
disease, obesity, and
Dr. Michael Silverman metabolic syndrome,
with systematic
inflammation and subclinical atherosclerosis: the
Multi-Ethnic Study of Atherosclerosis (MESA).
Atherosclerosis. 2015 Apr; 239(2):629-33.
Summary: Nonalcoholic fatty liver disease is
associated with increased inflammation and
coronary artery calcium independent of traditional
risk factors. There is a graded association between
obesity, metabolic syndrome, and liver disease with
inflammation and CAC.
17. Patel J, Al Rifai M, Blaha MJ, Budoff MJ,
Post WS, Polak JF, Bluemke DA, Scheuner MT,
Kronmal RA, Blumenthal
RS, Nasir K, McEvoy JW.
Coronary artery calcium
improves risk assessment in
adults with a family history
of premature coronary heart
disease: Results from MultiEthnic Study of
Atherosclerosis.
Dr. Bill McEvoy
Circulation, Cardiovascular
Imaging. 2015
Jun;8(6):e003186.
Summary: Nearly half of individuals reporting a
family history of premature coronary heart disease
have zero CAC and likely receive little net benefit
from aspirin or statin therapy. Among persons with
a family history of early atherosclerotic
cardiovascular disease (ASCVD), CAC is a robust
marker of absolute and relative risk of ASCVD, but
carotid intima-media thickness is not.
12
18. Al Rifai M,
Schneider AL, Alonso A,
Maruthur N, Parrinello
CM, Astor BC,
Hoogeveen RC, Soliman
EZ, Chen LY, Ballantyne
CM, Halushka MK,
Selvin E. sRAGE,
inflammation, and risk of
atrial fibrillation: results
Dr. Mahmoud Al Rifai
from the Atherosclerosis
Risk in Communities (ARIC) Study. The Journal
of Diabetes Complications. 2015 Mar;29(2):180-5.
Summary: The soluble advanced glycation end
product receptor (sRAGE) was strongly inversely
associated with markers of inflammation at
baseline, but not prospectively. Nor was it
significantly associated with incident atrial
fibrillation. This supports a role for the receptor in
attenuating current inflammation.
19. Kohli P, Whelton SP, Hsu S, Yancy CW, Stone
NJ, Chrispin J, Gilotra NA, Houston B, Ashen
MD, Martin SS, Joshi PH, McEvoy JW,
Gluckman TJ, Michos ED, Blaha MJ,
Blumenthal RS. Clinician’s guide to the updated
ABCs of cardiovascular disease prevention.
Journal of the American Heart Association. 2014
Sep 22;3(5):e001098.
Summary: To facilitate the guideline-based
implementation of treatment recommendations in
the ambulatory setting and to encourage
participation in the multiple preventive health
efforts that exist, we organized several recent
guideline updates into a simple ABCDEF
approach.
20. Quispe R, Bazo-Alvarez JC, Burroughs PMS
et al. Distribution of short-term and lifetime
predicted risks of cardiovascular diseases in
Peruvian adults. Journal of the American Heart
Association. 2015 Aug 7;4(8). Pii:e002112.
Summary: These findings highlight shortcomings
of using short-term risk tools for primary
prevention strategies because a substantial
proportion of Peruvian adults were classified as low
short-term risk but high lifetime risk. Vulnerable
adults, such as those from low socioeconomic
status and those living in urban areas, need greater
attention regarding preventive strategies.
21. Quispe R, Manalac RJ, Faridi KF, Blaha
MJ, Toth PP, Kulkarni
KR, Nasir K, Virani SS,
Banach M, Blumenthal
RS, Martin SS, Jones
SR. Relationship of the
triglyceride to highdensity lipoprotein
cholesterol (TG/HDL-C)
ratio to the remainder of
Dr. Kamil Faridi
the lipid profile:The very
large database of lipids-4 (VLDL-4) study.
Atherosclerosis. 2015 July 7;242(1):243-50.
Summary: A higher TG/HDL-C ratio was
associated with an increasingly atherogenic lipid
phenotype, characterized by higher remnant
lipoprotein particle cholesterol (RLP-C) along with
higher non-HDL-C and LDL density.
22. Quispe R, Al-Hijji M, Swiger KJ, Martin SS,
Elshazly MB, Blaha MJ, Joshi PH, Blumenthal
RS, Sniderman AD, Toth PP, Jones SR. Lipid
phenotypes at the extremes of high-density
lipoprotein cholesterol: The very large database of
lipids-9. Journal of Clinical Lipidology. 2015 JulAug;9(4):511-518.
Summary: There is a high prevalence of elevated
triglyceride-rich lipoprotein levels and increased
LDL density in patients with extremely low
HDL-C levels. The relative contributions of these
various changes in lipid profiles of patients with
low HDL-C to cardiovascular risk need to be
further scrutinized to establish if low HDL-C is
truly an independent risk factor for heart disease or
simply reflects detrimental shifts in the levels of
atherogenic lipoproteins.
23. Carrillo-Larco RM, Bernabe-Ortiz A, Pillay
TD...Quispe R, Smeeth L, Miranda JJ. Obesity risk
in rural, urban and rural-to-urban migrants:
prospective results of the Peru migrant survey.
International Journal of Obesity. 2015 Jul 31.
Summary: Peruvian urban individuals and ruralto-urban migrants show a higher incidence of
obesity compared to their rural counterparts. Given
the ongoing urbanization occurring in middleincome countries, the rapid development of
increased obesity risk by migrants suggests that
measures to reduce obesity should be a priority for
this group.
24. Elshazly MB, Quispe R, Michos ED,
Sniderman AD, Toth PP, Banach M, Kulkarni KR,
Coresh J, Blumenthal RS, Jones SR, Martin SS.
Patient-level discordance in population percentiles
of the total cholesterol to high-density lipoprotein
cholesterol ratio in comparison with low-density
lipoprotein cholesterol and non-high-density
lipoprotein cholesterol: The Very Large Database
of Lipids Study (VLDL-2B). Circulation. 2015
Aug 25;132(8):667-76.
25. Bazo-Alvarez JC, Quispe R, Peralta F et al.
Agreement between cardiovascular disease risk
scores in resource-limited settings: evidence from
Peruvian sites. Critical Pathways in Cardiology.
2015 Jun;14(2):74-80.
Summary: Poor concordance between current
CVD risk scores demonstrates the uncertainty of
choosing any of them for public health and clinical
interventions in Latin American populations. There
is a need to improve the evidence base of risk
scores for CVD in low-income and middle-income
countries.
26. Burroughs PMS, Bernabe-Ortiz A, CarrilloLarco RM, Sanchez JF, Quispe R et al. Migration,
urbanisation and mortality: 5-year longitudinal
analysis of the Peru Migrant study. Journal of
Epidemiology & Community Health. 2015
Jul;69(7):715-8.
Summary: Cardiovascular mortality of migrants
remains similar to that of the rural group,
suggesting that rural-to-urban migrants do not
appear to catch up with urban mortality in spite of
having a more urban cardiovascular risk factor
profile.
27. Diez-Canseco F,
Boeren Y, Quispe R,
Chiang ML, Miranda JJ.
Engagement of adolescents
in a health communications
program to prevent
noncommunicable
diseases. Preventing
Chronic Disease. 2015 Mar Dr. Renato Quispe
5;12:E28.
Summary: Engaging young people in public
health promotion activities was feasible and
advantageous for the design of tailored preventionrelated content and its dissemination among peers.
28. Zeballos-Palacios C, Quispe R et al. Shared
decision making in senior medical students: results
from a national survey. Medical Decision Making.
2015 May;35(4):533-8.
Summary: Despite limited exposure and training,
Peruvian medical students aspire to practice shared
decision making but their current attitude reflects
the less participatory approaches they see role
modeled by their teachers.
29. Valle GA, Poterico JA, Quispe R. Informal
caregivers of patients with cerebrovascular
diseases. Revista Peruana de Medicina
Experimental y Salud Publica. 2014;31(1):169-80.
30. Ali SS, Oni ET, Warraich HJ, Blaha MJ,
Blumenthal RS, Karim A, Shaharyar S, Jamal O,
Fiakow J, Cury R, Budoff MJ, Agatston AS, Nasir
K. Systematic review on noninvasive assessment
of subclinical cardiovascular disease in obstructive
sleep apnea: new kid on the block! Sleep Medicine
Reviews. 2014 Oct;18(5):379-91.
Summary: Obstructive sleep apnea is an
independent predictor of subclinical CVD as CVD
is more likely to occur in patients with longstanding and severe OSA.
31. Blaha MJ. The future of CV risk prediction:
multisite imaging to predict multiple outcomes. The
Journal of the American College of Cardiology,
Cardiovascular Imaging. 2014 Oct;7(10):1054-6.
Summary: The future of risk prediction will
include the selective upfront use of imaging. Based
on the cumulative results from a variety of imaging
studies, now is the time for us to initiate a complete
rethinking of the conventional approach to risk
prediction.
32. Martin SS, Khokhar AA, May HT, Kulkami
KR, Blaha MJ, Joshi PH, Toth PP, Muhlestein
JB, Anderson JL, Knight S, Li Y, Spertus JA, Jones
SR. HDL cholesterol subclasses, myocardial
infarction, and mortality in secondary prevention:
the Lipoprotein Investigators Collaborative.
European Heart Journal. 2015 Jan;36(1):22-30.
Summary: In secondary prevention, increased risk
for long-term hard clinical events is associated with
low high-density lipoprotein (HDL) 3-C, but not
HDL 2-C or HDL-C, highlighting the potential
value of subclassifying HDL-C.
33. Miedema MD, Lopez FL, Blaha MJ, Virani
SS, Coresh J, Ballantyne CM, Folson AR.
Eligibility for statin therapy according to new
cholesterol guidelines and prevalent use of
medication to lower lipid levels in an older US
Cohort: the Atherosclerosis Risk in Communities
Study Cohort. The Journal of the American
Medical Association, Internal Medicine. 2015 Jan;
175(1):138-40.
Summary: The increase in statin eligibility
according to the new guidelines is largely a
consequence of the 7.5% CVD risk threshold in
primary prevention. The 7.5% CVD risk threshold
is aggressive, creating a nearly universal
recommendation for statin use in individuals aged
65 years and older.
Ty Gluckman, MD
Currently
Medical
Director
of Clinical
Transformation
at the
Providence
Heart and Vascular Institute in
Portland, Ore., Ciccarone Center
alum Ty Gluckman, MD, was
one of the principal designers of a
medical app that clinicians around
the world now use to assess
what a person’s 10-year risk of a
heart attack and stroke are. The
app, which is available both on
the web and as an app on iTunes
and Google Play, also provides
a wealth of patient information.
To date, there have been more
than 3.9 million web visits and
over 240,000 app downloads. On
average, the app is used more than
11,000 times each day and has
received overwhelmingly positive
feedback, including being rated the
best medical app by MedPage in
2014.
34. Gibson AO, Blaha MJ, Arnan MK, Sacco RL,
Szklo M, Herrington DM, Yeboah J. Coronary
artery calcium and incident cerebrovascular events
in an asymptomatic cohort. The Mesa Study. The
Journal of the American College of Cardiology,
Cardiovascular Imaging. 2014 Nov;7(11):1108-15.
Summary: CAC is an independent predictor of
cerebrovascular events and improves the
discrimination afforded by current stroke risk
factors or the Framingham stroke risk score for
incident CV events in an asymptomatic multiethnic cohort.
35. Malik R, Aneni EC, Roberson L, Ogunmoroti
O, Ali SS, Shaharyar S,
Younus A, Jamal O, Aziz
MA, Martin SS, Blaha
MJ, Feldman T, Agatston
AS, Veledar E, Nasir K.
Measuring coronary artery
calcification: Is serum
vitamin D relevant?
Atherosclerosis. 2014
Dr. Seth Martin
Dec;237(2):734-8.
Summary: There is
insufficient evidence to support a consistent
association between low vitamin D levels and
CAC. Further high-quality studies are needed to
examine serum 25-OH vitamin D in relation to
subclinical coronary atherosclerosis.
36. Martin SS, Joshi PH, Blaha MJ. Highdensity lipoprotein and endothelial function in
patients with myocardial infarction: Pieces in a
puzzle. Atherosclerosis. 2014 Dec; 237 (2): 838-9.
Summary: If clinicians continue to be inspired by
the complexity of HDL and collaboratively
embrace the challenge of trying to understand it,
we may fit together the pieces of the puzzle with
this intricate lipoprotein and clarify whether it is a
viable therapeutic target.
37. Hung RK, Feldman DI, Blaha MJ.
Cardiovascular disease mortality and excessive
exercise in heart attack
survivors. Mayo Clinic
Proceedings. 2015
Jan;90(1):159.
Summary: It is too early
to sound the alarm on the
potential hazards of
exercise for all MI
survivors because most
patients would not engage
Rupert Hung
in the level of physical
activity reported as being potentially harmful.
13
publications
research
38. Gepner AD, Young R,
Delaney JA, Tattersall MC,
Blaha MJ, Post WS,
Gottesman RF, Kronmal R,
Budoff MJ, Burke GL,
Folsom AR, Liu K,
Kaufman J, Stein JH.
Comparison of coronary
artery calcium presence,
carotid plaque presence,
Dr. Michael Blaha
and carotid intima-media
thickness for cardiovascular
disease prediction in the Multi-Ethnic Study of
Atherosclerosis. Circulation, Cardiovascular
Imaging. 2015 Jan;8(1):11.
Summary: CAC presence improves prediction of
CVD and coronary heart disease (CHD) more than
carotid plaque presence or high intima-media
thickness. CAC and carotid ultrasound parameters
performed similarly for stroke/transient ischemic
attack event prediction.
39. Yeboah J, Sillau S, Delaney JC, Blaha MJ,
Michos ED, Young R, Qureshi WT, McClelland R,
Burke GL, Psaty BM, Herrington DM.
Implications of the new American College of
Cardiology/American Heart Association
cholesterol guidelines for primary atherosclerotic
cardiovascular disease event prevention in a multiethnic cohort: Multi-Ethnic Study of
Atherosclerosis (MESA). American Heart Journal.
2015 Mar;169(3):387-395.
Summary: Substituting the NCEP/ATP III
cholesterol guidelines with the 2013 ACC/AHA
cholesterol guidelines in MESA more than doubled
the number of participants eligible for statin
therapy. If the new guidelines extend the primary
prevention population eligible for treatment, the
risk-benefit profile is much better for moderateintensity than high-intensity statin treatment.
40. Qureshi TW, Alirhayim Z, Blaha MJ,
Juraschek SP, Keteyian SJ, Brawner CA, AlMallah MH. Cardiorespiratory fitness and risk of
incident atrial fibrillation: Results from the Henry
Ford exercise testing (FIT) project. Circulation.
2015 May 26;131(21):1827-34.
Summary: There is a graded, inverse relationship
between cardiorespiratory fitness and incident atrial
fibrillation, especially among obese patients. Future
studies should examine whether changes in fitness
increase or decrease risk of atrial fibrillation. This
association was stronger for obese patients.
41. O’Neal WT, Qureshi WT, Blaha MJ, Keteyian
SJ, Brawner CA, Al-Mallah MH. Systolic blood
pressure response during exercise stress testing:
The Henry Ford Exercise Testing (FIT) Project.
Journal of the American Heart Association. 2015
May 7; 4(5).
Summary: Modest increases in exercise systolic
blood pressure response are associated with adverse
outcomes.
42. Modolo R, Fiqueiredo VN, Moura FA, Almeida
B, Quinaglia E Silva JC, Jr WN, Lemos PA,
Coelho OR, Blaha MJ, Sposito AC. Coronary
artery calcifications score is an independent
predictor of the no-reflow phenomenon after
reperfusion therapy in acute myocardial infarction.
Coronary Artery Disease. 2015 May 19.
Summary: The CAC score is associated with the
presence of the no-reflow phenomenon in STelevation myocardial infarction patients.
43. Cainzos-Achirica M,
Blaha MJ. Cardiovascular
risk perception in women:
True unawareness or risk
miscalculation? Bio Med
Central Medicine. 2015
May 11;13:112.
Summary: This article
provides context for the
interpretation of studies on Dr. Miguel CaínzosAchirica
“discordance” between
calculated and perceived risk.
It explores alternative approaches aimed at
overcoming those limitations, enhancing
understanding of the factors and true magnitude
associated with such discordance.
44. Gassett AJ, Sheppard L, McClelland RL,
Olives C, Kronmal R, Blaha MJ, Budoff M,
Kaufman JD. Risk factors for long-term coronary
artery calcium progression in the multi-ethnic study
of atherosclerosis. Journal of the American Heart
Association. 2015 Aug 6;4(8). Pii: e001726.
Summary: CAC progression analyzed over 10
years of follow-up, with a novel analytical
approach, demonstrated strong relationships with
risk factors for incident
cardiovascular events.
Longitudinal CAC progression
analyzed in this framework can be
used to evaluate novel
cardiovascular risk factors.
45. Aneni EC, Oni ET, Martin SS, Blaha MJ,
Agatston AS, Feldman T, Veledar E, Conceiçao
RD, Carvalho JA, Santos RD, Nasir K. Blood
pressure is associated with the presence and
severity of nonalcoholic fatty liver disease across
the spectrum of cardiometabolic risk. Journal of
Hypertension. 2015 Jun; 33 (6): 1207-14.
Summary: Prevalent nonalcoholic fatty liver
disease (NAFLD) may be seen early in the
development of hypertension, even in the absence
of other metabolic risk factors. Controlling blood
pressure (BP) among non-obese hypertensive
patients may be beneficial in preventing or limiting
NAFLD.
14
46. Sahebkar A, Kotani K,
Seran C, Ursoniu S,
Mikhailidis DP, Jones SR,
Ray KK, Blaha MJ, Rysz
J, Toth PP, Muntner P, Lip
GY, Banach M; Lipid and
Blood Pressure Metaanalysis Collaboration
(LBPMC) Group. Statin
therapy reduces plasma
Dr. Peter Toth
endothelin-1 concentrations:
A meta-analysis of 15
randomized controlled trials. Atherosclerosis. 2015
Jun 3; 241 (2): 433-442.
Summary: Statin therapy significantly reduces
circulating endothelin-1 concentrations, regardless
of treatment duration or dose of statins. This effect
of statins may be influenced by statin lipophilicity.
There is a need to establish whether lowering
endothelin-1 levels has a beneficial effect on CV
events.
47. Miedema MD, Lopez FL, Blaha MJ, Virani
SS, Coresh J, Ballantyne CM, Folsom AR.
Implications of the eighth Joint National
Committee Guidelines for the Management of
High Blood Pressure for Aging Adults:
Atherosclerosis Risk in Communities Study.
Hypertension. 2015 Jul 6.
Summary: In a US cohort of aging white and
black individuals, ~1 in 6 individuals were
reclassified as having blood pressure at goal by
Eighth Joint National Committee guidelines.
Despite these less aggressive goals, >20% remain
uncontrolled by the new criteria.
48. DeFilippis AP, Young R, Blaha MJ.
Calibration and discrimination among multiple
cardiovascular risk scores in a modern multiethnic
cohort. Annals of Internal Medicine. 2015 Jul
7;163(1):68-9.
Summary: Diet, exercise, air pollution, ethnic
diversity, intensity of tobacco use, content of
tobacco products, and effectiveness of
antihypertensive therapy are among the
cardiovascular risk factors that have changed over
the past 25 years. Risk prediction is an evolving
science and will require continual updating through
the study of well-characterized, contemporary,
primary prevention cohorts.
49. Shaw LJ, Giambrone AE, Blaha MJ, Knapper
JT, Berman DS, Bellam N, Quyyumi A, Budoff
MJ, Callister TQ, Min JK. Long-term prognosis
after coronary artery calcification testing in
asymptomatic patients: A cohort study. Annals of
Internal Medicine. 2015 Jul 7;163(1):14-21.
Summary: The extent of CAC accurately predicts
15-year mortality in a large cohort of asymptomatic
patients. Long-term estimates of mortality provide
a unique opportunity to examine the value of novel
biomarkers, such as CAC, in estimating important
patient outcomes.
50. Qureshi WT, Keteyian SJ,
Brawner CA, Dardari Z,
Blaha MJ, Al-Mallah MH.
Impact of statin use on
cardiorespiratory fitness in
multi-racial men and women:
The Henry Ford Exercise
Testing (FIT) Project.
Zeina Dardari
International Journal of
Cardiology. 2015 Jun
20;197:76-77.
Summary: Statin use is not significantly associated
with lower peak METs in this large multi-racial
cohort. Cardiorespiratory fitness (CRF) is a
superior predictor of outcomes compared to selfreported physical activity. Long-term longitudinal
studies are needed to further characterize the
impact of statins on CRF over time.
51. Cainzos-Achirica M,
Desai CS, Wang L, Blaha
MJ, Lopez-Jimenez F,
Kopecky SL, Blumenthal
RS, Martin SS. Pathways
forward in cardiovascular
disease prevention one and a
half years after publication
Dr. Chintan Desai of the 2013 ACC/AHA
cardiovascular disease
prevention guidelines. Mayo Clinic Proceedings.
2015; Sep 242(1):243-50.
Summary: We discuss the key scientific literature
relevant to the guidelines published in the year and
a half after their release and provide cohesive,
evidence-based views that may offer pathways
forward toward greater consensus and benefit
clinical medicine.
52. Yeboah J, Polonsky TS, Young R, McClelland
RL, Delaney JC, Sawood F, Blaha MJ et al. Utility
of non-traditional risk markers in individuals
ineligible for statin therapy according to the 2013
ACC/AHA cholesterol guidelines. Circulation.
2015 July 29.
Summary: A large proportion of ASCVD events
occurred among adults with a 10-yr. recalibrated
risk estimate of <7.5%. The selective
measurements of CAC, hsCRP, and ABI
recommendations by the ACC/AHA cholesterol
guidelines (Class IIB) identify small subgroups of
asymptomatic population with estimated <7.5% 10
yr. risk but with observed ASCVD event rates
higher than 7.5% who may warrant statin therapy
considerations.
53. Swiger KJ, Martin SS, Tang F, Blaha MJ,
Blumenthal RS, Alexander KP, Arnold SV,
Spertus JA. Cognitive and physical function by
statin exposure in elderly individuals following
acute myocardial infarction (AMI). Clinical
Cardiology. 2015 Aug;38(8):455-61.
Summary: Among statin-naive elderly individuals
recovering from AMI, initiation of statin therapy
was not associated with detectable changes in
short-term cognitive or physical function. These
findings support the general safety of statin therapy
for secondary prevention.
54. Kotani K, Sahebkar A, Serban C, Andrica F,
Toth PP, Jones SR, Kostner K, Blaha MJ, Martin
SS et al. Tibolone decreases lipoprotein (a) levels in
postmenopausal women: a systematic review and
meta-analysis of 12 studies with 1009 patients.
Atherosclerosis. 2015 Jul 2;242(1):87-96.
Summary: Oral tibolone treatment significantly
lowers circulating Lp(a) levels in postmenopausal
women. Further studies are warranted to explore
the mechanism of this effect and the potential value
and place of tibolone or its analogues in the
treatment of elevated Lp(a).
55. Sahebkar A, Kotani K, Serban C, Ursoniu S,
Mikhailidis DP, Jones SR, Ray KK, Blaha MJ,
Rysz J, Toth PP et al. Statin therapy reduces
plasma endothelin-1 (ET-1) concentrations: a metaanalysis of 15 randomized controlled trials.
Atherosclerosis. 2015 Aug;241(2):433-42.
Summary: Statin therapy significantly reduces
circulating ET-1 concentrations, regardless of
treatment duration or dose. This effect may be
influenced by statin lipophilicity. There is a need to
establish whether lowering ET-1 levels has a
beneficial effect on CV events.
56. Tison GH, Blaha MJ, Nasir K, Blumenthal
RS, Szklo M, Ding J, Budoff MJ. Relation of
anthropometric obesity and computed tomography
measured nonalcoholic fatty liver disease
[NAFLD] (from the Multiethnic Study of
Atherosclerosis). American Journal of Cardiology.
2015 Aug 15;116(4):541-6.
Summary: Whites and Chinese had the strongest
association of obesity and NAFLD compared with
other ethnicities. Although waist circumference
provided the best discrimination for NAFLD, BMI
may perform similarly well in clinical settings to
screen for NAFLD.
57. Modolo R, Gigueiredo VN, Moura FA,
Almeida B,...Blaha MJ, Sposito AC. Coronary
artery calcification score is an independent
predictor of the no-reflow (NR) phenomenon after
reperfusion therapy in acute myocardial infarction.
Coronary Artery Disease. 2015 May 19.
Summary: The CAC score is associated with the
presence of the NR phenomenon in STEMI
patients.
58. O’Neal WT, Qureshi WT, Blaha MJ, Keteyian
SJ, Brawner CA, Al-Mallah MH. Systolic blood
pressure response during exercise stress testing: the
Henry Ford Exercise Testing (FIT) project. Journal
of the American Heart Association. 2015 May
7;4(5). pii: e002050.
Summary: Modest increases in exercise systolic
blood pressure response are associated with adverse
outcomes.
Seth S. Martin, MD, MHS
This past year has been a banner one for Seth
S. Martin, MD, MHS. Appointed Assistant
Professor of Medicine in Cardiology at the
Johns Hopkins University School of Medicine,
he became a permanent member of the
Ciccarone Center for the Prevention of Heart
Disease. Dr. Martin received several honors,
including the Steven N. Blair Award for Excellence
in Physical Activity Research from the American Heart Association’s (AHA)
Council on Lifestyle and Cardiometabolic Health. He also received the
Anna Huffstutler Stiles Award from the Johns Hopkins Bloomberg School of
Public Health in recognition of his outstanding achievements and innovative
thesis research. Seth took second place in the Oral Presentations category
of the Stanley L. Blumenthal, MD, Cardiology Research Awards in May. He
is also a co-winner of the 2015-2016 P.J. Schafer award, sharing honors with
his Ciccarone colleague J. Bill McEvoy, MBBch, MHS (see page 5 for more
information). Dr. Martin participated as a mHealth Scholar at the National
Institutes of Health 2015 Summer Institute on Mobile Technology Research
to Enhance Health, and started the CVD/Aging mHealth Interest Group of
the Ciccarone and Welch Centers. And he was appointed Vice Chair for the
AHA’s Greater Baltimore Young Hearts Board of Directors.
15
publications
research
59. Shaharyar S,
Roberson LL, Jamal O,
Younus A, Blaha MJ,
Alis SS, Zide K,
Agatston AA,
Blumenthal RS,
Conceicao RD, Santos
RD, Nasir K. Obesity
and metabolic phenotypes
Dr. Arthur Agatston (metabolically healthy
and unhealthy variants)
are significantly associated with prevalence of
elevated C-reactive protein and hepatic steatosis in
a large healthy Brazilian population. Journal of
Obesity. 2015;178526.
Summary: The metabolically healthy obese
phenotype and the metabolically unhealthy normal
weight phenotype are not benign and clinicians
should try to convince their patients to reverse these
conditions.
60. Aneni EC, Oni ET, Martin SS, Blaha MJ,
Agatston AS, Feldman T, Veledar E, Conceicao
RD, Carvalho JA, Santos RD, Nasir K. Blood
pressure is associated with the presence and
severity of nonalcoholic fatty liver disease across
the spectrum of cardiometabolic risk. Journal of
Hypertension. 2015 Jun;33(6): 1207-14.
Summary: Prevalent NAFLD may be seen early in
the development of hypertension, even in the
absence of other metabolic risk factors. Controlling
BP among nonobese hypertensive patients may be
beneficial in preventing or limiting NAFLD.
61. DeFilippis AP, Blaha MJ. Can the AHA-ACC
ASCVD risk score be applied outside the United
States in Korea? Atherosclerosis. 2015 Aug
14;242(2):560-562.
62. Tota-Maharaj R, Blaha MJ, Blankstein R,
Silverman MG, Eng J, Shaw LF, Blumenthal
RS, Budoff MJ, Nasir K. Association of coronary
artery calcium and coronary heart disease events in
young and elderly participants in the multi-ethnic
study of atherosclerosis: a secondary analysis of a
prospective, population-based cohort. Mayo Clinic
Proceedings. 2014 Oct; 89(10): 1350-1359.
Summary: Increased CAC imparts an increased
CHD risk in younger and elderly individuals. The
utility of CAC scoring as a risk-stratification tool
extends to both younger and elderly patients.
63. Blaha MJ, Dardari ZA, Blumenthal RS,
Martin SS, Nasir K, Al-Mallah MH. The new
“intermediate risk” group: a comparative analysis
of the new 2013 ACC/AHA risk assessment
guidelines versus prior guidelines in men.
Atherosclerosis. 2014 Nov;237(1):1-4.
Summary: The new 2013 ACC/AHA risk
assessment guidelines produce a markedly
smaller, lower absolute risk, and more temporary
“intermediate risk” group. These findings reshape
the modern understanding of “intermediate risk,”
and have distinct implications for risk assessment,
clinical decision making, and pharmacotherapy in
primary prevention.
16
64. Blumenthal RS, Jones SR. Tribute to Dr.
Peter O. Kwiterovich, Jr, MD. Journal of Clinical
Lipidology. 2014 Nov-Dec; 8(6): 644-645.
Summary: We summarize the many
accomplishments of the founder of the Johns
Hopkins Lipid Research Clinic, who was a
pioneer in preventive cardiology.
65. Ndumele CE, Coresh
J, Lazo M, Hoogeveen
RC, Blumenthal RS,
Folsom AR, Selvin E,
Ballantyne CM, Nambi
V. Obesity, subclinical
myocardial injury, and
incident heart failure. A
Journal of the American
College of Cardiology
Dr. Chiadi Ndumele
Heart Failure. 2014
Dec;2(6):600-7.
Summary: Among individuals without
CVD, higher BMI has an independent, linear
association with subclinical myocardial injury,
as assessed by hs-cTnT levels. Obesity and hscTnT provide independent and complementary
prognostic information regarding the risk of
incident HF.
66. Swiger KJ,
Manalac RJ, Blaha MJ,
Blumenthal RS, Martin
SS. Statins, mood, sleep,
and physical function:
a systematic review.
European Journal of
Clinical Pharmacology.
2014 Dec;70(12):1413-22.
Dr. Raoul Manalac Summary: There appears
to be no adverse effect of
statins on quality of life measures: mood, sleep,
and physical function. High-quality, prospective,
and adequately powered studies are needed in
the domains of sleep and physical function, with
careful attention to patients who may be most
vulnerable to adverse effects.
67. Hung RK, Al-Mallah MH, McEvoy JW,
Whelton SP, Blumenthal RS, Nasir K, Schairer
JR, Bawner C, Alam M, Keteyian SJ, Blaha MJ.
Prognostic value of exercise capacity in patients
with coronary artery disease: the FIT (Henry
Ford Exercise Testing) project. Mayo Clinic
Proceedings. 2014 Dec;89(12):1644-54.
Summary: Exercise capacity was a stronger
predictor of mortality, MI, and downstream
revascularization in this cohort. Patients with
similar exercise capacities had an equivalent
mortality risk, irrespective of baseline
revascularization status.
68. Juraschek SP,
Blaha MJ, Whelton SP,
Blumenthal R, Jones SR,
Keteyian SJ, Schairer J,
Brawner CA, Al-Mallah
MH. Physical fitness and
hypertension in population
at risk for cardiovascular
Dr. Seamus Whelton
disease: The Henry
Ford Exercise Testing
(FIT) project. Journal of the American Heart
Association. 2014 Dec;3(6):e001268.
Summary: Higher fitness is associated with
a lower probability of prevalent and incident
hypertension independent of baseline risk factor.
69. Oni ET, Kalathiya R, Aneni EC, Martin
SS, Blaha MJ, Feldman T, Agatston AS,
Blumenthal RS, Conceiçao RD, Carvalho
JA, Santos RD, Nasir K. Relation of physical
activity to prevalence of nonalcoholic fatty liver
disease independent of cardiometabolic risk.
The American Journal of Cardiology. 2015 Jan
1;115(1):34-9.
Summary: Physical activity presents a doseresponse association with nonalcoholic fatty liver
disease independent of the metabolic syndrome
or obesity. The results are compatible with the
idea that benefits of physical activity are relevant
to everyone, regardless of cardiometabolic risk.
70. Feldman DI, Blaha MJ, Santos RD,
Jones SR, Blumenthal RS, Toth PP,
Sperling LS, Martin SS. Recommendations
for the management of patients with familial
hypercholesterolemia. Current Atherosclerosis
Reports. 2015 Jan; 17(1): 473.
Summary: Many familial hypercholesterolemia
(FH) patients remain undiagnosed and/or
inadequately treated. A suggested action is to
provide concise overviews of how to screen for
and diagnose FH and summarize international
consensus recommendations for managing adults
and children with available treatments.
71. Tota-Maharaj R, Al-Mallah MH, Nasir
K, Qureshi WT, Blumenthal RS, Blaha MJ.
Improving the relationship between coronary
artery calcium score and coronary plaque burden:
addition of regional measure of coronary artery
calcium distribution. Atherosclerosis. 2015 Jan;
238(1):126-31.
Summary: Adding measures of regional
Agatston coronary artery calcium (CAC)
distribution improves the association of the
Agatston CAC score with total plaque burden.
72. Feldman DI, Al-Mallah MH, Keteyian
SJ, Brawner CA, Feldman T, Blumenthal
RS, Blaha MJ. No evidence of an upper
threshold for mortality benefit at high levels of
cardiorespiratory fitness. Journal of the American
College of Cardiology. 2015 Feb 17;65(6):62930.
Summary: Very few individuals are ultra
marathon runners and vigorous exercise is
generally associated with a longer and healthier
life.
73. DeFilippis AP, Young R, Carrubba CJ,
McEvoy JW, Budoff MJ, Blumenthal RS,
Kronmal RA, McClelland RL, Nasir K, Blaha
MJ. An analysis of calibration and discrimination
among multiple cardiovascular risk scores in a
modern multi-ethnic cohort. Annals of Internal
Medicine. 2015 Feb 17;162(4):266-75.
Summary: Four out of five risk scores showed
overestimation of risk (25-115%) in a multiethnic cohort without baseline clinical ASCVD.
Overestimation of ASCVD risk may have
substantial implications for individual patients
and the health care system.
74. Martin SS, Blaha MJ, Muse ED, Qasim
AN, Reilly MP, Blumenthal RS, Nasir K,
Criqui MH, McClelland RL, Hughes-Austin JM,
Allison MA. Leptin and incident cardiovascular
disease: the Multi-ethnic Study of Atherosclerosis
(MESA). Atherosclerosis. 2015 Mar;239(1):6772.
Summary: In a modern prospective study
of multi-ethnic adults, leptin levels are not
associated with incident cardiovascular events.
75. Muse ED, Feldman
DI, Blaha MJ, Dardari
ZA, Blumenthal RS,
Budoff MJ, Nasir K,
Criqui MH, Cushman
M, McClelland RL,
Allison MA. The
association of resistin with
cardiovascular disease
in the Multi-Ethnic
David Feldman
Study of Atherosclerosis.
Atherosclerosis. 2015 Mar;239(1):101-8.
Summary: In an ethnically diverse population
without known CVD at baseline, there was a
strong, independent association between higher
resistin levels and incident CVD heart failure.
76. McEvoy JW, Blaha MJ, DeFilippis AP,
Lima JA, Bluemke DA, Hundley WG, Min JK,
Shaw LJ, Lloyd-Jones DM, Barr RG, Budoff MJ,
Blumenthal RS, Nasir K. Cigarette smoking and
cardiovascular events: role of inflammation and
subclinical atherosclerosis from the MultiEthnic
Study of Atherosclerosis. Arteriosclerosis,
Thrombosis, and Vascular Biology. 2015
Mar;35(3):700-9.
Summary: In this multi-ethnic cohort,
current smoking and cumulative exposure
remain important modifiable determinants of
cardiovascular disease. High-risk smokers should
benefit from more intensive smoking-cessation
efforts.
77. Roberts ET, Horne A, Martin SS, Blaha
MJ, Blankstein R, Budoff MJ, Sibley C, Polak
JF, Frick KD, Blumenthal RS, Nasir K. Costeffectiveness of coronary artery calcium testing
for coronary heart and cardiovascular disease risk
prediction to guide statin allocation: The MultiEthnic Study of Atherosclerosis (MESA). PLOS
ONE. 2015 Mar 18;10(3):e0116377.
Summary: CAC testing is both effective and cost
saving as a risk-stratification tool, particularly
if there are adverse effects of long-term statin
use in a small segment of the population. CAC
may enable providers to better tailor preventive
therapy to patients’ risks of CVD.
78. Qureshi WT, Nasir K, Hacioglu Y, Sibley CT,
Gupta M, Rivera JJ, Blumenthal R, Katz R,
Budoff MJ. Determination and distribution of left
ventricular size as measured
by noncontrast CT in the
Multi-Ethnic Study of
Atherosclerosis. Journal of
Cardiovascular Computed
Tomography. 2015 MarApr;9(2):113-9.
Summary: This study
provides normative values
Dr. Khurram Nasir
for LV size as determined
from a single, non-enhanced
CT cross-section and indexed to body surface
area, and it demonstrates that the LV size index
varies by age, sex, and ethnic background.
79. Martin SS, Sperling LS, Blaha MJ,
Wilson PW, Gluckman TJ, Blumenthal RS,
Stone NJ. Clinician-patient risk discussion for
atherosclerotic cardiovascular disease prevention:
importance to implementation of the 2013 ACC/
AHA Guidelines. Journal of the American
College of Cardiology. 2015 Apr 7;65(13):13618.
Summary: Successful implementation of the
2013 cholesterol guidelines hinges on a clear
understanding of the clinician-patient risk
discussion (CPRD). Dedicating sufficient time
to high-quality CPRD offers an opportunity to
strengthen clinician-patient relationships, patient
engagement, and medication adherence.
80. Wanamaker BL,
Swiger KJ, Blumenthal
RS, Martin SS.
Cholesterol, statins,
and dementia: what the
cardiologist should know.
Clinical Cardiology. 2015
Apr;38(4):243-50.
Summary: We discuss
Dr. Brett Wanamaker
the role of dyslipidemia
and other cardiovascular
risk factors in the pathogenesis of Alzheimer’s
disease (AD), with a focus on evidence for the
use of statin medications in the treatment and
prevention of AD from observational studies and
randomized clinical trials.
81. Nakanishi R, Li D,
Blaha MJ, Whelton SP,
Matsumoto S, Alani A,
Rezaeian P, Blumenthal
RS, Budoff MJ. The
relationship between
coronary artery calcium
score and the long-term
mortality among patients
with minimum or absent
coronary artery risk factors.
International Journal of Cardiology. 2015 Apr
15;185:275-81.
Summary: During long-term follow-up, an
increasing CAC was significantly associated
with a higher risk of all-cause mortality among
patients with a very low CVD risk factor burden.
CAC scanning may be a potentially useful tool
for risk stratification among low CVD-risk
individuals who are ≥ 45 years old.
82. McEvoy JW, Nasir K, DeFilippis AP,
Lima JA, Bluemke DA, Hundley WG, Barr
RG, Budoff MJ, Szklo M, Navas-Acien A,
Polak JF, Blumenthal RS, Post WS, Blaha
MJ. Relationship of cigarette smoking with
inflammation and subclinical vascular disease:
The Multi-Ethnic Study of Atherosclerosis.
Arteriosclerosis, Thrombosis, and Vascular
Biology. 2015
Apr;35(4):1002-10.
Summary: These
findings expand our
understanding of the
harmful effects of
smoking and help explain
the cardiovascular
benefits of smoking
Dr. Andrew DeFilippis
cessation.
83. Tison GH, Guo M, Blaha MJ, McClelland
RL, Allison MA, Szklo M, Wong ND,
Blumenthal RS, Budoff MJ, Nasir K.
Multisite extracoronary calcification indicates
increased risk of coronary heart disease and
all-cause mortality: The Multi-Ethnic Study
of Atherosclerosis. Journal of Cardiovascular
Computed Tomography. 2015 Sep-Oct; 9(5):40614.
Summary: Increasing multisite extracoronary
calicification (ECC) has a graded association
with higher CHD and mortality risk, contributing
information beyond traditional risk factors.
Multisite ECC incidentally identified on imaging
can be used to improve individualized risk
prediction.
17
publications
research
84. Tota-Maharaj
R, Joshi PH, Budoff
MJ, Whelton S,
Zeb I, Rumberger
J, Al-Mallah M,
Blumenthal RS,
Nasir K, Blaha
MJ. Usefulness of
regional distribution
of coronary artery
Dr. Rajesh Tota-Maharaj calcium to improve
the prediction of allcause mortality. American Journal of Cardiology.
2015 May 1;115(9):1229-34.
Summary: Increasing number of vessels with
CAC and left main CAC predict increased allcause mortality and improve the prognostic power
of the traditional Agatston CAC score.
85. McEvoy JW, Lazo M, Chen Y, Shen L,
Nambi V, Hoogeveen RC, Ballantyne CM,
Blumenthal RS, Corseh J, Selvin E. Patterns and
determinants of temporal change in high-sensitivity
cardiac troponin-T: The Atherosclerosis Risk in
Communities Cohort Study. International Journal
of Cardiology. 2015 May 6;187:651-7.
Summary: Persons in higher ASCVD risk-groups
were more likely to have increases in hs-cTNT over
six years of follow-up. The modifiable risk-factors
primarily driving this association were diabetes,
hypertension, and obesity; particularly when they
were persistently elevated.
86. Tison GH, Blaha MJ, Nasir K, Blumenthal
RS, Szklo M, Ding J, Budoff MJ. Relation of
anthropometric obesity and computed tomography
measured nonalcoholic fatty liver disease (from
the Multiethnic Study of Atherosclerosis). The
American Journal of Cardiology. 2015 Aug
15;116(4):541-6.
Summary: Although waist circumference
provided the best discrimination for nonalcoholic
fatty liver disease (NAFLD), body mass index may
perform similarly well in clinical settings to screen
for NAFLD.
87. Rosendorff C, Lackland DT, Allison M,
Aronow WS, Black HR, Blumenthal RS, Cannon
CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh
BJ, Gore JM, Levy D, Long JB, O’Connor
CM, O’Gara PT, Ogedegbe G, Oparil S, White
WB. Treatment of hypertension in patients with
coronary artery disease: a scientific statement
from the American Heart Association, American
College of Cardiology, and American Society
of Hypertension. Journal of American College
of Cardiology. 2015 May 12;65(18):19982038. Hypertension. 2015 Jun;65(6):1372-407.
Circulation. 2015 May 12;131(19):e435-70;
Journal of the American Society of Hypertension.
2015 Jun;9(6):453-98.
18
88. Joshi PH, Martin SS, Blumenthal RS. The
remnants of residual risk. Journal of the American
College of Cardiology. 2015 Jun 2;65(21):2276-8.
Summary: This editorial advises the clinician to
follow the advice of a famous Super Bowl winning
coach when dealing with patients who have
elevated triglyceride levels.
93. Santa-Maria C, Blackford A, Nguyen A, Skaar
T, Philips S, Blumenthal RS, Ouyang P, Post W,
Flockhart D, Stearns V. Association of variants in
candidate genes with lipid profiles in women with
early breast cancer on adjuvant aromatase inhibitor
therapy. Clinical Cancer Research. Forthcoming
2015.
89. Juraschek SP, Blaha MJ, Blumenthal RS,
Brawner C, Qureshi W, Keteylan SJ, Schairer J,
Ehrman JK, Al-Mallah MH. Cardiorespiratory
fitness and incident diabetes: The FIT (Henry Ford
Exercise Testing) project. Diabetes Care. 2015
Jun;38(6):1075-81.
Summary: Higher fitness is associated with
a lower risk of incident diabetes regardless of
demographic characteristics and baseline risk
factors. Future studies should examine the
association between change in fitness over time and
incident diabetes.
94. Shah NP, CainzosAchirica M, Feldman DI,
Nasir K, Miner MM, Billups
KL, Blumenthal RS, Blaha
MJ. Cardiovascular disease
in men with vascular erectile
dysfunction: The view of
the preventive cardiologist.
American Journal of
Medicine. Forthcoming 2015. Dr. Nishant Shah
90. Hamirani YS, Katz R, Nasir K, Zeb I,
Blaha MJ, Blumenthal RS, Kronmal RN,
Budoff MJ. Association between inflammatory
markers and liver fat: The Multi-Ethnic Study
of Atherosclerosis. Journal of Clinical and
Experimental Cardiology. 2014;5. pii: 1000344.
Summary: C-reactive protein and interleukin-6
levels were found to be significantly associated
with liver fat assessed on CT scan after adjusting
for other risk factors.
91. Shaharyar S, Roberson LL, Jamal O, Younus
A, Blaha MJ, Ali SS, Zide K, Agatston AA,
Blumenthal RS, Conceiçao RD, Santos RD,
Nasir K. Obesity and metabolic phenotypes
(metabolically healthy and unhealthy variants) are
significantly associated with prevalence of elevated
C-reactive protein and hepatic steatosis in a large
healthy Brazilian population. Journal of Obesity.
2015;2015:178526.
Summary: This study suggests that metabolically
healthy obese and metabolically unhealthy
normal weight phenotypes may not be benign and
physicians should strive to treat individuals in these
subgroups to reverse these conditions.
92. Hung RK, Al-Mallah
MH, Qadi MA, Shaya
GE, Blumenthal RS, et al.
Cardiorespiratory fitness
attenuates risk for major
adverse cardiac events in
hyperlipidemic men and
women independent of
statin therapy: The Henry
Ford Exercise Testing
Dr. Gabriel Shaya
Project. American Heart
Journal. 2015;170(2):390-9.
Summary: We found that higher cardiorespiratory
fitness (CRF) reduced risk for mortality, MI, and
revascularization independent of gender and statin
therapy in hyperlipidemic patients. These results
reinforce the prognostic value of CRF and support
greater promotion of CRF.
95. Cainzos-Achirica M, Rampal S, Chang Y,
Ryu S, Zhang Y, Zhao D, Cho J, Choi Y, PastorBarriuso R, Lim SY, Bruguera J, Elosua R, Lima
JA, Shin H, Guallar E. Brachial-ankle pulse wave
velocity is associated with coronary calcium in
young and middle-aged asymptomatic adults: The
Kangbuk Samsung Health Study. Atherosclerosis.
2015;241(2):350-6.
Summary: Brachial-ankle pulse wave velocity
(BaPWV) was independently associated with the
presence and severity of CAC in a large sample
of young and middle-aged asymptomatic adults.
BaPWV may be a valuable tool for identifying
apparently low-risk individuals with increased
burden of coronary atherosclerosis.
96. Cainzos-Achirica M, Martin SS, Cornell JE,
Mulrow CD, Guallar E. PCSK9 Inhibitors: A new
era in lipid-lowering treatment? Annals of Internal
Medicine. 2015;163(1):64-5.
97. Valles E, Bazan V, Cainzos-Achirica M,
Jauregui ME, Benito B, Bruguera J, Marti-Almor
J. Incremental pacing maneuver for atrial flutter
recurrence reduction after ablation. International
Journal of Cardiology. 2014 Dec 20;177(3):902-6.
Summary: The addition of the incremental pacing
maneuver for the diagnosis of complete CTI block
reduces atrial flutter long-term recurrences after
ablation.
98. Cainzos-Achirica M, Eissler K, Blaha
MJ, Blumenthal RS, Martin SS. Tools for
cardiovascular risk assessment in clinical practice.
Current Cardiovascular Risk Reports. 9.6 (2015):112.
Summary: This article reviews different strategies
to better estimate one’s cardiovascular risk.
99. Whelton SP, Leucker T, Blumenthal RS.
Improving cardiovascular disease risk prediction
with albuminuria and glomerular filtration rate.
American Journal of Kidney Disease. Forthcoming
2015.
100. Miller PE, Scholten EL, Desai CS, Tedford
RJ. A patient with systolic dysfunction and an
alternating axis. The Journal of the American
Medical Association, Internal Medicine. 2014
Dec;174(12):2027-8.
101. Feldman DI, Martin SS, Blumenthal
RS, Deune EG. Carpal Tunnel Syndrome in the
digital era: Are electronic health records and
wrist pedometers potentially synergistic risk
factors? Jacobs Journal of Physical Rehabilitation
Medicine. Forthcoming 2015.
102. Florido R, Elander A, Blumenthal RS,
Martin SS. Statins and incident diabetes: can risk
outweigh benefit? Current Cardiovascular Risk
Reports. 2015; 9:14.
103. Florido R,
Blumenthal RS, Martin
SS. Insights into statinassociated diabetes: How
important is the risk and
how should you counsel
your patient? American
College of Cardiology:
Latest in Cardiology (ACC
Dr. Roberta Florido
website). 2015 January.
http://www.acc.org/latestin-cardiology/articles/2015/01/06/08/57/insightsinto-statin-associated-diabetes.
104. Korley FK, George RT, Jaffe AS, Rothman
RE, Sokoll LJ, Fernandez C, Falk H, Post WS,
Saheed MO, Gerstenblith G, Berkowitz SA,
Hill PM. Low high-sensitivity troponin I and zero
coronary artery calcium score identifies coronary
CT angiography candidates in whom further testing
could be avoided. Academic Radiology. 2015 Jun
3. pii: S1076-6332(15)00191-9.
Summary: The addition of coronary calcium score
to hsTnI improves the identification of low-risk
subjects in whom coronary computed tomography
angiography might be avoided.
105. Hays AG, Iantorno M, Soleimanifard S,
Steinberg A, Schär M, Gerstenblith G, Stuber
M, Weiss RG. Coronary vasomotor responses
to isometric handgrip exercise are primarily
mediated by nitric oxide: a noninvasive MRI test of
coronary endothelial function. American Journal
of Physiology, Heart Circulation Physiology. 2015
Jun 1;308(11):H1343-50.
Summary: The normal human coronary
vasoactive response to isometric handgrip
exercise is primarily mediated by nitric oxide.
This noninvasive, reproducible MRI exam of
nitric oxide-mediated coronary endothelial
function promises to be useful for studying CAD
pathogenesis in low-risk populations and for
evaluating strategies designed to lower CAD risk.
106. Hwang CW, Johnston PV, Gerstenblith G,
Weiss RG, Tomaselli GF, Bogdan VE, Panigrahi
A, Leszczynska A, Xia Z. Stem cell impregnated
nanofiber stent sleeve for on-stent production
and intravascular delivery of paracrine factors.
Biomaterials. 2015 Jun;52:318-26.
Summary: This article demonstrates the feasibility
of creating an intravascular paracrine factors
factory using a stem cell impregnated nanofiber
stent sleeve and paves the way for animal studies
to assess the efficacy of local paracine factors
production to treat ischemic artery disease.
107. Lai S, Gerstenblith G, Li J, Zhu H,
Bluemke DA, Liu CY, Zimmerman SL, Chen S,
Lai H, Treisman G. Chronic cocaine use and its
association with myocardial steatosis evaluated by
1H magnetic resonance spectroscopy in African
Americans. Journal of Addiction Medicine. 2015
Jan-Feb;9(1):31-9.
Summary: Cocaine users may have more fat
than nonusers and myocardial triglyceride is
independently associated with duration of cocaine
use, leptin, and visceral fat, whereas chronic
cocaine use may modify the relationships between
obesity measures and myocardial triglyceride.
108. Lai H, Stitzer M, Treisman G, Moore R,
Brinker J, Gerstenblith G, Kickler TS, Li J,
Chen S, Fishman E, Lai S. Cocaine abstinence
and reduced use associated with lowered marker
of endothelial dysfunction in African Americans.
Journal of Addiction Medicine. 2015 JulAug;9(4):331-9.
Summary: The findings of this study revealed
a possible association of cocaine abstinence/
reduction with lowered endothelin-1 levels; such
changes in cocaine use might be beneficial for
preventing endothelial damage. Further studies will
investigate whether endothelin-1 could be used as
a marker for cocaine abstinence and reduction in
cocaine use.
109. Makkar RR, Smith
RR, Czer LS, Russell SD,
Gerstenblith G, Marbán
E. Letter by Makkar et al
regarding article, “Cell
therapy for heart failure: a
comprehensive overview
of experimental and
clinical studies, current
Dr. Gary Gerstenblith
challenges, and future
directions.” Circulation
Research. 2014 Nov 7;115(11):e32.
110. Golden SH, Purnell T, Halbert JP,
Matens R, Miller ER, Levine DM, Nguyen
TH, Gudzune KA, Crews DC, MahlanguNgcobo M, Cooper LA. A community-engaged
cardiovascular health disparities research training
curriculum: implementation and preliminary
outcomes. Academic Medicine: Journal of the
Association of American Medical Colleges. 2014
Oct;89(10):1348-56.
Summary: This article summarizes the key
elements, implementation, and preliminary
outcomes of the CVD Disparities Fellowship and
Summer Internship Programs at the Johns Hopkins
University Schools of Medicine, Nursing, and
Bloomberg School of Public Health.
hurram Nasir, MD,
K
MPH
Over the past year, Khurram
Nasir, MD, MPH, has led
important research on the role of
a simple calcium test and its role in
predicting the future development
of heart disease. A landmark
study led by Dr. Nasir, Michael
Blaha, MD, MPH, and other
members of the Ciccarone Center,
and published in the Journal of the
American College of Cardiology, offers
evidence supporting a different
and novel role for calcium (CAC)
scores, raising the possibility that
about half of people who are
eligible to take statins might now
avoid taking them and focus simply
on lifestyle habits. Together with
Drs. Jaideep Patel and J.
Bill McEvoy, Khurram led an
important project that found that,
among people with a family history
of premature heart disease, only
those with elevated CAC score
were at elevated risk of a future
cardiovascular event, while carotid
artery thickness was not a good
predictor. Bill, Khurram, and Mike
also led two impressive publications
on the relationship of cigarette
smoking, inflammation, and the
development of subclinical vascular
disease and cardiovascular events,
such as stroke and heart attack.
19
publications
research
111. Rubin DJ, BonnellJackson K, Jhingan R,
Golden SH, Paranjape A.
Early readmission among
patients with diabetes:
a qualitative assessment
of contributing factors.
Journal of Diabetes and its
Complications. 2014 NovDr. Sherita Golden
Dec;28(6):869-73.
Summary: Several
interventions may reduce the risk of early
readmission for patients with diabetes, including
inpatient diabetes education, improving
communication of discharge instructions,
and involving patients more in medication
reconciliation and post-discharge planning.
112. De Ferranti SD, de Boer IH, Fonesca V, Fox
CS, Golden SH, Lavie CJ, Magge SN, Marx
N, McGuire DK, Orchard TJ, Zinman B, Eckel
RH. Type 1 diabetes mellitus and cardiovascular
disease: a scientific statement from the American
Heart Association and American Diabetes
Association. Diabetes Care. 2014 Oct;37(10):284363.
113. Wang X, Sánchez BN, Golden SH, Shrager
S, Kirschbaum C, Karlamangla AS, Seeman TE,
Roux AV. Stability and predictors of change in
salivary cortisol measures over six years: MESA.
Psychoneuroendocrinology. 2014 Nov;49:310-20.
Summary: The findings in this paper have
implications for characterization of features
in studies linking cortisol to health outcomes.
The presence of variability over time suggests
opportunities for future investigation of the
predictors of changes over time as well as the links
between these changes and health outcomes.
114. Palta P, Golden SH, Teresi JA, Palmas
W, Trief P, Weinstock RS, Shea S, Manly JJ,
Luchsinger JA. Depression is not associated
with diabetes control in minority elderly. Journal
of Diabetes and its Complications. 2014 NovDec;28(6):798-804.
Summary: Depression, with or without low
performance in tests of executive function and
memory, may not affect clinically significant
measures of diabetes control in the elderly.
115. Kalyani RR, Metter EJ, Egan J, Golden SH,
Ferrucci L. Hyperglycemia predicts persistently
lower muscle strength with aging. Diabetes Care.
2015 Jan;38(1):82-90.
Summary: Hyperglycemia is associated with
persistently lower muscle strength with aging,
but this effect may be mediated, at least in part,
by peripheral neuropathy. Future studies should
be explored to see if better glycemic control can
preserve muscle function in diabetes.
116. Palta P, Golden SH, Teresi J, Palmas W,
Weinstock RS, Sheas S, Manly JJ, Luchsinger
JA. Mild cognitive dysfunction does not affect
diabetes mellitus control in minority elderly adults.
Journal of the American Geriatrics Society. 2014
Dec;62(12):2363-8.
20
Summary: Cognitive dysfunction in the mild
range did not seem to affect diabetes mellitus
control parameters in this multiethnic cohort
of older adults with diabetes mellitus, although
cognitive impairment may have been overcome
through assistance from formal or informal
caregivers.
117. Cefalu WT, Golden SH. Innovative
approaches to understanding and addressing health
disparities in diabetes care and research. Diabetes
Care. 2015 Feb;38(2):186-8.
118. Mongraw-Chaffin ML, Anderson CA, Allison
MA, Ouyang P, Szklo M, Vaidya D, Woodward M,
Golden SH. Association between sex hormones
and adiposity: qualitative differences in women and
men in the multi-ethnic study of atherosclerosis.
The Journal of Clinical Endocrinology and
Metabolism. 2015 Apr;100(4):E596-600.
Summary: Sex hormones are significantly
associated with adiposity, and the associations
of androgens differ qualitatively by sex. This
heterogeneity may help explain the complexity of
the contribution of sex hormones to sex differences
in cardiovascular disease.
119. Mair C, Diez Roux AV, Golden SH, Seeman
T, Shea S. Change in neighborhood environments
and depressive symptoms in New York City: the
Multi-Ethnic Study of Atherosclerosis. Health and
Place. 2015 Mar;32:93-8.
Summary: Individuals living in neighborhoods
with adverse changes were more likely to have
increased depression scores, although due to
limited sample size associations were imprecisely
estimated. Changes in specific features of the
neighborhood environment may be associated with
changes in level of depressive symptoms among
residents.
120. Mathioudakis N, Golden SH. A comparison
of inpatient glucose management guidelines:
implications for patient safety and quality. Current
Diabetes Reports. 2015 Mar;15(3):13.
Summary: While most inpatient glucose
management guidelines align with respect to
outcome measures such as glycemic targets,
there is significant heterogeneity among process
measures, which might cause variation or
confusion in clinical practice and possibly affect
quality of care.
121. Ranasinghe PD, Maruthur NM, Nicholson
WK, Yeh HC, Brown T, Suh Y, Wilson LM,
Nannes EB, Verger Z, Bass EB, Golden SH.
Comparative effectiveness of continuous
subcutaneous insulin infusion using insulin analogs
and multiple daily injections in pregnant women
with diabetes mellitus: a systematic review and
meta-analysis. Journal of Women’s Health (2002).
2015 Mar;24(3):237-49.
Summary: Observational studies reported similar
improvements in HbA1c with CSII and MDI
during pregnancy, but also highlighted the need
for future studies to examine the effectiveness and
safety of CSII with insulin analogs and MDI in
pregnant women with diabetes mellitus.
122. Vaidya D, Golden SH, Haq N, Heckbert
SR, Liu K, Ouyang P. Association of sex
hormones with carotid artery dispensability in
men and postmenopausal women: multi-ethnic
study of atherosclerosis. Hypertension. 2015
May;65(5):1020-5.
Summary: An androgenic internal milieu is
associated with lesser carotid distensibility and
diameter remodeling in women, but the opposite
is true for men. Higher levels of estradiol are
associated with smaller carotid diameters in both
the sexes.
123. Golden SH, Ferketich A, Boyington J,
Dugan S, Garroutte E, Kaufmann PG, Krok
J, Kuo A, Ortega AN, Purnell T, Srinivasan S.
Transdisciplinary cardiovascular and cancer health
disparities training: experiences of the centers
for population health and health disparities. The
American Journal of Public Health. 2015 Jul;105
Suppl 3:S395-402.
Summary: There are five areas of scientific
training for empowering the next generation of
health disparities investigators with research
methods and skills that are needed to solve
disparities and inequalities in cancer and
cardiovascular disease.
124. Kalyani RR, Rodriguez DC, Yeh HC, Golden
SH, Thorpe RJ Jr. Diabetes, race and functional
limitations in older US men and women. Diabetes
Research and Clinical Practice. 2015 Jun;108
(3):390-7.
Summary: The burden of functional limitations
differs by race among both men and women
with diabetes. Future studies should examine
mechanisms underlying these differences to
prevent progression to disability in older adults
with diabetes.
125. Osei K, Golden SH. James R. Gavin III,
MD, PhD: A humble and remarkable trailblazer,
scientist, advocate, mentor, and educator for
diabetes. Diabetes Care. 2015 Jun;38(6):963-7.
126. Mathioudakis N, Pronovost PJ, Cosgrove SE,
Hager D, Golden SH. Modeling inpatient glucose
management programs on hospital infection
control programs: An infrastructural model of
excellence. Joint Commission Journal on Quality
and Patient Safety/ Joint Commission Resources.
2015;41(97):325-336.
Dr. Ty Gluckman
127. Gluckman TJ,
Freeman AM. The role
of cardiac rehabilitation.
In: Handberg E and
Anderson RD, eds. Acute
Coronary Syndrome:
Urgent and Follow-up
Care. Minneapolis, Minn.:
Cardiotext Publishing.
Forthcoming 2015.
128. Freeman AM, Gluckman TJ. Lifestyle
modification. In: Handberg E and Anderson RD,
eds. Acute Coronary Syndrome: Urgent and
Follow-up Care. Minneapolis, Minn.: Cardiotext
Publishing. Forthcoming 2015.
129. Handy CE, Desai
CS, Dardari ZA, AlMhalla MH, Miedema
MD, Ouyang P, Budoff MJ,
Blumenthal RS, Blaha
MJ. The association of
coronary artery calcium with
non-cardiovascular disease
from the Multi-Ethnic Study
of Atherosclerosis. Journal Dr. Cathy Handy
of the American College of
Cardiology: Cardiovascular Imaging. Forthcoming
2015.
Summary: Elevated coronary artery calcium
score is associated with a higher risk of noncardiovascular disease, including cancer,
pneumonia, COPD, and hip fracture. Those with
coronary calcium scores of zero had lower rates
of these non-cardiovascular diseases and represent
“healthy agers.”
130. Michalska-Kasiczak M, Sahebkar A,
Mikhailidis DP, Rysz J, Muntner P, Toth PP,
Jones SR, Rizzo M, Kees Hovingh G, Farnier
M, Moriarty PM, Bittner VA, Lip GY, Banach M.
Analysis of vitamin D levels in patients with and
without statin-associated myalgia—a systematic
review and meta-analysis of 7 studies with 2420
patients. International Journal of Cardiology. 2015
Jan 15;178:111-6.
Summary: This meta-analysis provides evidence
that low vitamin D levels are associated with
myalgia in patients on statin therapy. Randomized
controlled trials are necessary to establish whether
vitamin D supplementation reduces the risk for
statin-associated myalgia.
131. Banach M, Serban C, Sahebkar A, Ursoniu
S, Rysz J, Mutner P, Toth PP, Jones SR, Rizzo
M, Glasser SP, Lip GY, Dragan S, Mikhailidis
DP. Effects of coenzyme Q10 on statin-induced
myopathy: a meta-analysis of randomized
controlled trials. Mayo Clinic Proceedings. 2015
Jan;90(1):24-34.
Summary: The results of this meta-analysis
of available randomized controlled trials do
not suggest any significant benefit of CoQ10
supplementation in improving statin-induced
myopathy. Larger, well-designed trials are
necessary to confirm the findings from this metaanalysis.
132. Banach M, Rizzo M, Toth PP, Farnier
M, Davidson MH, Al-Rasadi K, Aronow WS,
Athyros V, Djuric DM, Ezhov, Greenfield RS,
Hovingh GK, Kostner K, Serban C, Lighezan
D, Fras Z, Moriarty PM, Mutner P, Goudev
A, Ceska R, Nichollis SJ, Broncei M, Nikolic
D, Pella D, Puri R, Rysz J, Wong ND, Bajnok
L, Jones SR, Ray KK, Mikhailidis DP. Statin
intolerance—an attempt at a unified definition,
a position paper from an International Lipid
Expert Panel. Archives of Medical Science. 2015
Mar 16;11(1):1-23.
Summary: The aim of this paper was to suggest
a unified definition of statin intolerance, and to
complement the recent European Atherosclerosis
Society statement on statin associated muscle
symptoms, where the pathophysiology, diagnosis
and the management were comprehensively
presented.
Chiadi Ndumele, MD, MHS
In addition to leading the Ciccarone Center’s efforts at
improving employee cardiovascular health at Johns
Hopkins, Chiadi Ndumele, MD, MHS, also
published an important study in 2015. Appearing in
JACC Heart Failure, the study found that obesity has an
independent relationship with myocardial injury, as
reflected by the biomarker high-sensitivity cardiac
troponin-T, and that both provide complementary
prognostic information regarding the risk of heart failure. He also led a
portion of a Cardiometabolic Think Tank sponsored by the American
College of Cardiology and the CardioMetabolic Health Alliance, leading to
a recent publication in the Journal of the American College of Cardiology
regarding the development of a new care model for the metabolic syndrome.
133. Kotani K, Sahebkar A, Serban C, Andrica
F, Toth PP, Jones SR, Kostner K, Blaha MJ,
Martin S, Rysz J, Glasser S, Ray KK, Watts
GF, Mikhailidis DP, Banach M; Lipid and Blood
Pressure Meta-analysis Collaboration (LBPMC)
Group. Tibolone decreases Lipoprotein(a) levels
in postmenopausal women: A systematic review
and meta-analysis of 12 studies with 1009 patients.
Atherosclerosis. 2015 Jul 2;242(1):87-96.
Summary: This meta-analysis shows that oral
tibolone treatment significantly lowers circulating
Lp(a) levels in postmenopausal women. Further
studies are warranted to explore the mechanism
of this effect and the potential value and place
of tibolone or its analogues in the treatment of
elevated Lp(a) in individuals at risk of CVD.
134. Elshazly MB, Quispe R, Michos ED,
Sniderman AD, Toth PP, Banach M, Kulkarni KR,
Coresh J, Blumenthal RS, Jones SR, Martin SS.
Patient-level discordance in population percentiles
of the TC/HDL-C ratio compared with LDL-C
and non-HDL-C: The Very Large Database of
Lipids Study (VLDL-2B). Circulation. 2015 Aug
25;132(8):667-76.
Summary: In this cross-sectional analysis of US
adults who underwent advanced lipid testing,
the extent of patient-level discordance suggests
that TC/HDL-C may offer potential additional
information to LDL-C and non-HDL-C. Future
studies are required to determine the clinical
implications of this observation.
135. Joshi PH, Nasir K.
Discordance between risk
factors and coronary artery
calcium: Implications for
guiding treatment strategies in
primary prevention settings.
Progress in Cardiovascular
Diseases. 2015 JulAug;58(1):10-8.
Dr. Parag Joshi
Summary: This article
focuses on a clinical perspective of the
considerable heterogeneity between risk factors
and atherosclerotic burden in the context of the
2013 ACC/AHA cholesterol treatment and risk
assessment guidelines.
136. Maroules CD, Cheezum MK, Joshi PH,
Williams M, Simprini LA, Nelson KH, Bittencourt
MS, Carr JJ, Weigold WG, Cury RC, Blankenstein
R, Abbara S. SCCT curriculum guidelines for
general (level 1) cardiovascular CT training.
Journal of Cardiovascular Computed Tomography.
2015 Mar-Apr;9(2):81-8.
Summary: The Society of Cardiovascular
Computed Tomography has developed general
(level 1) cardiovascular CCT training guidelines for
radiology resident and cardiology fellow education,
which ensures that residents and fellows-in-training
obtain a fundamental understanding of CCT to stay
current in the landscape of cardiovascular imaging
and know how and when to use CCT.
21
publications
research
137. Joshi PH, Nasir K. The highs and lows of
cardiovascular risk prediction: time for paradigm
shift? Atherosclerosis. 2015 Apr;239(2):436-8.
138. Martin SS, Khokhar AA, May HT, Kulkarni
KR, Blaha MJ, Joshi PH, Toth PP, Muhlestein
JB, Anderson JL, Knight S, Li Y, Spertus JA,
Jones SR. HDL cholesterol subclasses, myocardial
infarction, and mortality in secondary prevention:
The lipoprotein investigators collaborative.
European Heart Journal. 2015 Jan 1;36(1):22-30.
139. Joshi PH, Miller JI, Rinehart S. A middleaged woman with hyperlipidemia, subclinical
atherosclerosis, and statin intolerance. http://ldl.
cardiosource.org/. September 25, 2014.
140. Basra SS, Pokharel
Y, Hira RS, Bandeali SJ,
Nambi V, Deswal A, Nasir
K, Martin SS, Vogel RA,
Roberts AJ, Ballantyne
CM, Virani SS. Relation
between playing position
and coronary artery
calcium scores in retired
National Football League
Players. The American Journal of Cardiology. 2014
Dec 15.114(12)1836-40.
Summary: Lineman status retired NFL players are
associated with presence and severity of subclinical
atherosclerosis, which is partly explained by race.
141. Shah NP, Swiger KJ, Martin SS. Impact on
cognitive function-are all statins the same? Current
Atherosclerosis Reports. 2015 Jan;17(1):466.
Summary: This narrative review specifically
explores the various properties of different
statin types and whether these differences lead
to a clinically significant differential impact on
cognitive function, emphasizing important new
findings.
142. Pokharel Y, Nambi V, Martin SS, Hoogevenn
RC, Nasir K, Khera A, Wong ND, Jones PH,
Boone J, Roberts AJ, Ballantyne CM, Virani
SS. Association between lipoprotein associated
phospholipase A2 mass and subclinical coronary
and carotid atherosclerosis in Retired National
Football League players. Atherosclerosis. 2014
Oct;236(2):251-6.
Summary: Lipoprotein Associated Phospholipase
A2 (LpPLA2) mass was not associated with
coronary or carotid subclinical atherosclerosis in
retired NFL players.
143. Martin SS, Shapiro EP, Mukherjee M. Atrial
septal defects—clinical manifestations, echo
assessment, and intervention. Clinical Medicine
Insights, Cardiology. 2015 Mar 23;8(suppl 1):93-8.
Summary: This study focuses on atrial septal
defect, a common congenital abnormality that
occurs in the form of ostium secundum, ostium
primum, sinus venosus, and rarely, coronary sinus
defects as well as techniques to assess and, in some
cases, intervene with the process if detected.
22
144. Martin SS, Michos ED. Mapping
hyperlipidemia in young adulthood to coronary
risk: importance of cumulative exposure and how
to stay young. Circulation. 2015 Feb 3;131(5):4457.
Summary: Cumulative hypercholesterolemia
exposure in early adulthood was linked to
future coronary heart disease risk. This editorial
discusses whether we should be treating moderate
hyperlipidemia earlier in life to reduce risk.
145. Martin SS. My approach to patients intolerant
to statins. Trends in Cardiovascular Medicine. 2015
Apr;25(3):265-6.
146. Patel J, Superko HR,
Martin SS, Blumenthal RS,
Christopher-Stine L. Genetic
and immunologic susceptibility
to statin-related myopathy.
Atherosclerosis. 2015
May;240(1):260-71.
Summary: This
article examines the
Dr. Jaideep Patel
influence of genetic and
immunologic variation on the pharmacokinetics,
pharmacodynamics, and gene expression of statinrelated myopathy.
147. Swiger KJ, Martin SS. PCSK9 inhibitors and
neurocognitive adverse events: Exploring the FDA
directive and a proposal for n-of-1 trials. Drug
Safety. 2015 Jun;38(6):519-26.
Summary: Ultimately, any neurocognitive adverse
effects that might exist
with PCSK9 inhibition
and lipid lowering must
be weighed against
potential benefits of
therapy, including
avoidance of myocardial
infarction and stroke,
and a reduced risk of
Dr. Kristopher Swiger dementia due to lipid
lowering.
148. Martin SS, Joshi P, Michos ED. Lipids
in coronary heart disease: From epidemiology
to therapeutics. In: Aronow WS, McClung JA,
eds. Translational Research in Coronary Artery
Disease: Pathophysiology to Treatment. Waltham,
Mass.: Elsevier. Forthcoming 2015.
149. Martin SS, Faridi KF, Joshi PH, Blaha
MJ, Kulkarni KR, Khokhar AA, Maddox TM,
Havranek EP, Toth PP, Tang F, Spertus JA,
Jones SR. Remnant lipoprotein cholesterol and
mortality after acute myocardial infarction: Further
evidence for a hypercholesterolemia paradox from
the TRIUMPH Registry. Clinical Cardiology.
Forthcoming 2015.​
150. Mathews L. Variation in the prevalence of
familial hypercholesterolemia around the world.
http://www.acc.org/. July 17, 2015.
151. Mathews L, Blumenthal R, Michos ED.
My approach to using coronary artery calcium
scoring in primary prevention of atherosclerotic
cardiovascular disease. PracticeUpdate.com. March
23, 2015.
152. Selvin E, Lazo M, Chen Y, Shen L, Rubin
J, McEvoy JW, Hoogeveen RC, Sharrett AR,
Ballantyne CM, Coresh J. Diabetes mellitus, prediabetes, and incidence of subclinical myocardial
damage. Circulation. 2014 Oct 14;130(16):137482.
Summary: Pre-diabetes and diabetes mellitus were
independently associated with the development
of subclinical myocardial damage, as assessed
by hs-cTnT, and those persons with evidence
of subclinical damage were at highest risk for
clinical events. This supports a deleterious effect
of hyperglycemia on the myocardium, possibly
reflecting a microvascular cause.
153. McEvoy JW, Blumenthal RS, Michos ED.
Cardiac prevention guidelines. In: Gowraganahalli
J, Pitchai B, Khin M, eds. Pathophysiology and
Pharmacotherapy of Cardiovascular Disease. New
York, NY: Springer, Forthcoming 2015.
154. McEvoy JW, Chen Y, Nambi V, Ballantyne
CM, Sharrett AR, Appel LJ, Post WS, Blumenthal
RS, Matsushita K, Selvin E. High-sensitivity
cardiac troponin T and risk of hypertension.
Circulation. 2015 Sep 1;132(9):825-33.
Summary: In a population with no history
of cardiovascular disease, high-sensitivity
cardiac troponin T was associated with incident
hypertension and risk of left ventricular
hypertrophy.
155. McKibben RA, Haberlen SA, Post WS,
Brown TT, Budoff M, Witt MD, Kingsley LA,
Palella FJ Jr, Thio CL, Seaberg EC. Chronic
Hepatitis C virus infection is associated with
subclinical coronary atherosclerosis in the
Multicenter AIDS Cohort Study (MACS): a crosssectional study. Journal of Infectious Disease. 2015
Jul 27. pii: jiv396.
Summary: Chronic Hepatitis C virus infection is
associated with subclinical cardiovascular disease,
suggesting that infected individuals warrant
vigilant cardiovascular risk assessments. Future
research should determine whether Hepatitis C
virus infection duration or HCV treatment impact
coronary plaque development.
156. McKibben
RA, Margolick JB,
Grinspoon S, Li X,
Palella FJ Jr, Kingsley
LA, Witt MD, George
RT, Jacobson LP, Budoff
M, Tracy RP, Brown
TT, Post WS. Elevated
levels of monocyte
Dr. Rebeccah McKibben
activation markers are
associated with subclinical atherosclerosis in men
with and those without HIV infection. The Journal
of Infectious Diseases. 2015 Apr 15;211(8):121928.
Summary: Levels of monocyte activation markers
(sCD163, sCD14, and CCL2) were elevated in
treated HIV-infected men and associated with
atherosclerosis. Monocyte activation may increase
the risk for cardiovascular disease in individuals
with HIV infection.
157. Lupton JR, Faridi
KF, Martin SS, Sharma
S, Kulkarni K, Jones SR,
Michos ED. Deficient
serum 25-hydroxy
vitamin D is associated
with an atherogenic
lipid profile: The Very
Large Database of Lipids
(VLDL-3) Study. The
Journal of Clinical
Lipidology. Forthcoming 2015.
Summary: Deficient levels of serum vitamin
D were found to be associated with a more
atherogenic lipid profile, including significantly
lower HDL-C and higher directly-measured
LDL-C, IDL-C, VLDL-C, RLP-C, and
triglycerides. Future trials examining vitamin D
supplementation and cardiovascular risk should
consider using changes in an extended lipid panel
as an additional outcome measurement.
158. Liu K, Colangelo LA, Daviglus ML, Goff
DC, Pletcher M, Schreiner PJ, Sibley CT, Burke
GL, Post WS, Michos ED, Lloyd-Jones DM.
Can antihypertensive treatment restore the risk
of cardiovascular disease to ideal levels?: The
Coronary Artery Risk Development in Young
Adults (CARDIA) Study and the Multi-Ethnic
Study of Atherosclerosis (MESA). The Journal of
the American Heart Association. 2015 Sep 21;4(9). Summary: Treatment of blood pressure with
medications cannot restore cardiovascular disease
risk to ideal levels. Emphasis should be placed on
preventing high blood pressure from developing
in the first place (i.e. primordial prevention) to
further reduce cardiovascular disease morbidity and
mortality.
159. Michos ED, Martin SS, Blumenthal
RS. Bringing back targets to “IMPROVE”
atherosclerotic cardiovascular disease outcomes:
The duel for dual goals; are two targets better than
one? Circulation. 2015 Sep 29;132(13):1218-20.
Summary: This editorial discusses a secondary
analysis from IMPROVE-IT [Improved
Reduction of Outcomes: Vytorin Efficacy
International Trial], which studied the benefits of
adding ezetimibe on top of simvastatin in patients
after an acute coronary syndrome. This editorial
discusses whether or not we should be treating
high-risk patients to achieve the dual treatment
goals of an LDL-cholesterol of <70 mg/dL and a
high-sensitivity C-reactive protein ≥2 mg/L.
160. McKibben RA, Al Rifai M, Mathews LM,
Michos ED. Primary prevention of atherosclerotic
cardiovascular disease in women. Current
Cardiovascular Risk Reports. Forthcoming 2015.
Summary: This article reviews traditional and
non-traditional assessments of atherosclerotic
cardiovascular disease (ASCVD) risk in women
and discusses lifestyle and pharmacologic therapies
for the primary prevention of ASCVD in women.
161. Michos ED. Cardiovascular disease
prevention in women. In: Wong ND, Amsterdam
EA, Blumenthal RS, eds. American Society
of Preventive Cardiology (ASPC) Manual on
Preventive Cardiology. New York, NY: Demos
Medical Publishing. 2015.
162. Hueper K, Vogel-Claussen J, Parikh MA,
Austin JH, Bluemke DA, Carr J, Choi J, Goldstein
TA, Gomes AS, Hoffman EA, Kawut SM, Lima
J, Michos ED, Post WS, Po MJ, Prince MA, Liu
K, Rabinowitz D, Skrok J, Smith BM, Watson K,
Yin Y, Zambeli-Ljepovic AM, Barr RG. Pulmonary
micro-vascular blood flow in mild chronic
obstructive pulmonary disease and emphysema,
The MESA COPD Study. American Journal of
Respiratory and Critical Care Medicine. 2015 Jun
11.
Summary: Pulmonary microvascular blood flow
was reduced in mild COPD, including in regions of
lung without frank emphysema, and may represent
a distinct pathological process from small airways
disease. The condition may provide an imaging
biomarker for therapeutic strategies targeting the
pulmonary microvasculature.
163. Schneider AL, Lutsey PL, Selvin E, Mosley
TH, Sharrett AR, Carson KA, Post WS, Pankow
JS, Folsom AR, Gottesman RF, Michos ED.
Vitamin D, vitamin D binding protein gene
polymorphisms, race and risk of incident stroke:
the Atherosclerosis Risk in Communities (ARIC)
study. European Journal of Neurology: the
Official Journal of the European Federation of
Neurological Societies. 2015 Aug;22(8):1220-7.
Summary: Low vitamin D levels, measured by
serum 25-hydroxyvitamin D [25(OH)D], are a
risk factor for stroke. Persons with low 25(OH)D
who are genetically predisposed to high vitamin D
binding protein (rs7041 G, rs4588 A alleles), who
therefore have lower predicted bioavailable 25(OH)
D, may be at greater risk for stroke.
164. Michos ED,
Misialek JR, Selvin E,
Folsom AR, Pankow
JS, Post WS, Lutsey
PL. 25-hydroxyvitamin
D levels, vitamin D
binding protein gene
polymorphisms and
incident coronary heart
disease among whites and blacks: the ARIC study.
Atherosclerosis. 2015 Jul; 241(1):12-7.
Summary: Low 25(OH)D was associated with
incident CHD in whites, but no interactions of
25(OH)D with key vitamin D binding protein
genotypes was found.
165. Reis JP, Michos ED,
Selvin E, Pankow JS, Lutsey
PL. Race, vitamin D-binding
protein gene polymorphisms,
25-hydroxyvitamin D,
and incident diabetes: the
Atherosclerosis Risk in
Communities (ARIC) Study.
The American Journal of
Dr. Erin Michos
Clinical Nutrition. 2015
Jun;101(6):1232-40.
Summary: Low 25(OH)D concentrations were
associated with diabetes among whites but not
blacks. Interactions by key vitamin D-binding
protein (DBP) single nucleotide polymorphisms
(SNP) varied between genotypes associated with
either high or low DBP concentrations among
whites but not blacks. There are important
differences in the association of 25(OH)D with
incident diabetes between white and black adults.
166. Takiar R, Lutsey
PL, Zhao D, Guallar E,
Schneider AL, Grams ME,
Appel LJ, Selvin E, Michos
ED. The associations of
25-hydroxyvitamin D levels,
vitamin D binding protein
gene polymorphisms, and
race with risk of incident
fracture-related hospitalization: Twenty-year
follow-up in a bi-ethnic cohort (the ARIC study).
Bone. 2015 Sep;78:94-101.
Summary: Deficient 25(OH)D levels are
associated with higher incidence of hospitalized
fractures. Marginal effects were seen in whites for
the vitamin D binding protein genotype associated
with lower bioavailable vitamin D, but result
inconclusive. Further investigation will directly
evaluate the association between bioavailable
vitamin D and fracture risk.
167. Lutsey PL, Michos ED, Misialek JR,
Pankow JS, Loehr L, Selvin E, Reis JP, Gross M,
Eckfeldt JH, Folsom AR. Race and Vitamin D
Binding Protein Gene Polymorphisms Modify the
Association of 25-Hydroxyvitamin D and incident
Heart Failure: The ARIC (Atherosclerosis Risk in
Communities) Study. A Journal of the American
College of Cardiology, Heart Failure. 2015
May;3(5):347-56.
Summary: Low serum 25(OH)D was
independently associated with heart failure (HF)
among whites, but not among blacks. However, in
both races, low 25(OH)D was associated with HF
risk among those genetically predisposed to high
vitamin D binding protein. Metabolic differences
may underlie racial variation in the association
between 25(OH)D and cardiovascular risk.
23
publications
research
168. Lutsey PL, Eckfeldt JH, Ogagarue
ER, Folsom AR, Michos ED, Gross M.
The 25-hydroxyvitamin D3 C-3 epimer:
distribution, correlates, and reclassification of
25-hydroxyvitamin D status in the populationbased Atherosclerosis Risk in Communities Study
(ARIC). Clinica Chimica Acta; International
Journal of Clinical Chemistry. 2015 Mar
10;442:75-81.
Summary: Low concentrations of the D3 epimer
were present in adult serum and overall the epimer
concentration is moderately correlated with the
25(OH)D3 concentration. There was minimal
reclassification of participant’s clinical 25(OH)D
status upon inclusion of the epimer.
169. Steffen BT, Guan W, Remaley AT, Paramsothy
P, Heckbert SR, McClelland RL, Greenland P,
Michos ED, Tsai MY. Use of lipoprotein particle
measures for assessing coronary heart disease
risk post-American Heart Association/American
College of Cardiology guidelines: the MultiEthnic Study of Atherosclerosis. Arteriosclerosis,
Thrombosis, and Vascular Biology. 2015
Feb;35(2):448-54.
Summary: Lipoprotein particle measures ApoB/
ApoA-I and LDL-P/high-density lipoprotein-P
marginally improved net reclassification
improvement scores, but null findings for
corresponding c-statistic are not supportive of
lipoprotein testing. The attenuated associations
of lipoprotein particle measures with CHD
after the adjustment for lipids indicate that
their measurement does not detect risk that is
unaccounted for by the standard lipid panel.
170. Rieke K, Durazo-Arvizu R, Liu K, Michos
ED, Luke A, Kramer H. Association between
anxiety levels and weight change in the multiethnic study of atherosclerosis. Journal of Obesity.
2014;2014:894627.
Summary: Among adults, age 45-84, higher levels
of anxiety, defined by the STPI trait anxiety scale,
are associated with lower average baseline weight
but not with weight change.
171. Folsom AR,
Alonso A, Misialek
JR, Michos ED, Selvin
E, Eckfeldt JH, Coresh J,
Pankow JS, Lutsey PL.
Parathyroid hormone
concentration and risk of
cardiovascular diseases:
the Atherosclerosis Risk
in Communities (ARIC)
study. American Heart Journal. 2014;168(3):296302.
Summary: This large prospective study failed to
support the hypothesis that elevated parathyroid
hormone (PTH) is an independent risk marker for
incident cardiovascular disease (CVD). When our
data were added to the previous meta-analysis,
the association with CVD remained statistically
significant but weakened.
24
Juan Rivera, MD
Juan Rivera, MD, better known as “Dr. Juan,” is
the Chief Medical Correspondent for Univision, a
popular Hispanic TV network in the US. His
health segments reach millions of Hispanics with
weekly appearances on three top-rated shows.
A proud alumnus of the Ciccarone Center,
Dr. Rivera’s goal is to be a vehicle for bringing
scientific research and medical knowledge to as
many people as possible. For example, this past
year he was Univision’s image and content leader for the Asegurate
Campaign, a program designed to educate Hispanics on the new Affordable
Care Act. He appeared on more than 50 public service announcements,
participated in numerous educational health fairs across the country, and
created weekly segments that incorporated elements of the new law.
Dr. Juan has created several new health initiatives for Univision. For
example, in partnership with the Ciccarone Center and the American
Heart Association, Dr. Juan and his team created a 28-day online weight
loss plan which was provided free of cost to viewers. In one month,
400,000 people enrolled and the webpage received 8 million visits. Besides
helping Hispanics lose weight, the program showed that it is possible to
change human behavior, in this case health related, through media outlets.
172. Miller PE, Martin SS, Toth PP, Blaha
MJ, Nasir K, Virani SS, Post WS, Santos RD,
Blumenthal RS, and Jones SR. Comparison
of Friedewald and biologic LDL-C in familial
hypercholesterolemia screening: The Very Large
Database of Lipids Study-17 (VLDL-17). Journal
of Clinical Lipidology. 2015 Sep-Oct;9(5):676-83.
Summary: Of those who screened positive for
familial hypercholesterolemia, Friedewald and
biologic LDL-C levels were closely correlated.
173. Yeboah J, Carr JJ, Terry JG, Ding J, Zeb I,
Liu S, Nasir K, Post W, Blumenthal RS, Budoff
MJ. Computed tomography-derived cardiovascular
risk markers, incident cardiovascular events, and
all-cause mortality in nondiabetics: the Multi-Ethnic
Study of Atherosclerosis.
European Journal of
Preventive Cardiology.
2014 Oct;21(10):1233-41.
Summary: The
addition of CAC to the
FRS provides superior
discrimination especially
in intermediate-risk
individuals compared with the addition of TAC
or LA for incident CVD and incident CHD. The
addition of TAC, PAT, or LA individually is
unlikely to be useful for improving cardiovascular
risk prediction.
174. Roberson L, Shaharyar S, Aneni E, Freitas W,
Blaha M, Agatston A, Blumenthal R, Santos RD,
Feiz H, Nasir K, Sposito A. The prevalence of the
metabolically healthy obese phenotype in an aging
population and its association with subclinical
cardiovascular disease: The Brazilian study on
healthy aging. Diabetology & Metabolic Syndrome.
2014 Nov 7;6(1):121.
Summary: Our results suggest that the MHO
phenotype exists in the elderly; however,
subclinical CVD measures were not different in
sub-group analysis suggesting traditional metabolic
risk factor algorithms may not be accurate in the
very elderly.
175. Nasir K, Blankstein R. Disparities between
ideal cardiovascular health metrics and subclinical
atherosclerotic burden: more than meets the eye.
Circulation, Cardiovascular Imaging. 2014 Dec
31;8(1).pii:e002761.
176. Nasir K. Novel risk model predicting
high-risk coronary artery disease: let common
sense prevail in medical decision making. The
Journal of the American College of Cardiology,
Cardiovascular Imaging. 2015 Apr;8(4):435-7.
177. Ogunmoroti O, Yonus A, Rouseff M.
Spatz ES, Das S, Parris D, Aneni E, Holzwarth
L, Guzman H, Tran T, Roberson L, Ali SS,
Agatston A, Maziak W, Feldman T, Veledar
E, Nasir K. Assessment of American Heart
Association’s Ideal Cardiovascular Health
Metrics among Employees of a large Healthcare
Organization: The Baptist Health South Florida
Employee Study. Clinical Cardiology. 2015
Jul;38(7):422-9.
Summary: A combination of HRAs and wellness
examinations can provide useful insights into
the cardiovascular health status of an employee
population. Future tracking of the CV health
metrics will provide critical feedback on the
impact of system wide wellness efforts.
178. Pokharel Y, Sun W, de Lemos JA, Taffet GE,
Virani SS, Ndumele CE, Mosley TH, Hoogeveen
RC, Coresh J, Wright JD, Heiss G, Boerwinkle
EA, Bozkurt B, Solomon SD, Ballantyne CM,
Nambi V. High-sensitivity troponin T and
cardiovascular events in systolic blood pressure
categories: atherosclerosis risk in communities
study. Hypertension. 2015 Jan;65(1):78-84.
Summary: There was no similar association of
SBP with cardiovascular events across troponin
T categories. Higher troponin T levels within
narrow SBP categories portend increased
cardiovascular risk, particularly for heart failure.
Individuals with lower SBP but measurable
troponin T had greater cardiovascular risk
compared with those with suboptimal SBP but
undetectable troponin T.
179. Lazo M, Rubin J, Clark JM, Coresh J,
Schneider AL, Ndumele C, Hoogeveen RC,
Ballantyne CM, Selvin E. The association of
liver enzymes with biomarkers of subclinical
myocardial damage and structural heart disease.
Journal of Hepatology. 2015 Apr;62(4):841-7.
Summary: The results suggest that elevated liver
enzyme levels in the absence of elevated alcohol
consumption may be associated with subclinical
myocardial injury. The inverse association
between NT-proBNP and both ALT and AST
supports the metabolic role of natriuretic
peptides.
180. Ojeifo O, Gilotra
NA, Kemp CD,
Leventhal A, Resar
J, Zehr KJ, Jones S.
Mediastinal fibrosis
of the pulmonary
artery secondary to
tuberculosis. The Annals
of Thoracic Surgery.
2015 Sep;100(3):e49-50.
181. Ojeifo O, Berkowitz S. Cardiology and
accountable care. Circulation: Cardiovascular
Quality and Outcomes. 2015; 8: 213-217.​
182. Ong KL, McClelland RL, Rye KA,
Cheung BM, Post WS, Vaidya D, Criqui MH,
Cushman M, Barter PJ, Allison MA. The
relationship between insulin resistance and
vascular calcification in coronary arteries, and the
thoracic and abdominal aorta: the Multi-Ethnic
Study of Atherosclerosis. Atherosclerosis. 2014
Oct;236(2):257-62.
Summary: Atherosclerotic calcification,
especially in the coronary arteries, is related to
insulin resistance. Further studies are needed
to delineate the mechanisms by which visceral
obesity can lead to vascular calcification.
183. Metkus TS Jr,
Brown TT, Post WS.
Cardiovascular disease
associated with human
immunodeficiency virus:
an update. Current
Treatment Options in
Cardiovascular Medicine.
2014 Nov;16(11):346.
Dr. Wendy Post
Summary: The
pathogenesis of HIV-associated atherosclerosis
is complex and involves a state of chronic
inflammation, exposure to traditional risk factors,
and metabolic side effects of ART. Treatment of
HIV-associated atherosclerosis should include
special attention to drug-drug interactions and is
best accomplished by a multidisciplinary team
experienced in the care of HIV-infected persons.
184. Jones MR, Diez-Roux AV, Hajat A,
Kershaw KN, O’Neill MS, Guallar E, Post
WS, Kaufman JD, Navas-Acien A. Race/
ethnicity, residential segregation, and exposure to
ambient air pollution: the Multi-Ethnic Study of
Atherosclerosis (MESA). American Journal of
Public Health. 2014 Nov;104(11):2130-7.
Summary: Living in majority white
neighborhoods was associated with lower air
pollution exposures, and living in majority
Hispanic neighborhoods was associated with
higher air pollution exposures. This highlights
the importance of measuring neighborhoodlevel segregation in the environmental justice
literature.
185. Smith JG, Luk K,
Schulz CA, Engert JC,
Do R, Hindy G, Rukh
G, Dufresne L, Almgren
P, Owens DS, Harris
TB, Peloso GM, Kerr
KF, Wong Q, Smith
AV, Budoff MJ, Rotter
JI, Cupples LA, Rich
S, Kathiresan S, OrhoMelander M, Gudnason V, O’Donnell CJ, Post
W, Thanassoulis G. Association of low-density
lipoprotein cholesterol-related genetic variants
with aortic valve calcium and incident aortic
stenosis. The Journal of the American Medical
Association. 2014 Nov 5;312(17):1764-71.
Summary: Genetic predisposition to elevated
LDL-C was associated with presence of aortic
valve calcium and incidence of aortic stenosis,
providing evidence supportive of a causal
association between LDL-C and aortic valve
disease. Whether earlier intervention to reduce
LDL-C could prevent aortic valve disease merits
further investigation.
186. Kovell LC, Ahmed
HM, Misra S, Whelton
SP, Prokopowicz GP,
Blumenthal RS, McEvoy
JW. U.S. hypertension
management guidelines: A
review of the recent past
and recommendations for
the future. Journal of the
Dr. Haitham Ahmed
American Heart Association.
Forthcoming 2015.
187. Chahal H, Bluemke DA, Wu CO,
McClelland R, Liu K, Shea SJ, Burke G,
Balfour, Herrington D, Shi P, Post W, Olson J,
Watson KE, Folsom AR, Lima JA. Heart failure
risk prediction in the Multi-Ethnic Study of
Atherosclerosis. Heart (British Cardiac Society).
2015 Jan;101(1):58-64.
Summary: A clinical
algorithm based on risk
factors readily available
in the primary care setting
can be used to identify
individuals with high
likelihood of developing
HF without pre-existing
cardiac disease.
Dr. Shay Ojeifo
25
publications
research
188. Reynolds LM, Taylor JR, Ding J, Lohman
K, Johnson C, Siscovick D, Burke G, Post
W, Shea S, Jacobs DR Jr, Stunnerberg H,
Kritchevsky SB, Hoeschele J, McCall CE,
Herrington DM, Tracy RP, Liu Y. Age-related
variations in the methylome associated with gene
expression in human monocytes and T cells.
Nature Communications. 2014 Nov 18;5:5366.
Summary: This research identifies and
characterizes potentially functional age-related
methylation in human T cells and monocytes and
provides novel insights into the role age-dMS
may have in the aging process.
189. Tereschchenko LG, Henrikson CA,
Sotoodehnia N, Arking DE, Agarwal SK,
Sisovick DS, Post WS, Solomon SD,
Coresh J, Josephson ME, Soliman EZ.
Electrocardiographic deep terminal negativity
of the P wave in V(1) and risk of sudden cardiac
death: the Atherosclerosis Risk in Communities
(ARIC) study. Journal of the American Heart
Association. 2014 Nov 21;3(6):e001387.
Summary: Deep terminal negativity of the P
wave in V(1) is predictive of SCD suggesting
its potential utility in risk stratification in the
general population.
190. Miller PE, Haberlen
SA, Metkus T, Rezaeian
P, Palella F, Kingsley
LA, Witt MD, George
RT, Jacobson LP, Brown
TT, Budoff M, Post
WS. HIV and coronary
arterial remodeling from
the Multicenter AIDS
Dr. Elliott Miller
Cohort Study (MACS).
Atherosclerosis. 2015 Jun
18;241(2):716-722.
Summary: HIV+ men have more positively
remodeled arterial segments, which may be due
to more coronary segments with atherosclerosis
or HIV-related immunosuppression. Further
studies are needed to evaluate whether
this contributes to higher rates of MI in
HIV+ individuals.
191. Beinart R, Zhang Y, Lima JA, Bluemke DA,
Soliman EZ, Heckbert SR, Post WS, Guallar
E, Nazarian S. The QT interval is associated
with incident cardiovascular events: the MESA
study. The Journal of the American College of
Cardiology. 2014 Nov 18-25;64(20):2111-9.
Summary: The QT interval was associated with
incident cardiovascular events in middle-aged
and older adults without prior CVD.
26
192. Post WS, George RT, Budoff M.
HIV infection and subclinical coronary
atherosclerosis. Annals of Internal Medicine.
2014 Dec 16;161(12):923-4.
193. Waks JW, Soliman EZ, Henrikson CA,
Sotoodehnia N, Han L, Agarwal SK, Arking
DE, Siscovick DS, Solomon SD, Post WS,
Josephson ME, Coresh J, Tereshchenko LG.
Beat-to-beat spatiotemporal variability in the T
vector is associated with sudden cardiac death in
participants without left ventricular hypertrophy:
the Atherosclerosis Risk in Communities (ARIC)
Study. Journal of American Heart Association.
2015 Jan 19;4(1):e001357.
Summary: In a large, prospective, communitybased cohort of left ventricular hypertrophyfree participants, increased beat-to-beat
spatiotemporal variability in the T vector, as
assessed by increasing TT’ angle, was associated
with SCD.
194. Monroe AK, Fu W,
Zikusoka MN, Jacobson
LP, Witt MD, Palella FJ,
Kingsley LA, Post WS,
Brown TT. Low-density
lipoprotein cholesterol
levels and statin treatment
by HIV status among
multicenter AIDS
cohort study men. AIDS Research and Human
Retroviruses. 2015 Jun;31(6):593-602.
Summary: This study examined whether HIV
serostatus is associated with not achieving
LDL-C target. The results found that HIVinfected and HIV-uninfected men receiving statin
therapy demonstrated similar nonachievement of
LDL-C targets.
195. Guan W, Cao J, Steffen BT, Post WS, Stein
JH, Tattersall MC, Kaufman JD, McConnell JP,
Hoefner DM, Warnic R, Tasi MY. Race is a key
variable in assigning lipoprotein (a) cutoff values
for coronary heart disease risk assessment:
the Multi-Ethnic Study of Atherosclerosis.
Arteriosclerosis, Thrombosis, and Vascular
Biology. 2015 Apr;35(4):996-1001.
Summary: The results of this study suggest that
the 30 mg/dL cutoff for Lp(a) is not appropriate
in white and Hispanic individuals, and the
higher 50 mg/dL cutoff should be considered. In
contrast, the 30 mg/dL cutoff remains suitable in
black individuals.
196. Reynolds LM, Ding J, Taylor JR, Lohman
K, Soranzo N, de la Fuente A, Liu TF, Johnson
C, Barr RG, Register TC, Donohue KM, Taylor
MV, Cihakova D, Gu C, Divers J, Sisovick
D, Burke G, Post W, Shea S, Jacobs DR Jr,
Hoeschele I, McCall CE, Kritchevsky SB,
Herrington D, Tracy RP, Liu Y. Transcriptomic
profiles of aging in purified human immune
cells. Bio Medical Central Genomics. 2015 Apr
22;16:333.
Summary: An overall decline in expression
of ribosomal protein synthesis genes with age
was detected in CD14+ monocytes and CD4+
T cells, demonstrating that some patterns of
aging are likely shared between different cell
types. Additionally, the findings in this study
also support cell-specific effects of age on gene
expression, illustrating the importance of using
purified cell samples for future transcriptomic
studies.
197. Hanna DB, Post WS, Deal JA, Hodis HN,
Jacobson LP, Mack WJ, Anastos K, Gange SJ,
Landay AL, Lazar JM, Palella FJ, Tien PC, Witt
MD, Xue X, Young MA, Kaplan RC, Kingsley
LA. HIV Infection is associated with Progression
of Subclinical Carotid Atherosclerosis. Clinical
Infectious Diseases: an Official Publication of
the Infectious Diseases Society of America. 2015
Apr 22.Pii:civ325.
Summary: HIV infection is associated with
greater increases in focal plaque among women
and men, potentially mediated by factors
associated with immunodeficiency or HIV
replication at levels below current limits of
detection.
198. Metkus TS, Brown T, Budoff M, Kingsley
L, Palella FJ Jr, Witt MD, Li X, George RT,
Jacobson LP, Post WS. HIV infection is
associated with an increased prevalence of
coronary noncalcified plaque among participants
with coronary artery calcium score of zero:
Multicenter AIDS Cohort Study (MACS). HIV
Medicine. 2015 May 13. Doi:10.1111/hiv.12262.
Summary: Among men with CAC scores
of zero, HIV infection is associated with an
increased prevalence of noncalcified coronary
plaque independent of traditional risk factors.
This finding suggests that CAC scanning may
underestimate plaque burden in HIV-infected
men.
199. Manichalkui A, Wang XQ, Musani SK,
Herrington DM, Post WS, Wilson JG, Rich SS,
Rodriguez A. Association of the Lipoprotein
Receptor SCARB1 Common Missense Variant
rs4238001 with Incident Coronary Heart Disease.
PLOS ONE. 2015 May 20;10(5):e0125497.
Summary: SCARB1 missense rs4238001 is
statistically significantly associated with incident
CHD across a large population of multiple race/
ethnic groups.
200. Ketlogetswe KS, McKibben R, Jacobson
LP, Li X, Dobs AS, Budoff M, Witt MD, Palella
FJ Jr, Kingsley L, Margoick JB, Post WS, Brown
TT. Osteoprotegerin (OPG), but not Receptor
Activator for Nuclear Factor Kappa B Ligand
(RANKL), is associated with Subclinical Coronary
Atherosclerosis in HIV-infected Men. Journal of
Acquired Immune Deficiency Syndromes (1999).
2015 Jun 18.
Summary: OPG and RANKL are dysregulated
in HIV-infected men and their relationship to the
presence and extent of subclinical atherosclerosis
varies by HIV-status. The role of these biomarkers
in CVD pathogenesis and risk prediction may be
different in HIV-infected men.
201. Kiani AN, Magder LS, Post WS, Szklo
M, Bathon JM, Schreiner PJ, O’Leary D, Petri
M. Coronary calcification in SLE: comparison
with the Multi-Ethnic Study of Atherosclerosis.
Rheumatology (Oxford, England). 2015 Jun 22.
Pii:kev198.
Summary: Women with SLE have a higher
prevalence of CAC than comparable women
without SLE, even after adjusting for traditional
cardiovascular risk factors, especially among those
aged 45-54 years.
202. Jones MR, Diez-Roux
AV, O’Neill MS, Guallar
E, Sharrett AR, Post W,
Kaufman JD, Navas-Acien
A. Ambient air pollution
and racial ethnic differences
in carotid intima-media
thickness in the Multi-Ethnic
Study of Atherosclerosis
(MESA). Journal of
Epidemiology and Community Health. 2015 Jul
3.Pii:jech-2015-205588.
Summary: The smaller carotid IMT levels in
Chinese participants were even smaller after
accounting for higher PM2.5 concentrations in
Chinese participants compared with CaucasianAmerican participants. Air pollution was not
related to IMT differences in African-American and
Hispanic participants compared with CaucasianAmerican participants.
203. Ratchford EV,
Evans NS. Raynaud’s
phenomenon. Vascular
Medicine (London,
England). 2015
Jun;20(3):269-71.
204. Ratchford EV, Evans
NS. Carotid artery disease.
Vascular Medicine (London,
England). 2014 Dec;19(6):512-5.
205. Evans NS,
Ratchford EV.
Vascular disease
patient information
page: Inferior vena
cava (IVC) filters.
Vascular Medicine.
2015;20(4):382-3.
206. Catapano AL,
Farnier M, Foody JM,
Toth PP, Tomassini JE,
Brudi P, Tershakovec
AM. Combination therapy in dyslipidemia:
where are we now? Atherosclerosis. 2014
Nov;237(1):319-35.
Summary: This review of the evidence for statin
use in combination with fibrates, explores the
impact of such combination therapies on lipids,
attainment of lipid targets, and on cardiovascular
outcomes and pathology.
Dr. Elizabeth Ratchford
207. Toth PP, Grabner M, Ramey N, Higuchi K.
Clinical and economic outcomes in a real-world
population of patients with elevated triglyceride
levels. Atherosclerosis. 2014 Dec;237(2):790-7.
Summary: These results suggest that severe
hypertriglyceridemia is undertreated and healthcare
utilization and costs scale with magnitude of TG
elevation.
208. Toth PP, Thanassoulis G, Williams K,
Furberg CD, Sniderman A. The Risk-Benefit
Paradigm vs the Causal Exposure Paradigm: LDL
as a primary cause of vascular disease. Journal of
Clinical Lipidology. 2014 Nov-Dec;8(6):594-605.
Summary: This article explains the strengths and
weaknesses of both paradigms to provide a more
secure framework to compare the strengths and
weaknesses in the different cholesterol guidelines
with particular emphasis on the evidence that the
risk and the benefit from statin therapy is related to
the level of LDL.
Seamus Whelton, MD,
MPH
As one of two new Pollin
Cardiovascular Prevention
fellows named this year (see
page 1 for more information),
Seamus Whelton, MD,
MPH, continued his work
promoting the importance of
lifestyle improvements to reduce
the burden of cardiovascular
disease and strategies to improve
cardiovascular risk prediction
through selective use of vascular
imaging and measurement of
exercise capacity. Seamus also led
a clinical research paper looking
at the predictive role of resting
heart and inflammatory markers
with Dr. Erin Michos. And he
and Dr. Michael Blaha led an
important study of predictors
of long-term healthy arterial
aging in the Multi-Ethnic Study of
Atherosclerosis cohort, which is
due out in December 2015.
27
publications
research
Erin Michos, MD, MHS
An Associate Professor of Cardiology at the Johns
Hopkins School of Medicine, with a joint appointment
within the Department of Epidemiology at the
Johns Hopkins Bloomberg School of Public Health,
Erin Michos, MD, MHS, was recently named an
Associate Faculty of the Welch Center for Prevention,
Epidemiology, and Clinical Research. This past year,
she led the research for several important publications regarding vitamin D
deficiency and risk of heart attack, stroke, heart failure, cognitive decline,
and diabetes. She also published key articles on the prognostic value of
cardiac troponin in persons with kidney disease, and the predictive value
of resting heart rate and lipoprotein measurements. In September 2015,
she joined the Cardiology Executive Leadership team as the inaugural
representative of the Women’s Task Force for the Division of Cardiology.
In this role, Erin provides advice and perspective on all Cardiology
Divisional issues and the implications for women on the faculty and in the
training program.
209. Toth PP. Overview of saxagliptin efficacy
and safety in patients with type 2 diabetes
and cardiovascular disease or risk factors for
cardiovascular disease. Vascular Health and Risk
Management. 2014 Dec 23;11:9-23.
Summary: Saxagliptin was well tolerated
and consistently improved glycemic control,
regardless of the presence or absence of baseline
cardiovascular disease, hypertension, statin use,
number of risk factors, or high risk score.
210. Larkin AT, Healty CS, Toth PP. Knowledge
of PCSK9 and continued educational gaps:
evaluating the impact of continuing medical
education. Critical Pathways in Cardiology. 2015
Mar;14(1):48-51.
Summary: This study evaluated the impact
of continuing medical education on increasing
knowledge and awareness of the role of PCSK9
in lipid metabolism and analyzed persistent
educational gaps to determine needs for future
education.
211. Sniderman A, Furberg CD, Toth PP,
Thanassoulis G. Is the Guideline Process
Replicable and, if not, What Does this Mean?
Progress in Cardiovascular Diseases. 2015 JulAug;58(1):3-9.
Summary: Considerable discordance among the
recommendations in the multiple recent cholesterol
guidelines is evident, pointing to an important role
for the participants, in addition to the evidence, in
the development of guideline recommendations.
28
212. Toth PP, Murthy AM, Sidhu MS, Boden
WE. Is HPS2-THRIVE the death knell for niacin?
Journal of Clinical Lipidology. 2015 MayJun;9(3):343-50.
Summary: This article addresses whether the
results from randomized clinical trials performed
in stable ischemic heart disease populations be
applied to patients who sustain an acute coronary
syndrome or myocardial infarction.
213. Punekar RS, Fox KM, Richariya A, Fisher
MD, Cziraky M, Gandra SR, Toth PP. Burden of
First and Recurrent Cardiovascular Events Among
Patients with Hyperlipidemia. Clinical Cardiology.
2015 Jun 23.doi:10.1002/clc.22428.
Summary: Statins and lipid-modifying
medications were significantly underutilized in all
cohorts, despite the presence of CVD.
214. Toth PP. Ezetimibe
provides incremental
reduction in risk for
cardiovascular events and
need for revascularisation
following an acute coronary
syndrome. Evidence-based
Medicine. 2015 Aug 10. pii:
ebmed-2015-110253.
215. Watts GF, Gidding S, Wierzbicki AS,
Toth PP, et al. Integrated guidance on the care
of familial hypercholesterolaemia from the
International FH Foundation. European Journal of
Preventive Cardiology. 2015 Jul;22(7):849-54.
Summary: Although at least 20 million people
have the disorder, it remains undetected and current
treatment is often suboptimal.
216. Sonmez A, Nikolic D, Dogru T, Ercin CN,
Genc H, Cesur M, Tapan S, Karslioğlu Y, Montalto
G, Banach M, Toth PP, Bagci S, Rizzo M. Lowand high-density lipoprotein subclasses in subjects
with nonalcoholic fatty liver disease. Journal of
Clinical Lipidology. 2015 Jul-Aug;9(4):576-82.
Summary: Increased levels of small, dense LDL3
and LDL4 in patients with nonalcoholic fatty liver
disease may help to explain their increased risk for
atherosclerosis and cardiovascular diseases.
217. Franzese CJ, Bliden KP, Gesheff MG, Pandya
S, Guyer KE, Singla A, Tantry US, Toth PP,
Gurbel PA. Relation of fish oil supplementation to
markers of atherothrombotic risk in patients with
cardiovascular disease not receiving lipid-lowering
therapy. The American Journal of Cardiology. 2015
May 1;115(9):1204-11.
Summary: This study sought to determine if the
use of fish oil supplementation is associated with
lower indices of atherothrombotic risk in patients
with suspected CAD.
218. Sonmez A, Yilmaz MI, Saglam M, Unal HU,
Gok M, Cetinkaya H, Karaman M, Haymana
C, Eyileten T, Oguz Y, Vural A, Rizzo M,
Toth PP. The role of plasma triglyceride/highdensity lipoprotein cholesterol ratio to predict
cardiovascular outcomes in chronic kidney disease.
Lipids in Health and Disease. 2015 Apr 16;14:29.
Summary: The elevated triglyceride/high-density
lipoprotein cholesterol ratio predicts poor CVD
outcome in subjects with chronic kidney disease.
219. Toth PP. Lipoproteins and atherosclerosis. In:
Schott M et al, eds. Year Book of Endocrinology.
Philadelphia, PA: Elsevier Health Sciences;
2014;25-72.
220. Toth PP. Lipoproteins and atherosclerosis.
In: Barker JA et al, eds. Year Book of Medicine.
Philadelphia, PA: Elsevier Health Sciences;
2014;451-463.
221. Toth PP, Nikolic D, Rizzo M, Rysz J,
Banach M. Use of combination statin and bile
acid sequestrant therapy to treat dyslipidemia.
In: Banach M, ed. Combination Therapy in
Dyslipidemia. Verlag, Germany: Springer; 2015;110.
222. Chrisciel P, Mikhailidis D, Toth PP,
Banach M. The role of fenofibrate in present day
pharmacotherapy. In: Banach M, ed. Combination
Therapy in Dyslipidemia. Verlag, Germany:
Springer; 2015;11-23.
223. Nikolic D, Katsiki N, Toth PP, Banach M, AlWaili K, Al-Rasadi K, Rizzo M, Mikhailidis D. The
combination of simvastatin and fenofibrate: When
and for whom? In: Banach M, ed. Combination
Therapy in Dyslipidemia. Verlag, Germany:
Springer; 2015;179-190.
224. Rebholz CM, Coresh
J, Ballew SH, McMahon B,
Whelton SP, Selvin E, Grams
ME. Kidney Failure and
ESRD in the Atherosclerosis
Risk in Communities
(ARIC) Study: Comparing
Ascertainment of Treated
and Untreated Kidney Failure in a Cohort Study.
American Journal of Kidney Diseases: the Official
Journal of the National Kidney Foundation. 2015
Mar 12.pii:S0272-6386(15)00427-8.
Summary: A kidney failure definition including
treated and untreated disease identifies more
cases than linkage to the USRDS registry alone,
particularly among older adults. Future studies
might consider reporting both USRDS-identified
ESRD and a more inclusive kidney failure
definition.
225. Youssef G, Guo M, McClelland RL, Shavelle
DM, Nasir K, Rivera J, Carr JJ, Wong ND,
Budoff MJ. Risk factors for the development and
progression of thoracic aorta calcification: MESA.
Academic Radiology. 2015; Sept 21.
226. Darabian S, Luo Y, Homat A, Khosraviani K,
Wong N, Zeb I, Nasir K, Budoff MJ. CAC score
as a possible criterion for administration of ACE
inhibitors and/or ARBs: MESA. Coronary Artery
Disease. 2015 Sept 22.
Gary Gerstenblith, MD
227. Nasir K. Overhauling cardiovascular risk
prediction in primary prevention; difficult journey
worth the destination. Circulation Cardiovascular
Quality & Outcomes. 2015 Sept 8.
228. Katz R, Budoff MJ, O’Brien KD, Wong ND,
Nasir K. The metabolic syndrome and diabetes
mellitus as predictors of thoracic aortic calcification
as detected by non-contrast CT in MESA. Diabetes
Medicine. 2015 Sept 4.
229. Aneni EC, Oni ET, Osundo CU, Martin SS,
Blaha MJ, Veledqar E, Agatston AS, Feldman T,
Carvalho JA, Conceicao RD, Santos RD, Nasir
K. Obesity modifies the effect of fitness on heart
rate indices during stress testing in asymptomatic
individuals. Cardiology. 2015; Sept 2;132(4):242-8
230. Nasir K, Bittencourt MS, Blaha MJ,
Blankstein R, Agatston AS, Rivera JJ,
Miemdema MD, Sibley ST,
Shaw LJ, Blumenthal RS,
Budoff MJ, Krumholz HM.
Implications of coronary artery
calcium testing among statin
candidates according to
American College of
Cardiology/American Heart
Dr. Juan Rivera
Association Cholesterol
Management Guidelines.
Journal of the American College of Cardiology.
2015 Oct 6.
Summary: The absence of coronary artery calcium
is present in nearly one-half of candidates eligible
for statin therapy and is associated with a very low
risk of a subsequent CVD event over the next
decade.
This past year, Hopkins investigators, led by Gary
Gerstenblith, MD, developed a novel method to
visualize blood flow in heart arteries using magnetic
resonance imaging (MRI). This safe, non-invasive
technique allows physicians to perform research
studies with none of the radiation or risks associated
with an invasive procedure. Studies to date demonstrated a range of
abnormal function in individuals with varying degrees of atherosclerosis.
The methodology also allows serial research studies to evaluate whether
interventions can improve function. Gary also participated in a recent
double-blind, cross-over study of whether a class of medication known as
xanthine oxidase inhibitor improved endothelial function. The endothelium
is the innermost lining of the coronary arteries, forming the interface
between the blood and the remaining arterial wall. Abnormal endothelial
function is a “final common pathway” for several classical and novel
coronary risk factors, including dyslipidemia, insulin resistance, cigarette
use, and inflammation.
231. Abd TT, George RT. Association of
coronary plaque burden with fractional flow
reserve: Should we keep attempting to derive
physiology from anatomy? Cardiovascular
Diagnosis and Therapy. 2015;5(1):67-70.
232. Lardo AC, Rahsepar AA, Seo JH, Eslami
P, Korley F, Kishi S, Abd TT, Mittal R, George,
RT. Estimating coronary blood flow using
CT transluminal attenuation flow encoding:
Formulation, preclinical validation, and clinical
feasibility. Journal of Cardiovascular Computed
Tomography. Forthcoming 2015.
233. Mechanick J, Neeland I, Herrick C, Despres
JP, Ndumele CE, et al. The CardioMetabolic
Health Alliance: Working toward a new care
model for the metabolic syndrome. Journal of
the American College of Cardiology. 2015 Sep
1;66(9):1050-67.
234. Same RV, Miner MM, Blaha MJ, Feldman
DI, Billups KL. Erectile dysfunction: An early
sign of cardiovascular disease. In: Nasir K,
Ed. Novel + Emerging Risk Factors: Current
Cardiovascular Risk Reports. December 2015,
9:49.
235. McKibben RA, Zhao D, Lutsey PL,
Schneider ALC, Guallar E, Mosley TH,
Michos ED. Factors associated with change in
25-hydroxyvitamin D levels over longitudinal
followup in the ARIC study. Journal of Clinical
Endocrinology and Metabolism. Forthcoming
2015.
Summary: We found that serum
25-hydroxyvitamin D [25(OH)D] levels
remained relatively stable within individuals over
time. Increasing 25(OH)D levels over time were
associated with use of vitamin D supplements,
greater physical activity, and higher HDL-C.
Decreases in 25(OH)D levels over time were
associated with current smoking, higher body
mass index, higher education, diabetes, and
hypertension.
236. Yao L, Folsom AR, Pankow JS, Selvin
E, Michos ED, Alonso A, Tang W, Lutsey
PL. Parathyroid hormone and the risk of
incident hypertension: The Atherosclerosis
Risk in Communities (ARIC) Study. Journal of
Hypertension. Forthcoming 2015.
Summary: In this large,
population-based cohort,
elevated levels of serum
PTH were associated with
a seemingly higher risk
of hypertension among
black but not white adults,
independent of traditional
cardiovascular risk factors.
29
presentations
research
A listing of the late-breaking
clinical research data presented
at major cardiology meetings
by the faculty and fellows of the
Johns Hopkins Ciccarone Center
for the Prevention of Heart
Disease.
Presentations at the 2015
Scientific Sessions of the
American Heart Association (AHA)
November 7-11; Orlando, FL.
1. Aladin AI, Al Rifai M, Rasool SH, Keteyian
SJ, Brawner CA, Blumenthal RS, Al Mallah M,
Blaha MJ, McEvoy JW. Prospective
association of incident atrial fibrillation with
resting heart rate: The Henry Ford Hospital
Exercise Testing (FIT) Project.
2. Florido R, Kwak L, Lazo M, Nambi V,
Ahmed H, Hegde SM, Gerstenblith G,
Ballantyne CM, Selvin E, Folsom A, Coresh J,
Ndumele CE. Changes in physical activity and
the risk of incident heart failure: The
Atherosclerosis Risk in Communities (ARIC)
Study.
3. Ogunmoroti O, Allen NB, Michos ED,
Rundek T, Rana J, Blankstein R, Blumenthal
RS, Cushman M, Blaha MJ, Veledar E, Nasir
K. The association of life’s simple 7 health
metrics and incident non-cardiovascular disease:
The Multi-Ethnic Study of Atherosclerosis.
4. Patel J, Cainzos-Achirica M, Kandula N,
Kanaya A, Blumenthal RS, Nasir K, Blaha
MJ, Joshi PH. Family history of coronary heart
disease and coronary artery calcium in South
Asians and 4 other racial/ethnic groups in the
US: The Mediators of Atherosclerosis in South
Asians Living in America Study and the MultiEthnic Study of Atherosclerosis.
5. Farag Y, Guallar E, Zhao D, Kalyani RR,
Martin SS, Lutsey PL, Billups K, Michos ED.
Vitamin D deficiency is associated with
increased risk of erectile dysfunction: Results
from the National Health and Nutrition
Examination Survey (NHANES) 2001-2004.
6. Michos ED, Selvin E, Misialek JR, McEvoy
JW, Ndumele C, Folsom A, Gross M,
Ballantyne CM, Lutsey PL. Vitamin D
deficiency is associated with risk of subclinical
myocardial damage in younger but not older
adults: the Atherosclerosis Risk in Communities
(ARIC) Study.
7. Michos ED, Zhao D, Guallar E, Lutsey LP,
Alonso A, Sharrett AR, Post WS, Reis JP,
Mosley T, Gottesman RF. Parathyroid hormone
and subclinical cerebrovascular disease:
Findings from the Atherosclerosis Risk in
Communities (ARIC) Brain MRI Study.
30
8. Adesiyun T, Zhao
D, Korada S, Blaha
MJ, Brawner C,
Keteyian SJ, AlMallah MH, Michos
ED. Exercise
parameters and risk of
coronary heart disease
and mortality among
obstructive lung
disease patients: The
Henry Ford Exercise
Testing Project [FIT].
16. Besseling J, Huijgen R, Martin SS, Hutten
BA, Kastelein JJP, Hovingh GK.Association
between distance-to-index and phenotype in
familial hypercholesterolemia in a genetic
cascade screening program.
Dr. Tolulope Adesiyun
9. Quispe R, Hendrani A, Elshazly MB, Michos
ED, McEvoy JW, Blaha MJ, Toth PP, Coresh
J, Blumenthal RS, Jones SR, Martin SS.
Inaccuracy of Friedewald-Estimation at
clinically relevant very low levels of LDLCholesterol: The Very Large Database of Lipids
Study 1C.
10. Qureshi W, Flueckiger P, Blaha MJ, Michos
ED, Sandfort V, Herrington DM, Burke G,
Yeboah J. The impact of replacing the pooled
cohort equation with other CVD risk scores on
atherosclerosis cardiovascular disease risk
assessment: MESA.
11. Flueckiger P, Qureshi W, Blaha MJ, Burke
G, Sandfort V, Michos ED, Herrington D,
Yeboah J. Class I indication for statin therapy in
primary prevention by three cholesterol
guidelines and prevalence of coronary artery
calcium in asymptomatic adults: Multi-ethnic
Study Of Atherosclerosis (MESA).
12. Flueckiger P, Qureshi W, Blaha MJ, Burke
G, Sandfort V, Michos ED, Herrington D,
Yeboah J. Class I indication for statin therapy in
primary prevention by three cholesterol
guidelines and risk of incident cardiovascular
outcomes: The Multi-ethnic Study Of
Atherosclerosis (MESA).
13. Tehrani DM, Zhao Y, Blaha MJ, Mora S,
Mackey R, Michos ED, Budoff M, Cromwell
W, Otvos J, Rosenblit PD, Wong ND. LDL and
HDL particle vs. cholesterol concentration in
metabolic syndrome and diabetes for the
prediction of coronary heart disease: The Multiethnic Study of Atherosclerosis (MESA).
14. Wanamaker BL, Swiger KJ, Blumenthal
RS, Saczynski JS, McManus DD, Waring ME,
Kiefe CI, Martin SS. Changes in cognition and
lipid-lowering therapy after ACS: Results from
TRACE-CORE.
15. Martin SS, Daya N, Lutsey PL, Matsushita
K, Fretz A, McEvoy JW, Blumenthal RS,
Coresh J, Steffes MW, Greenland P, Kottgen A,
Selvin E. Thyroid dysfunction, cardiovascular
risk factors, and incident cardiovascular events:
The Atherosclerosis Risk in Communities
(ARIC) Study.
17. Elshazly MB, Nicholls SJ, Nissen SE, St.
John J, Martin SS, Jones SR, Stegman B,
Kapadia SR, Tuzcu EM, Puri R. The total-tohigh density lipoprotein-cholesterol ratio
associates with coronary atheroma progression
rates and reclassifies disease progression across
populations with varying metabolic risk.
18. McEvoy JW, Ndumele CE, Chen Y,
Solomon SD, Steffes M, Nambi V, Ballantyne
CM, Blumenthal RS, Coresh J, Selvin E.
Prognostic value of 6-year change in high
sensitivity cardiac troponin-T for risk of heart
failure, heart failure subtype, and death.
19. Florido R, Kwak L, Lazo M, Nambi V,
Ahmed H, Hegde SM, Gerstenblith G,
Blumenthal RS, Ballantyne CM, Selvin E,
Folsom A, Coresh J, Ndumele CE. Changes in
physical activity and the risk of incident heart
failure: The Atherosclerosis Risk in
Communities (ARIC) Study.
20. Gilotra N, Wanamaker BL, Rahim H,
Kunkel K, Rizvi S, Yenokyan G, Wittstein IS,
Tedford RJ, Russell SD, Silber HA. Pulse
amplitude changes during the Valsalva
maneuver measured using finger
photoplethysmography identify elevated
pulmonary capillary wedge pressure in heart
failure patients.
21. Toth PP, Cannon C, Kastelein JJ, Colhoun
HM, Koren A, Louie MJ, Asset G, Rader D.
Alirocumab LDL-C-lowering efficacy in
patients with moderate chronic kidney disease.
22. Toth PP, Palmer MK, Henriksson K. No
changes in average lipid profiles in the United
States from 2003 to 2012: The National Health
and Nutrition Examination Survey 2003-2012.
23. Nasir K, Arrieta A, Veledar E. Economic
evaluations of PCSK9 inhibitors in reducing
cardiovascular risk from societal and United
States payer perspective.
24. Nasir K, Bittencourt M, Blankstein R,
Blaha M, Veledar E. Potential role of
enrichment strategies with CAC testing for
future clinical trials assessing PCSK-9 inhibitors
efficacy among diabetics without established
cardiovascular disease.
25. Ahmed A, Qureshi W, Brawner C, Keteyian
S, Ehrman J, Blumenthal R, Nasir K, Blaha
M, Al-Mallah M. Prognostic value of
cardiorespiratory fitness in patients with chronic
renal dysfunction: The FIT (Henry Ford
Exercise Testing) Project.
26. Toth PP, Palmer MK, Henriksson K.
No major change in low-density lipoprotein
cholesterol goal attainment in the United States
From 2003 to 2012: A time-sensitivity analysis
using national health and nutrition examination
survey data.
27. Toth PP, Bays H, Farnier M, Jensen E,
Tomasinni JA, Polis A, Foody J, Tershakovec A.
Variability of LDL-C lowering responses to
statin therapy in achievement of ACC/AHA
target levels.
28. Ndumele CE, Cobb L, Lazo M, Bello N,
Shah A, Nambi V, Blumenthal RS,
Gerstenblith G, Solomon SD, Ballantyne CM,
Selvin E, Coresh J. Weight history influences
the likelihood of subclinical myocardial injury.
29. Silvestre OM, Gonçalves A, Roca GQ,
Claggett B, Ndumele CE, Lazo M, Solomon
SD. Liver injury in alcohol drinkers and
incidence of heart failure: the Atherosclerosis
Risk in Communities Study.
Presentations at the Obesity
Society’s 2015 Annual Scientific
Meeting, November 2-6;
Los Angeles
Lena Mathews, MD
Lena Mathews, MD, is a cardiovascular
fellow at Johns Hopkins. She did her medical
school training at the University of Pennsylvania
and internal medicine residency at the Brigham
and Women’s Hospital. Lena’s major interests
include cost-effective prevention strategies for
cardiovascular diseases in low income countries
that disproportionately carry the burden of
cardiovascular disease morbidity and mortality.
She has worked with the Ciccarone Center on a review of the worldwide
prevalence of familial hypercholesterolemia and cardiovascular disease in
women. She hopes to work on studying endothelial dysfunction and its role
in atherosclerosis in low income countries.
Presentations at the 2015
Congress of the European Society
of Cardiology (ESC),
August 29-September 2; London
1. Bradshaw PT, Reynolds K, Wagenknecht LE,
Ndumele CE, Stevens J. Cardiometabolic risk
factor incidence among the metabolically
healthy obese: the Atherosclerosis Risk in
Communities (ARIC) study.
1. Gotani K, Sahebkar A, Serban C, Andrica F,
Toth PP, Jones SR, Kostner K, Blaha MJ,
Martin S, Banach M. Ribolone can decrease
lipoprotein (A) concentrations in
postmenopausal women: A systematic review
and meta-analysis of controlled trials.
Presentations at the 2015
American Society of Human
Genetics National Meeting,
October 6-10; Baltimore, MD
2. Banach M, Serban C, Sahebkar A, Rysz J,
Muntner P, Toth PP, Jones SR, Glasser SP, Lip
GYH, Mikhailidis DP. Futility of
supplementation with coenzyme Q10 for statininduced myopathy: An updated meta-analysis of
randomized controlled trials.
1. Maxwell TJ, Ma Y, Cao Y, Ballantyne CM,
Cheverud JM, Guild CS, Ndumele CE,
Boerwinkle E, Wei P. PIK3CG rQTL for blood
pressure (SBP & DBP) modifies CHD/LDL and
CHD/DBP relationships among other rQTL and
GxG found in a blood pressure rQTL screen.
2. Ma Y, Cao Y, Wei P, Ballantyne CM,
Cheverud JM, Guild CS, Ndumele CE,
Boerwinkle E, Maxwell TJ. CETP genotype is
associated with phenotypic variability of HDL
among other loci identified in a lipid vQTL
study.
3. Blazing MA, McGuire DK, Cannon CP,
Giugliano RP, Toth PP, White JA, Lokhnygina
YV, Tershakovec AM, Mussliner TA, Braunwald
E. Incidence of new onset diabetes in the
IMPROVE-IT trial: does adding ezetimibe to
simvastatin increase risk compared to
simvastatin alone?
Presentations at the 2015
International Society on
Thrombosis and Haemostasis
(ISTH) Congress Meeting,
June 20-25; Toronto
1. Blondon M, Cushman M, Jenny N, Michos
ED, Smith N, Kestenbaum B, de Boer IH.
Cross-sectional associations of
25-hydroxyvitamin D with hemostatic and
inflammatory biomarkers in the Multi-Ethnic
Study of Atherosclerosis.
Presentations at the
Arteriosclerosis, Thrombosis,
and Vascular Biology/Peripheral
Vascular Disease (ATVB) 2015
Scientific Sessions, May 7-9;
San Francisco
1. Quispe R, Al-Hijji M, Swiger KJ, Martin
SS, Elshazly M, Blaha MJ, Joshi PH,
Blumenthal RS, Sniderman A, Toth PP, Jones
SR. Prevalence of Fredrickson-Levy
dyslipidemia phenotypes at extreme HDL-C
levels: The Very Large Database of Lipids
(VLDL 9B).
2. Lotufo P, Toth PP, Blaha MJ, and Jones SR.
Impact of psoriasis on serum lipids.
Presentations at the 2015
Congress of the European
Atherosclerosis Society (EAS),
March 20-25; Glasgow
1. Toth PP, Case D, Joshi PH, Jones SR,
Martin SS, Bloedon LT, Jensen P. Impact of
lomitapide and lomitapide/ezetimibe
combination therapy on
low-density lipoprotein
subfractions and risk
marker ratios.
2. Toth PP, Catapano A,
Farnier M, Foody J,
Tomassini JE, Jensen E,
Polis AB, Musliner T,
Dr. Steven Jones
Tershakovec AM. Ezetimibe
does not increase fasting
glucose levels more than statins alone in nondiabetic, hypercholesterolemic patients.
31
presentations
research
Presentations at the 2015
Scientific Sessions of the American
College of Cardiology (ACC),
March 14-16; San Diego
1. Bliden K, Guyer K, Gesheff M, Franzese C,
Pandya S, Toth PP, Tantry U, and Gurbel P.
OxLDL/β2GPI complex but not free OxLDL is
associated with CAD severity in patients
undergoing elective cardiac catheterization.
2. Toth PP, Grabner M, Punekar RS, Quimbo
RA, Cziraky MJ, Pourfarzib R, Cromwell WC,
Winegar DA, Jacobson TA. Comparison of
cardiovascular events between patients
achieving low-density lipoprotein particle
targets and patients achieving low-density
lipoprotein cholesterol targets in a mixed
primary/secondary risk sample.
3. Toth PP, Sattar N, Genest J, Descamps O,
Dent R, Djedjos C, Legg J, Wasserman S, Stein
E. A comprehensive safety analysis of 6026
patients from phase 2 and 3 short and long term
clinical trials with evolocumab.
4. Toth PP, Bays HE, Brown WV, Tomassini
JE, Jensen E, Polis AB, Musliner TM,
Tershakovec AM. Differences in methods of
remnant-like protein cholesterol quantitation.
5. Toth PP, Catapano A, Farnier M, Foody J,
Tomassini JE, Jensen E, Polis AB, Musliner T,
Tershakovec, AM. Ezetimibe does not increase
fasting glucose levels more than statins alone in
non-diabetic, hypercholesterolemic patients.
6. Gurbel PA, Bliden K, Franzese C, Gesheff M,
Guyer K, Singla A, Toth PP, Tantry U.
Simultaneous assessment of lipids,
thrombogenicity, and inflammation in patients
on fish oil supplementation.
7. Nwabuo CC, Choi E.Y,
Ambale-Venkatesh B,
Kishi S, Almeida AL,
Moreira HT, Sharma R,
Armstrong A.C, Teixido
G, Gjesdal O, Lewis C,
Sidney S, Gidding S,
Lima JA. Gender and race
Dr. Chike Nwabuo differences in agingrelated alteration in
myocardial systolic function sssessed by 2D
speckle tracking echocardiography over a 20
year follow-up: The CARDIA Study.
8. Pokharel Y, Sun W, Nambi V, Virani S,
Solomon S, Chan W, Hoogeveen R, Chang P,
Ndumele C, Selvin E, Bozkurt B, Ballantyne C,
Deswal A. Pre-morbid body mass index, high
sensitivity troponin-T and mortality after
incident heart failure hospitalization: The
Atherosclerosis Risk in Communities Study
(ARIC).
32
Presentations at the 2015
American Heart Association
(AHA): Epidemiology and
Prevention (EPI)/Lifestyle and
Cardiometabolic Health Scientific
Sessions, March 3-6;
Baltimore, MD
1. Patel J, Al Rifai M, Hung RK, Nasir K,
Keteyian SJ, Brawner CA, Al-Mallah MH,
Blaha MJ. All-cause mortality and
cardiorespiratory fitness among patients with a
family history of CHD: The FIT Project.
2. Yao L, Folsom A, Tang W, Michos ED,
Pankow J, Selvin E, Alvaro A, Lutsey PL.
Parathyroid hormone and the risk of incident
hypertension: The Atherosclerosis Risk in
Communities Study (ARIC).
3. Misialek JR, Alonso A, Michos ED, Chen
LY, Soliman EZ, Selvin E, Gross M, Eckfeldt
JH, Lutsey PL. Serum 25-hydroxyvitamin D
levels and incidence of atrial fibrillation: The
Atherosclerosis Risk in Communities Study.
4. Martin SS, Feldman DI, Blumenthal RS,
Jones SR, Post WS, Ndumele CE, Ratchford
EV, Coresh J, Blaha MJ. mActive: A blinded,
randomized mHealth trial supporting digital
tracking and smart texting for promotion of
physical activity.
5. McEvoy JW, Chen Y, Nambi V, Ballantyne
CM, Sharrett AR, Appel LJ, Post WS,
Blumenthal RS, Matsushita K, Selvin E.
Baseline high-sensitivity cardiac troponin-T is
independently associated with incident
hypertension.
6. Florido R, Ndumele CE, Pang Y, Matsushita
K, Schrack JA, Lazo M, Nambi V, Blumenthal
RS, Folsom AR, Coresh J, Ballantyne CM,
Selvin E. Poor physical activity is associated
with subclinical myocardial injury in obese
adults.
7. Hung RK, Al-Mallah M, Whelton SP,
Blumenthal RS, Brawner CA, Keteyian SJ,
Blaha MJ. Effect of beta-blocker therapy,
maximal heart rate and exercise capacity during
stress testing on long-term survival.
8. Cainzos-Achirica M, Rampal S, Chang Y,
Ryu S, Zhang Y, Zhao D, Cho J, Choi Y, PastorBarriuso R, Lim SY, Lima J, Shin H, Guallar E.
Pulse wave velocity is associated with coronary
calcification and improves its prediction in
young and middle-aged asymptomatic adults:
The Kangbuk Samsung health study.
9. Ryu S, Chang Y, Cho J, Zhang Y, Rampal S,
Zhao D, Choi Y, Ahn J, Cainzos-Achirica M,
Pastor-Barriuso R, Lima J, Shin H, Guallar E.
Metabollically healthy obesity and the risk of
incident ischemic heart disease and stroke: The
Kangbuk Samsung Health Study.
10. Choi Y, Ryu S, Chang Y, Lee JE, Sung E,
Cho J, Rampal S, Zhao D, Zhang Y, Ahn J,
Cainzos-Achirica M, Pastor-Barriuso R, Lima
J, Shin H, Guallar E. Animal and vegetable
protein intake and coronary artery calcium: The
Kangbuk Samsung Health Study.
11. Chang Y, Ryu S, Cho J, Rampal S, Zhang Y,
Zhao D, Choi Y, Ahn J, Cainzos-Achirica M,
Pastor-Barriuso R, Lima J, Shin H, Guallar E.
Nonalcoholic fatty liver disease, insulin
resistance, and the risk of incident ischemic
heart disease and stroke: The Kangbuk Samsung
Health Study.
12. Guallar E, Zhao D, Pastor-Barriuso R,
Rampal S, Chang Y, Ryu S, Choi Y, Lima J,
Cainzos-Achirica M, Shin H, Cho J, Zhang Y.
Associations of early and contemporary
cardiovascular risk factors with coronary artery
calcification.
13. Lim SY, Lima J, Zhao D, Rampal S, Zhang
Y, Cho J, Pastor-Barriuso R, Cainzos-Achirica
M, Bello S, Choi Y, Chang Y, Ryu S, Shin H,
Guallar E. Lung function and arterial stiffness in
apparently healthy men and women: The
Kangbuk Samsung Health Study.
14. Collison AO, Nambi V, Lazo M, Hoogeveen
RC, Blumenthal RS, Folsom AR, Selvin E,
Ballantyne CM, Coresh J, Ndumele CE.
Combined measures of total and abdominal
adiposity and the likelihood of subclinical
myocardial damage.
15. Ndumele CE, Cobb L, Lazo M, Bello N,
Shah A, Nambi V, Blumenthal RS,
Gerstenblith G, Solomon SD, Ballantyne CM,
Selvin E, Coresh J. Prior weight history
provides prognostic information beyond current
weight regarding HF risk.
Presentations at the 2015 Meeting
of the American Physical Society,
March 2-6; San Antonio
1. Sampath K, Abd TT, George RT and Katz J.
Particle tracking velocimetry using
echocardiographic data resolves flow in the left
ventricle.
2. Mittal R, Seo JH, Abd TT, George RT. A
computation chemo-fluidic modeling for the
investigation of patient-specific left ventricle
thrombogensis.
ciccarone center
the
Uniting the Proud Traditions of Hopkins
The Ciccarone Center for the
prevention of coronary heart disease
Prevention of Heart Disease was
events. The Ciccarone Center sought to unite
founded in 1989 in memory of
the proud traditions of Hopkins
Henry A. “Chic” Ciccarone,
lacrosse and Hopkins Medicine.
a legendary athlete and lacrosse
coach at Johns Hopkins who died
We all have a stake in
at age 50 after his third heart
winning the battle against
attack.
heart disease. By joining the
Henry Ciccarone, 1983
team at the Ciccarone Center, by
But he was more than that. In the way he led
sharing our enthusiasm and dedication to it,
his teams and his life, Chic embodied all that
your support of coronary disease prevention
Johns Hopkins itself represents: dedication,
will protect your life and the lives of
excellence, leadership.
those you love.
With intense, energetic competitiveness, pride,
and engaging, infectious humor, Chic compiled
an extraordinary record of
achievements in athletics. As a three-time
All-American midfielder and team captain, he
won nearly every major Hopkins lacrosse
award and was named to the All-Time
Hopkins lacrosse team upon his
graduation in 1962.
In 1989, the friends and former players of
Coach Ciccarone began raising funds for the
development of a comprehensive
program geared toward the
Coach Henry Ciccarone (center), with his sons, Henry, Jr. (left) and Brent.
33
How to Contact the Ciccarone Center
We see patients Monday through Friday
at the Johns Hopkins Ciccarone Center at
Green Spring Station and on Mondays at the
Johns Hopkins Outpatient Center. Dr. Michos
also sees patients at Odenton. At each location
we can perform exercise stress tests, treadmill
stress echo tests, echo Doppler tests, EKGs, Holter
monitors and refer patients for cardiac CT scans.
Vascular ultrasound testing and consultations are
available at Green Spring Station. Vascular Medicine
consultations are also available at White Marsh.
Appointments for Vascular Medicine consultations
or vascular ultrasound testing can also be scheduled
through Dr. Ratchford’s Center for Vascular Medicine
Scheduling line at 443-997-1800. Dr. Elizabeth
Ratchford serves as the Medical Director of the
vascular ultrasound laboratory at Green Spring Station.
Appointments at the Johns Hopkins Ciccarone
Center at Green Spring Station, 10755 Falls
Road, Pavilion I Suite 360, Lutherville, MD
21093 location can be scheduled at 443-997-0275.
(Drs. Blumenthal, Post, Ashen, Ratchford, Billups,
and Blaha)
Appointments at the Johns Hopkins Outpatient
Center, 601 North Caroline Street, Baltimore,
Maryland 21287, can be scheduled at 443-997-0270.
(Drs. Jones, Ndumele, Blumenthal, Martin, McEvoy,
and Gerstenblith)
Appointments at the Johns Hopkins Cardiology
Center at Odenton, 1132 Annapolis Road,
Suite 104, Odenton, MD 21113, can be scheduled
at 443-997-0275 or 410-874-1520. (Dr. Michos)
Support the Prevention of Heart Disease
Heart disease is America’s #1 killer—more
than cancer and accidents combined. Our goal
at the Ciccarone Center is to stop heart disease
before it develops, through an aggressive program
of risk assessment and comprehensive lifestyle and
medical management.
Like all pioneering medical programs, however, we
are in constant pursuit of funding to accelerate our
progress. We depend on the support of generous
donors to thrive.
34
The Johns Hopkins Ciccarone Center for the
Prevention of Heart Disease has just completed its
26th year of service and is going strong. When you
give to the Ciccarone Center, you’re ensuring that,
if you or a loved one is at risk for heart disease or
stroke, you’ll have a program to help prevent it. Or if
you already have heart disease, you’ll maximize your
opportunity for an active and enjoyable life.
You can help support this program by contributing
to the future of heart disease research, education,
and patient care. Make a tax-deductible donation
to the Ciccarone Center today and help save lives
tomorrow.
Gifts may be made in the form of cash, check, credit
card, securities, real estate or personal property. For
more information, please call the development office at
443-287-7384, or visit http://www.hopkinsmedicine.org/
heart_vascular_institute/about_us/charitable_giving/.
The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
www.hopkinsmedicine.org/heart
410-955-7376