nisha parikh

BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes …

Objective This study aimed to identify predictors of immediate postpartum breastfeeding among women with maternal cardiac disease (MCD). Study Design This study included all gravidas with MCD who delivered at a single institution from 2012 to 2018. Charts were abstracted for maternal demographics, obstetrical outcome, cardiac diagnoses, cardiac risk stratification scores, and prepregnancy echocardiogram findings. Kruskal–Wallis and Fisher's exact tests were used to compare the breastfeeding (BF) group versus the nonbreastfeeding (NBF) group. Logistic regression was used to obtain odds ratios (ORs) with 95% confidence intervals (CIs). Results Among 211 gravidas with MCD, 12% were not breastfeeding at the time of postpartum hospital discharge. Compared with the BF group, the NBF group had a significantly higher proportion of women with cardiomyopathy (21% NBF vs. 7% BF, OR 3.44, 95 …

BackgroundAlthough gestational diabetes mellitus and delivering high-birthweight infants are known to predict a higher risk of future type 2 diabetes mellitus, the association of hypertensive disorders of pregnancy and other adverse pregnancy outcomes with type 2 diabetes mellitus is not well established.ObjectiveThis study aimed to examine the associations between different types of adverse pregnancy outcomes and incident type 2 diabetes mellitus among postmenopausal women.Study DesignThe Women’s Health Initiative, a nationwide cohort of postmenopausal women, collected self-reported history of adverse pregnancy outcomes, including gestational diabetes mellitus, hypertensive disorders of pregnancy, preterm birth, and delivering low- birthweight (<2500 g) or high-birthweight (>4500 g) infants. Participants were followed up annually for self-reported incident type 2 diabetes mellitus treated with …

Postpartum lifestyle modification is recommended to hypertension risk. We conducted a systematic literature review to assess the evidence for postpartum lifestyle interventions to reduce blood pressure. We searched for relevant publications from 2010 through November 2022. Two authors independently conducted article screening and data extraction; a third resolved discrepancies. Ultimately, nine studies met inclusion criteria. Most were randomized controlled trials and had sample sizes< 100. In all but one of the eight studies reporting race data, nearly all participants identified as White. None of the studies reported a significant intervention effect on blood pressure. However, most interventions were associated with improvements in other outcomes, such as physical activity. Overall, the evidence for postpartum lifestyle interventions to reduce blood pressure is limited to a handful of studies characterized by small …

Brief Research Communications 559 associated with in-hospital mortality in acute COVID-19, 3, 4 the prognostic implications of RV dilation alone are less clear. Similarly, little is known about the clinical significance of RV dilation and dysfunction among patients hospitalized with acute COVID-19 compared with other respiratory illnesses, such as bacterial pneumonia. We studied the association of RV dilation and dysfunction with in-hospital mortality in acute COVID-19 compared with bacterial pneumonia. A retrospective cohort study design was utilized to compare 225 consecutive adults admitted for acute COVID-19 between March 2020 and February 2021 at UCSF Health and Zuckerberg San Francisco General Hospital with 257 control hospitalizations for bacterial pneumonia. To be included, all patients had to have a clinically ordered transthoracic echocardiogram (TTE) during hospitalization. COVID-19 was …

Background The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Methods The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors …

ObjectivesPatients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events.Study designWe identified patients with CHD who delivered between 2008 and 2020 at a tertiary centre and had follow-up data for greater than 6 months post partum. Late cardiovascular events were defined as heart failure, arrhythmia, thromboembolic events, endocarditis, urgent cardiovascular interventions or death. Survival analysis and Cox proportional model were used to estimate the incidence of late cardiovascular events and determine the hazard ratio of factors associated with these events.ResultsOf 117 patients, 19% had 36 late …

Background Methamphetamine misuse affects 27 million people worldwide and is associated with cardiovascular disease (CVD); however, risk factors for CVD among users have not been well studied. Methods and Results We studied hospitalized patients in California, captured by the Healthcare Cost and Utilization Project database, between 2005 and 2011. We studied the association between methamphetamine use and CVD (pulmonary hypertension, heart failure, stroke, and myocardial infarction). Among 20 249 026 persons in the Healthcare Cost and Utilization Project, 66 199 used methamphetamines (median follow‐up 4.58 years). Those who used were more likely younger (33 years versus 45 years), male (63.3% versus 44.4%), smoked, misused alcohol, and had depression and anxiety compared with nonusers. Methamphetamine use was associated with the development of heart failure …

BackgroundAlthough right ventricular (RV) dysfunction is associated with mortality in acute COVID-19, the role of RV dilation is uncertain. The prognostic significance of RV dilation and dysfunction among hospitalized patients with acute COVID-19 compared to other respiratory illnesses.MethodsWe conducted a retrospective cohort study to examine 225 consecutive adults admitted for acute COVID-19 and 6,150 control adults admitted for influenza, pneumonia or ARDS who had a clinical echocardiogram performed. We used logistic regression models to assess associations between RV parameters and in-hospital mortality adjusted for confounders.ResultsAmong those with COVID-19, 48/225 (21.3%) died during the index hospitalization compared to 727/6150 (11.8%) with other respiratory illness (p=0.001). Independent of COVID-19, mild and moderate to severe RV dilation were associated with 1.4 and 2.0 times higher risk of inpatient mortality, respectively (95%CI 1.17 to 1.69; p=0.0003; 95%CI 1.62 to 2.47; p<0.0001, respectively). Similarly, mild and moderate RV dysfunction were associated with 1.4 and 1.7 times higher risk of inpatient mortality (95%CI 1.10 to 1.77; p=0.007; 95%CI 1.17 to 2.42; p=0.005, respectively). Relative to normal RV size and non-COVID-19 acute respiratory illness, mild and moderate RV dilation were associated with 1.4 times and 2.0 times higher risk among those without COVID-19 and 1.9 times higher and 3.0 times higher risk among those with COVID-19, with similar findings for RV dysfunction. Having both RV dilation and dysfunction or RV dilation alone were associated with 1.7 times higher risk while RV …

ObjectiveTo evaluate the association of blood pressure category < 20 weeks according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) criteria with adverse perinatal outcomes.Study designA retrospective cohort study of singleton deliveries between 1/2014 and 10/2017 was undertaken. Blood pressure category assigned by 2017 ACC/AHA criteria applied to blood pressures prior to 20 weeks gestation: normal (systolic < 120 and diastolic < 80), elevated blood pressure (systolic 120–129 and diastolic < 80 mmHg), stage 1 hypertension (systolic 130–139 and/or diastolic 80–89), stage 2 hypertension (prior diagnosis of chronic hypertension or systolic ≥ 140 or diastolic ≥ 90 mmHg).Main outcome measuresThe primary outcome was preeclampsia. Secondary outcomes included preterm birth and postpartum readmission. Chi-square, ANOVA and Kruskal-Wallis tests and …

ObjectiveTo investigate the association of infertility with atherosclerotic cardiovascular disease (ASCVD) among postmenopausal participants in the Women’s Health Initiative (WHI). We hypothesized that nulliparity and pregnancy loss may reveal more extreme phenotypes of infertility, enabling further understanding of the association of infertility with ASCVD.DesignProspective cohort study.SettingForty clinical centers in the United States.Patient(s)A total of 158,787 postmenopausal participants in the Women’s Health Initiative cohort.Intervention(s)Infertility, parity, and pregnancy loss.Main Outcome Measure(s)The primary outcome was risk of ASCVD among women with and without a history of infertility, stratified by history of live birth and pregnancy loss. Cox proportional-hazards models were adjusted for demographics and risk factors for ASCVD.Result(s)Among 158,787 women, 25,933 (16.3%) reported a history …

Context SARS-CoV-2 infects cells via the angiotensin converting enzyme 2 (ACE2) receptor, whose downstream effects “counterbalance” the classical renin angiotensin aldosterone system (RAAS). Objective We aimed to determine to what extent circulating RAAS biomarker levels differ in persons with and without COVID-19 throughout the disease course. Methods We measured classical (renin, aldosterone, aldosterone/renin ratio [ARR], Ang2, ACE activity) and nonclassical (ACE2, Ang1,7) RAAS biomarkers in hospitalized COVID-19 patients vs SARS-CoV-2 negative controls. We compared biomarker levels in cases with contemporaneous samples from control patients with upper respiratory symptoms and a negative SARS-CoV-2 PCR test. To assess RAAS biomarker changes during the course of COVID-19 hospitalization, we studied cases at 2 …

Lipids, such as cholesterol and triglyceride, are insoluble in plasma. They are made soluble by attachment to circulating lipoproteins that transport lipids to various tissues for energy utilization, lipid deposition, steroid hormone production, and bile acid formation. The lipoprotein consists of esterified and unesterified cholesterol, triglycerides, and phospholipids, and protein.There are five major lipoproteins in blood: chylomicrons, very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Each of these classes of lipoproteins carries cholesterol and triglyceride to a varying degree, with LDL carrying the majority of cholesterol and VLDL carrying the majority of triglyceride.

BackgroundInfertility is a heterogenous disease process that has been associated with increased risk of later-life atherosclerotic cardiovascular disease (ASCVD). While individual causes of infertility may have varied biologic pathways to ASCVD, prior population studies of infertility and CVD risk combine infertile patients into a single exposure category and have not explored this variability.ObjectiveTo compare ASCVD risk among various infertility subtypes in the Women’s Health Initiative (WHI) Cohort.Materials and MethodsInfertility, defined as ever attempting conception for at least 12 months without success, was self-reported by post-menopausal participants at the time of enrollment in the WHI Cohort. Women were included in this study if they reported a history of infertility, had ever seen a doctor or clinic for infertility evaluation, and if a reason was found for their infertility. The primary outcome was any first-time …

INTRODUCTION—Ischemic heart disease, also referred to as coronary heart disease, is the term associated with an inadequate supply of blood to the myocardium due to obstruction of the epicardial coronary arteries, usually from atherosclerosis (see" Pathogenesis of atherosclerosis"). Patients may have chronic (stable) or acute (unstable) disease.Most patients can be given the diagnosis of chronic coronary syndrome (CCS), also referred to as stable ischemic heart disease (SIHD), based on a classic history of angina pectoris in the presence of either risk factors for or known atherosclerotic cardiovascular disease [1]. Angina pectoris, or angina for short, refers to chest discomfort that occurs when myocardial oxygen demand exceeds oxygen supply. Stable angina refers to chest discomfort that occurs predictably and reproducibly at a certain level of exertion and is relieved with rest or nitroglycerin. The prevalence of anginal symptoms varies and is thought to be lower among community-dwelling patients than trial participants [2, 3].(See" Approach to the patient with suspected angina pectoris", section on'Evaluation of suspected stable angina'.)

Stroke resulting from cardiac catheterization is relatively common due to the high volume of cardiac procedures performed worldwide. This topic will review periprocedural stroke in the setting of cardiac catheterization, which includes diagnostic and interventional procedures. Other aspects of acute stroke are discussed elsewhere.(See" Initial assessment and management of acute stroke" and" Intravenous thrombolytic therapy for acute ischemic stroke: Therapeutic use".)

ImportanceSome prior evidence suggests that adverse pregnancy outcomes (APOs) may be associated with heart failure (HF). Identifying unique factors associated with the risk of HF and studying HF subtypes are important next steps.ObjectiveTo investigate the association of APOs with incident HF overall and stratified by HF subtype (preserved vs reduced ejection fraction) among postmenopausal women in the Women’s Health Initiative (WHI).Design, Setting, and ParticipantsIn 2017, an APO history survey was administered in the WHI study, a large multiethnic cohort of postmenopausal women. The associations of 5 APOs (gestational diabetes, hypertensive disorders of pregnancy [HDP], low birth weight, high birth weight, and preterm delivery) with incident adjudicated HF were analyzed. In this cohort study, the association of each APO with HF was assessed using logistic regression models and with HF …

BackgroundIn January 2019,~ 151,278 people were homeless in California. Prior studies correlate homelessness with cardiovascular disease (CVD) risk factors (RFs). We identified clinical and social correlates of homeless versus housed persons in a California cohort. We studied associations of homelessness and CVD, recurrent CVD hospitalization, and mortality.MethodsThis retrospective cohort study used Office of Statewide Health Planning and Development California data. Homeless patients were identified by a specific zip code. The primary or secondary admission diagnosis was used to identify CVD outcome. Patients with myocardial infarction (MI), heart failure (HF), or stroke were identified by ICD-9 codes. We used Cox proportional hazards models comparing time to event in persons with and without homelessness. Models were adjusted for variables including age, gender, race, traditional CVD RFs …

Introduction: Myocardial injury is associated with COVID-19 mortality, but the prognostic value of adverse right ventricular (RV) remodeling on transthoracic echocardiogram (TTE) is uncertain. Therefore we studied the association between RV dilation and in-hospital mortality in acute COVID-19. Methods: We included all adults hospitalized with COVID-19 between March 2020 and February 2021 who had a clinical TTE performed during hospitalization at UCSF Health (Parnassus, Mission Bay, or Mount Zion) or Zuckerberg San Francisco General. Clinical and echo data were extracted from the electronic medical record. Biomarkers (BNP & troponin) were log transformed. The primary exposure was qualitative assessment of RV dilation on TTE and the primary outcome was in-hospital mortality. We conducted analysis with STATA MP 16.1 using logistic regression models with adjustment for age and sex (Model 1 …

BackgroundHeart failure (HF) is a leading cause of cardiac morbidity among women, whose risk factors differ from those in men. We used machine-learning approaches to develop risk- prediction models for incident HF in a cohort of postmenopausal women from the Women’s Health Initiative (WHI).MethodsWe used 2 machine-learning methods—Least Absolute Shrinkage and Selection Operator (LASSO) and Classification and Regression Trees (CART)—to perform variable selection on 1227 baseline WHI variables for the primary outcome of incident HF. These variables were then used to construct separate Cox proportional hazard models, and we compared these results, using receiver-operating characteristic (ROC) curve analysis, against a comparator model built using variables from the Atherosclerosis Risk in Communities (ARIC) HF prediction model. We analyzed 43,709 women who had 2222 incident HF …