132 results on '"Heckbert, Susan R."'
Search Results
2. Genetic variants associated with cardiac structure and function
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Vasan, Ramachandran S., Glazer, Nicole L., Felix, Janine F., Lieb, Wolfgang, Wild, Philipp S., Felix, Stephan B, Watzinger, Norbert, Larson, Martin G., Smith, Nicholas L., Dehghan, Abbas, Gro-henning, Anika, Schillert, Arne, Teumer, Alexander, Schmidt, Reinhold, Kathiresan, Sekar, Lumley, Thomas, Aulchenko, Yurii S., Konig, Inke R., Zeller, Tanja, Homuth, Georg, Struchalin, Maksim, Aragam, Jayashri, Bis, Joshua C., Rivadeneira, Fernando, Erdmann, Jeanette, Schnabel, Renate B., Dorr, Marcus, Zweiker, Robert, Lind Lars, Rodeheffer, Richard J., Greiser, Karin Halina, Levy, Daniel, Haritunians, Talin, Deckers, Jaap W., Stritzke, Jan, Lackner, Karl J., Volker, Uwe, Ingelsson, Erik, Kullo, Iftikhar, Haerting, Johannes, OEDonnell, Christopher J., Heckbert, Susan R., Stricker, Bruno H., Ziegler, Andreas, Reffelmann, Thorsten, Redfield, Margaret M., Werdan, Karl, Mitchell, Gary F., Rice, Kenneth, Arnett, Donna K., Hofman, Albert, Gottdiener, John S., Uitterlinden, Andre G., Meitinger, Thomas, Blettner, Maria, Friedrich, Nele, Wang, Thomas J., Psaty, Bruce M., van Duijn, Cornelia M., Wichmann, H.-Erich, Munzel, Thomas F., Kroemer, Heyo K., Benjamin, Emelia J., Rotter, Jerome I., Witteman, Jacqueline C., Schunkert, Heribert, Schmidt, Helena, Volzke, Henry, and Blankenberg, Stefan
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Cardiovascular diseases -- Genetic aspects ,Echocardiography -- Usage ,Heart -- Physiological aspects ,Heart -- Genetic aspects ,Meta-analysis -- Usage - Abstract
A study was conducted to investigate and identify genetic variants that are associated with cardiac structure and function through a meta-analysis. Results indicated that there were 5 genetic loci, associated with variance in cardiac dimensions and aortic root size; however, the proportion of variance is quite small.
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- 2009
3. Esterified estrogens and conjugated equine estrogens and risk of venous thrombosis
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Smith, Nicholas L., Lemaitre, Rozen N., Lumley, Thomas, Larson, Eric B., Psaty, Bruce M., Rosendal, Frits R., Weiss, Noel S., Reiner, Alex P., and Heckbert, Susan R.
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Postmenopausal women -- Health aspects ,Postmenopausal women -- Risk factors ,Estrogen -- Risk factors ,Estrogen -- Research ,Thrombophlebitis -- Risk factors ,Thrombophlebitis -- Research - Abstract
The risk of venous thrombosis among esterified estrogen users, conjugated equine estrogen users and nonusers are compared. The results revealed that conjugated equine estrogen associated with venous thrombotic risk needs to be replicated and may have implications for the choice of hormones in perimenopausal and postmenopausal women.
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- 2004
4. Antibiotic use in relation to the risk of breast cancer
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Velicer, Christine M., Heckbert, Susan R., Lampe, Julianna W., Potter, John D., and Taplin, Stephen H.
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Breast cancer -- Risk factors ,Breast cancer -- Research ,Antibiotics -- Risk factors ,Antibiotics -- Research - Abstract
The relationship between the use of antibiotics and the risk of breast cancer was studied. The study reveals that the use of antibiotics is associated with increased risk of incident and fatal breast cancer.
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- 2004
5. Diuretic therapy, the [alpha]-adducin gene variant, and the risk of myocardial infarction or stroke in persons with treated hypertension. (Original Contribution)
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Psaty, Bruce M., Smith, Nicholas L., Heckbert, Susan R., Vos, Hans L., Lemaitre, Rozenn N., Reiner, Alexander P., Siscovick, David S., Bis, Joshua, Lumley, Thomas, Longstreth, W.T., Jr., and Rosendaal, Frits R.
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Genetic polymorphisms -- Health aspects ,Hypertension -- Genetic aspects ,Diuretics -- Health aspects ,Heart attack -- Prevention ,Stroke (Disease) -- Prevention - Abstract
People with a mutation in the gene for a protein called alpha adducin may benefit from treatment with diuretics to prevent a heart attack or stroke, according to a study of 1,038 people. This mutation causes salt-sensitive hypertension., Context A genetic variant in [alpha]-adducin has been associated with renal sodium reabsorption and salt-sensitive hypertension. Whether this genetic variant modifies the effect of diuretic therapy on the incidence of myocardial infarction (MI) and stroke is unknown. Objectives To estimate the interaction between [alpha]-adducin and diuretic therapy on the risk of MI or stroke. Specifically, we hypothesized that in participants with treated hypertension, the risk of MI or stroke associated with diuretic use would be lower in carriers of the adducin variant than in carriers of the adducin wild-type genotype. Design, Setting, and Participants Population-based case-control study of patients enrolled in a health maintenance organization, treated pharmacologically for hypertension, and genotyped as homozygous carriers of the adducin wild-type genotype or carriers of i or 2 copies of the Trp460 variant allele. Cases had a first nonfatal MI (n=206) or stroke (n=117) between January 1995 and December 1998. Controls (n=715) were a stratified random sample of pharmacologically treated hypertensive patients who were matched to MI cases by age, sex, and calendar year. Main Outcome Measure Risk of the combined outcome of first nonfatal MI or stroke. Results The adducin variant was present in more than one third of the participants. Among the 653 carriers of the adducin wild-type genotype, diuretic therapy was not associated with the risk of Ml or stroke (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.78-1.52). Among the 385 carriers of the adducin variant allele, diuretic therapy was associated with a lower risk of the combined outcome of Ml and stroke than other antihypertensive therapies (OR, 0.49; 95% CI, 0.32-0.77). The OR in carriers of the adducin variant was less than half of the OR in carriers of the wild-type genotype (P=.005). The case-control synergy index (SI) was 0.45 (95% CI, 0.26-0.79) for the combined outcome of MI and stroke. The point estimates of the diuretic-adducin interaction were similar in separate analyses of MI (SI, 0.41; 95% CI, 0.21-0.80) and stroke (SI, 0.53; 95% CI, 0.24-1.19). The diuretic-adducin interaction was not confounded by traditional cardiovascular risk factors, was specific to diuretic therapy but not pres ent for other major antihypertensive drug classes, and did not differ substantially between subgroups defined by age, sex, race, diabetes, and history of cardiovascular disease. Conclusions In carriers of the adducin variant, diuretic therapy was associated with a lower risk of combined Ml or stroke than other antihypertensive therapies. If these findings are confirmed in other studies, this large subgroup of the hypertensive population may be especially likely to benefit from low-dose diuretic therapy.
- Published
- 2002
6. Validation of an atrial fibrillation risk algorithm in whites and African Americans
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Schnabel, Renate B., Aspelund, Thor, Li, Guo, Sullivan, Lisa M., Suchy-Dicey, Astrid, Harris, Tamara B., Pencina, Michael J., D'Agostino, Ralph B., Sr., Levy, Daniel, Kannel, William B., Wang, Thomas J., Kronmal, Richard A., Wolf, Philip A., Burke, Gregory L., Launer, Lenore J., Vasan, Ramachandran S., Psaty, Bruce M., Benjamin, Emelia J., Gudnason, Vilmundur, and Heckbert, Susan R.
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Atrial fibrillation -- Risk factors ,Atrial fibrillation -- Demographic aspects ,Atrial fibrillation -- Research ,Health risk assessment -- Methods ,Health risk assessment -- Research ,Health - Published
- 2010
7. Use of alendronate and risk of incident atrial fibrillation in women
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Heckbert, Susan R., Li, Guo, Cummings, Steven R., Smith, Nicholas L., and Psaty, Bruce M.
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Atrial fibrillation -- Risk factors ,Alendronate -- Dosage and administration ,Alendronate -- Complications and side effects ,Alendronate -- Research ,Health - Published
- 2008
8. Newly detected atrial fibrillation and compliance with antithrombotic guidelines
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Glazer, Nicole L., Dublin, Sascha, Smith, Nicholas L., French, Benjamin, Jackson, Lisa A., Hrachovec, Jennifer B., Siscovick, David S., Psaty, Bruce M., and Heckbert, Susan R.
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Atrial fibrillation -- Drug therapy ,Atrial fibrillation -- Research ,Stroke (Disease) -- Prevention ,Patient compliance -- Research ,Thrombolytic drugs -- Dosage and administration ,Thrombolytic drugs -- Research ,Health - Published
- 2007
9. Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis
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Psaty, Bruce M., Smith, Nicholas L., Siscovick, David S., Koepsell, Thomas D., Weiss, Noel S., Heckbert, Susan R., Lemaitre, Rozenn N., Wagner, Edward H., and Furberg, Curt D.
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Antihypertensive drugs -- Evaluation ,Hypertension -- Drug therapy ,Diuretics -- Evaluation ,Adrenergic beta blockers -- Evaluation ,ACE inhibitors -- Evaluation ,Calcium channel blockers -- Evaluation - Abstract
Diuretics and beta blockers remain the treatment of choice for hypertension. Researchers reviewed all of the long-term clinical trials of antihypertensive drugs, including beta blockers, diuretics, ACE inhibitors and calcium channel blockers. There is strong evidence that diuretics and beta blockers can reduce the risk of stroke and heart failure, which are the major complications of chronic hypertension. There is much less evidence that ACE inhibitors and calcium channel blockers are effective, except in speciific patient groups such as those with coronary artery disease and congestive heart failure., Objective.--To review the scientific evidence concerning the safety and efficacy of various antihypertensive therapies used as first-line agents and evaluated in terms of major disease end points. Data Sources.--MEDLINE searches and previous meta-analyses for 1980 to 1995. Data Selection.--We selected long-term studies that assessed major disease end points as an outcome. For the meta-analysis, we chose placebo-controlled randomized trials. For randomized trials using surrogate end points such as blood pressure, we selected the largest studies that evaluated multiple drugs. Where clinical trial evidence was lacking, we relied on information from observational studies. Data Synthesis.--Diuretics and [Beta]-blockers have been evaluated in 18 long-term randomized trials. Compared with placebo, [Beta]-blocker therapy was effective in preventing stroke (relative risk [RR], 0.71; 95% confidence interval [CI], 0.59-0.86) and congestive heart failure (RR, 0.58; 95% CI, 0.40-0.84). The findings were similar for high-dose diuretic therapy (for stroke, RR, 0.49; 95% CI, 0.39-0.62; and for congestive heart failure, RR, 0.17; 95% CI, 0.07-0.41). Low-dose diuretic therapy prevented not only stroke (RR, 0.66; 95% CI, 0.55-0.78) and congestive heart failure (RR, 0.58; 95% CI, 0.44-0.76) but also coronary disease (RR, 0.72; 95% CI, 0.61-0.85) and total mortality (RR, 0.90; 95% CI, 0.81-0.99). Although calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure in hypertensive patients, the clinical trial evidence in terms of health outcomes is meager. For several short-acting dihydropyridine calcium channel blockers, the available evidence suggests the possibility of harm. Whether the long-acting formulations and the nondihydropyridine calcium channel blockers are safe and prevent major cardiovascular events in patients with hypertension remains untested and therefore unknown. Conclusion.--Until the results of large long-term clinical trials evaluating the effects of calcium channel blockers and ACE inhibitors on cardiovascular disease incidence are completed, the available scientific evidence provides strong support for the current national guidelines, which recommend diuretics and [Beta]-blockers as first-line agents and low-dose therapy for all antihypertensive agents. JAMA. 1997;277:789-745
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- 1997
10. Risk of new-onset atrial fibrillation in relation to body mass index
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Dublin, Sascha, French, Benjamin, Glazer, Nicole L., Wiggins, Kerri L., Lumley, Thomas, Psaty, Bruce M., Smith, Nicholas L., and Heckbert, Susan R.
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Atrial fibrillation -- Risk factors ,Atrial fibrillation -- Research ,Body mass index -- Research ,Obesity -- Research ,Health - Published
- 2006
11. Esterified estrogen and conjugated equine estrogen and the risk of incident myocardial infarction and stroke
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Lemaitre, Rozenn N., Weiss, Noel S., Smith, Nicholas L., Psaty, Bruce M., Lumley, Thomas, Larson, Eric B., and Heckbert, Susan R.
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Menopause -- Care and treatment ,Esterified estrogens -- Research ,Conjugated estrogens -- Research ,Heart attack -- Risk factors ,Stroke (Disease) -- Risk factors ,Health - Published
- 2006
12. Conjugated equine estrogens and coronary heart disease: the Women's Health Initiative
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Hsia, Judith, Langer, Robert D., Manson, JoAnn E., Kuller, Lewis, Johnson, Karen C., Hendrix, Susan L., Pettinger, Mary, Heckbert, Susan R., Greep, Nancy, Crawford, Sybil, Eaton, Charles B., Kostis, John B., Caralis, Pat, and Prentice, Ross
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Conjugated estrogens -- Research ,Heart attack -- Prevention ,Postmenopausal women -- Health aspects ,Postmenopausal women -- Research ,Cardiovascular research -- Reports ,Health - Published
- 2006
13. The risk of myocardial infarction associated with antihypertensive drug therapies
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Psaty, Bruce M., Heckbert, Susan R., Koepsell, Thomas D., Siscovick, David S., Raghunathan, Trivellore, Weiss, Noel S., Rosendaal, Frits R., Lemaitre, Rozenn N., Smith, Nicholas L., Wahl, Patricia W., Wagner, Edward H., and Furberg, Curt D.
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Calcium channel blockers -- Adverse and side effects ,Hypertension -- Drug therapy ,Heart attack -- Risk factors - Abstract
People taking calcium channel blockers appear to have a greater risk of heart attack than those taking other classes of drugs used to lower blood pressure. Researchers studied the records of 623 patients who had heart attacks while taking antihypertensive medication and 2,032 patients who were treated for high blood pressure but did not have heart attacks. The patients ranged in age from 30 to 79. Patients taking high doses of short-acting calcium channel blockers had a 60% higher risk of heart attack compared to patients taking beta-blockers or angiotensin-converting enzyme (ACE) inhibitors. The risk, however, was small for patients on low doses of calcium channel blockers., Objective.--To assess the association between first myocardial infarction and the use of antihypertensive agents. Design and Setting.--We conducted a population-based case-control study among enrollees of the Group Health Cooperative of Puget Sound (GHC). Patients and Methods.--Cases were hypertensive patients who sustained a first fatal or nonfatal myocardial infarction from 1986 through 1993 among women and from 1989 through 1993 among men. Controls were a stratified random sample of hypertensive GHC enrollees, frequency matched to the cases on age, sex, and calendar year. All 623 cases and 2032 controls had pharmacologically treated hypertension. Data collection included a review of the ambulatory medical record and a brief telephone interview of consenting survivors. Antihypertensive therapy was assessed using the GHC's computerized pharmacy database. Results.--The first analysis included only the 335 cases and 1395 controls initially free of cardiovascular disease. Compared with users of diuretics alone, the adjusted risk ratio of myocardial infarction was increased by about 60% among users of calcium channel blockers with or without diuretics (risk ratio=1.62; 95% confidence interval [CI], 1.11 to 2.34; P=.01). The second analysis was restricted to 384 cases and 1108 controls who were taking either a calcium channel blocker or a [beta]-blocker. Among these subjects, the use of calcium channel blockers compared with [beta]-blockers was associated with about a 60% increase in the adjusted risk of myocardial infarction (risk ratio=1.57; 95% CI, 1.21 to 2.04; P Conclusions.--In this study of hypertensive patients, the use of short-acting calcium channel blockers, especially in high doses, was associated with an increased risk of myocardial infarction. Ongoing large-scale clinical trials will assess the effect of various antihypertensive therapies, including calcium channel blockers, on several important cardiovascular end points. Until these results are available, the findings of this study support the current guidelines from the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure that recommend diuretics and [beta]-blockers as first-line agents unless contraindicated, unacceptable, or not tolerated.
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- 1995
14. Time trends in high blood pressure control and the use of antihypertensive medications in older adults: the Cardiovascular Health Study
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Psaty, Bruce M., Manolio, Teri A., Smith, Nicholas L., Heckbert, Susan R., Gottdiener, John S., Burke, Gregory L., Weissfeld, Joel, Enright, Paul, Lumley, Thomas, Powe, Neil, and Furberg, Curt D.
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Antihypertensive drugs -- Evaluation ,Antihypertensive drugs -- Usage ,Blood pressure -- Regulation ,Company business management ,Health - Published
- 2002
15. Hormone replacement therapy and associated risk of stroke in postmentopausal women
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Lemaitre, Rozenn N., Heckbert, Susan R., Psaty, Bruce M., Smith, Nicholas L., Kaplan, Robert C., and Longstreth, W.T., Jr.
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Hormone therapy -- Adverse and side effects ,Stroke (Disease) -- Risk factors ,Health - Published
- 2002
16. Therapy with hydroxymethylglutaryl coenzyme a reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults: evidence from the Cardiovascular Health Study. (Original Investigation)
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Lemaitre, Rozenn N., Psaty, Bruce M., Heckbert, Susan R., Kronmal, Richard A., Newman, Anne B., and Burke, Gregory L.
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Anticholesteremic agents -- Evaluation ,Cardiovascular diseases -- Prevention ,Aged -- Health aspects ,Health - Abstract
Background: Recommendations to treat older adults with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) for the primary prevention of coronary heart disease events are supported by a single clinical trial restricted to adults 73 years or younger with low levels of high-density lipoprotein cholesterol. Methods: We investigated the association of statin use with incident cardiovascular disease and all-cause mortality during up to 7.3 years' follow-up of 1250 women and 664 men from the Cardiovascular Health Study. Study participants were 65 years and older and free of cardiovascular disease at baseline. They received drug therapy to lower cholesterol levels at baseline or no treatment with a recommendation for therapy according to the National Cholesterol Education Program guidelines. Use of these drugs was assessed annually. We used proportional-hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for confounding variables. Results: We found 382 incident cardiovascular events (159 myocardial infarctions, 159 strokes, and 64 deaths due to coronary heart disease) and 362 total deaths from June 1, 1989, to May 31, 1997. Compared with no use of drugs to lower cholesterol levels, statin use was associated with decreased risk of cardiovascular events (multivariate HR, 0.44; 95% CI, 0.27-0.71) and all-cause mortality (HR, 0.56; 95% CI, 0.36-0.88). Similar associations were observed among participants 74 years or older at baseline. Conclusions: Use of statins was associated with decreased risk of incident cardiovascular events among elderly adults. These findings lend support to the National Cholesterol Education Program guidelines, which recommend therapy for the lowering of cholesterol levels for older adults with hypercholesterolemia. Arch Intern Med. 2002;162:1395-1400
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- 2002
17. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. (Original Investigation)
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Tsai, Albert W., Cushman, Mary, Rosamond, Wayne D., Heckbert, Susan R., Polak, Joseph F., and Folsom, Aaron R.
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Thromboembolism -- Demographic aspects ,Prevalence studies (Epidemiology) -- Analysis ,Cardiovascular diseases -- Risk factors ,Venous thrombosis -- Causes of ,Pulmonary embolism -- Causes of ,Health - Abstract
Background: The association between traditional cardiovascular risk factors and risk of venous thromboembolism (VTE) has not been extensively examined in prospective studies. Methods: To determine whether atherosclerotic risk factors are also associated with increased incidence of VTE, we conducted a prospective study of 19293 men and women without previous VTE in 6 US communities between 1987 and 1998. Results: There were 215 validated VTE events (1.45 per 1000 person-years) during a median of 8 years of follow-up. The age-adjusted hazard ratio was 1.4 (95% confidence interval [CI], 1.1-1.9) for men vs women, 1.6 (95% CI, 1.2-2.2) for blacks vs whites, and 1.7 (95% CI, 1.5-2.0) per decade of age. Cigarette smoking, hypertension, dyslipidemia, physical inactivity, and alcohol consumption were not associated with risk of VTE. Age-, race-, and sex-adjusted hazard ratios for body mass index categories (calculated as the weight in kilograms divided by the height in meters squared) of less than 25, 25 to less than 30, 30 to less than 35, 35 to less than 40, and 40 or more were 1.0, 1.5, 2.2, 1.5, and 2.7, respectively (P Conclusions: Our data showing no relationship of some arterial risk factors with VTE corroborate the view that the etiology of VTE differs from atherosclerotic cardiovascular disease. In addition, the findings suggest a hypothesis that avoidance of obesity and diabetes or vigilance in prophylaxis in patients with those conditions may prevent some venous thromboses.
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- 2002
18. Fasting and 2-hour postchallenge serum glucose measures and risk of incident cardiovascular events in the elderly: the Cardiovascular Health Study
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Smith, Nicholas L., Barzilay, Joshua I., Shaffer, Douglas, Savage, Peter J., Heckbert, Susan R., Kuller, Lewis H., Kronmal, Richard A., Resnick, Helaine E., and Psaty, Bruce M.
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Blood sugar monitoring ,Stroke (Disease) -- Risk factors ,Heart attack -- Risk factors ,Health - Published
- 2002
19. Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity.
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Johnson, Kimson E., Li, Hanyu, Zhang, Min, Springer, Mellanie V., Galecki, Andrzej T., Whitney, Rachael T., Gottesman, Rebecca F., Hayward, Rodney A., Sidney, Stephen, Elkind, Mitchell S. V., Longstreth Jr, W. T., Heckbert, Susan R., Gerber, Yariv, Sullivan, Kevin J., and Levine, Deborah A.
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- 2024
- Full Text
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20. Temporal patterns in the medical treatment of congestive heart failure with angiotensin-converting enzyme inhibitors in older adults, 1989 through 1995
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Smith, Nicholas L., Psaty, Bruce M., Pitt, Bertram, Garg, Rekha, Gottdiener, John S., and Heckbert, Susan R.
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Congestive heart failure -- Drug therapy ,ACE inhibitors -- Health aspects ,Health - Abstract
Background: Evidence from clinical trials in the past decade has consistently shown that angiotensin-converting enzyme (ACE) inhibitors reduce morbidity and mortality in patients with congestive heart failure (CHF). The extent to which clinical practice has adopted ACE inhibitor therapy is unknown. Methods: The Cardiovascular Health Study is a prospective observational study of 5201 community-dwelling adults aged 65 years and older. Prevalent CHF cases were identified on study entry (from June 10, 1989, through May 31, 1990) and incident CHF cases were identified throughout 5 years of follow-up. Medication data were collected from annual medication inventories. The percentage of patients with CHF using ACE inhibitors was calculated at each annual examination. Temporal trends in CHF treatment with ACE inhibitors between June 10, 1989, through May 31, 1990, and June 1, 1994, through May 31, 1995, were analyzed. Results: Use of ACE inhibitors to treat CHF increased slightly over time among prevalent cases at each annual examination: 26% of prevalent CHF cases were treated in 1989-1990 compared with 36% of prevalent cases in 1994-1995. This 10% increase was statistically significant (P [is less than] .01). Participants with low ejection fractions were 2 times more likely to be treated with ACE inhibitors than were those with normal ejection fraction and this tendency did not change over time. Among cases newly diagnosed in the year before the 1990-1991 examination, 42% were using ACE inhibitors; among those newly diagnosed in the year before 1994-1995, 40% were using ACE inhibitors. This 2% decrease was not statistically significant (P=.68). Conclusion: These findings suggest that, while the medical management of CHF with ACE inhibitors has increased modestly over time in prevalent cases, these drugs may still be underused, especially among incident cases. Arch Intern Med. 1998;158:1074-1080
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- 1998
21. Duration of estrogen replacement therapy in relation to the risk of incident myocardial infarction in postmenopausal women
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Heckbert, Susan R., Weiss, Noel S., Koepsell, Thomas D., Lemaitre, Rozenn N., Smith, Nicholas L., Siscovick, David S., Lin, Danyu, and Psaty, Bruce M.
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Estrogen -- Health aspects ,Heart attack -- Risk factors ,Postmenopausal women -- Health aspects ,Health - Abstract
Background: There is little information about whether an increasing duration of estrogen replacement therapy is associated with a declining risk for myocardial infarction in postmenopausal women. Objective: To conduct a population-based, case-control study among enrollees of the Group Health Cooperative (GHC) of Puget Sound, Seattle, Wash. Subjects and Methods: Case subjects were all postmenopausal women who were enrolled in the GHC with an incident fatal or nonfatal myocardial infarction from July 1986 through December 1993. Control subjects were a stratified random sample of postmenopausal women who were enrolled in the GHC without myocardial infarction and matched to case subjects by age and calendar year. We reviewed the medical records of the 850 case subjects and 1974 control subjects and conducted telephone interviews with consenting survivors. Use of estrogen or estrogen and progestin was assessed using GHC's computerized pharmacy database. Results: Among women who were currently using estrogen, a longer duration of use was inversely associated with a risk for myocardial infarction after adjustment for age, year of identification, diabetes mellitus, angina, and smoking. For categories of increasing duration of estrogen use (never, [is greater than] 0- [is less than] 1.8 years, 1.8- [is less than] 4.2 years, 4.2- [is less than] 8.2 years, and [is greater than or equal to] 8.2 years), the odds ratios for myocardial infarction were 1.00 (reference), 0.91, 0.70, 0.65, and 0.55 (for trend among the current users, P=.05). Among women who had used estrogen in the past, there was no evidence of decreasing risk with increasing duration of estrogen use. Conclusion: In this study, a long duration of hormone replacement therapy among women currently using estrogen was associated with a reduced risk for first myocardial infarction. Arch Intern Med. 1997; 157:1330-1336
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- 1997
22. Leisure-time physical activity and the risk of nonfatal myocardial infarction in postmenopausal women
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Lemaitre, Rozenn N., Heckbert, Susan R., Psaty, Bruce M., and Siscovick, David S.
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Heart attack -- Risk factors ,Sex factors in disease -- Health aspects ,Exercise -- Health aspects ,Postmenopausal women -- Health aspects ,Health - Abstract
Background: Few studies have examined the association of physical activity with coronary heart disease among women. Objective: To examine whether participation in physical activity during leisure time decreases the risk of myocardial infarction in postmenopausal women. Method: A population-based, case-control study among enrollees of the Group Health Cooperative of Puget Sound, a health maintenance organization based in Seattle, Wash. Cases were postmenopausal women who sustained an incident nonfatal myocardial infarction during the period 1986 through 1991. Controls were a random sample of Group Health Cooperative enrollees who were frequency matched to the cases by age and calendar year. Participation in physical activity during leisure time was assessed from a telephone interview. A total of 268 cases and 925 controls were interviewed. Results: After adjustment for potential confounding factors, the odds ratios for nonfatal myocardial infarction for women in the second, third, and fourth quartile of total energy expenditure, relative to women in the first quartile, were 0.52 (95% confidence interval, 0.34 to 0.80), 0.40 (95% confidence interval, 0.26 to 0.63), and 0.40 (95% confidence interval, 0.25 to 0.63), respectively. Similar odds ratios were associated with the energy expended in nonstrenuous leisure-time physical activity, and with walking for exercise. Conclusion: This case-control study suggests that the risk of myocardial infarction among postmenopausal women is decreased by 50% with modest leisure-time energy expenditures, equivalent to 30 to 45 minutes of walking for exercise three times a week.
- Published
- 1995
23. The risk of myocardial infarction associated with the combined use of estrogens and progestins in postmenopausal women
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Psaty, Bruce M., Heckbert, Susan R., Atkins, David, Lemaitre, Rozenn, Koepsell, Thomas D., Wahl, Patricia W., Siscovick, David S., and Wagner, Edward H.
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Heart attack -- Risk factors ,Estrogen -- Health aspects ,Progestational hormones -- Health aspects ,Health - Abstract
Background: While observational studies have suggested that unopposed estrogens reduce the incidence of coronary disease in postmenopausal women, there are few data on the effect of combined therapy with estrogens and progestins - a regimen adopted in recent years to minimize the risk of endometrial hyperplasia and cancer. In clinical trials, the addition of progestins has an adverse effect on serum lipid levels, and these lipid effects have raised the question of whether combined estrogen-progestin therapy increases the risk of coronary disease compared with the use of estrogen alone. Methods: We conducted a population-based, case-control study among enrollees of Group Health Cooperative of Puget Sound. Cases were postmenopausal women who sustained an incident fatal or nonfatal myocardial infarction in 1986 through 1990. Controls were a stratified random sample of female Group Health Cooperative enrollees frequency matched to the cases by age and calendar year. We reviewed the medical records of the 502 cases and 1193 controls and conducted brief telephone interviews with consenting survivors. The health maintenance organization's computerized pharmacy database was used to ascertain the use of postmenopausal hormones. For the primary analysis of current use, we classified women into one of three groups: (1) nonusers of hormones; (2) users of estrogens alone; or (3) users of combined therapy including both estrogens and progestins. Each group of hormone users was compared with nonusers. Results: After adjustment for potential confounding factors, the risk ratio of myocardial infarction associated with current use of estrogens alone was 0.69 (95% confidence interval, 0.47 to 1.02); and the risk ratio of myocardial infarction associated with current use of combined therapy was 0.68 [95% confidence interval, 0.38 to 1.22). Duration of combined-therapy use was relatively short, averaging less than 2 years in cases and controls. Conclusions: In this case-control study, the reduced risk of myocardial infarction associated with the use of estrogens alone was consistent with previous observational studies. Although the 95% confidence interval only excluded a risk above 1.22, the current use of combined therapy was not associated with an adverse effect on the incidence of myocardial infarction in postmenopausal women. (Arch Intern Med. 1994;154:1333-1339)
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- 1994
24. A review of the association of estrogens and progestins with cardiovascular disease in postmenopausal women
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Psaty, Bruce M., Heckbert, Susan R., Atkins, David, Siscovick, David S., Koepsell, Thomas D., Wahl, Patricia W., Longstreth, W.T., Jr., Weiss, Noel S., Wagner, Edward H., Prentice, Ross, and Furberg, Curt D.
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Estrogen -- Physiological aspects ,Progestational hormones -- Physiological aspects ,Cardiovascular diseases -- Risk factors ,Postmenopausal women -- Diseases ,Health - Abstract
The purpose of this article was to review, with special attention to the hypothesized mechanisms of atherosclerosis and thrombosis, the literature on the association of estrogens and progestins with cardiovascular disease. The data sources included recent reviews and their citations as well as literature searches of Medline. For coronary heart disease, we relied on a recent meta-analysis; for the lipid effects of estrogens and progestins, we refer to recent reviews and studies; for stroke, we identified all cohort and case-control studies; and for the effects of hormones on coagulation factors, we identified all relevant studies. The lipid effects of estrogens in postmenopausal women probably prevent atherosclerosis, and we would expect long duration of use rather than current use to provide the greatest benefit. Few epidemiologic studies have, however, assessed duration of estrogen use. High doses of estrogens are likely to be thrombogenic during current use, and it is possible that even moderate doses may increase the risk of clotting among women who smoke or who have existing coronary atherosclerosis. Compared with the lipid effects of estrogens alone, the lipid effects of combined therapy with progestins may increase atherosclerosis. The effect of progestins on coagulation factors is largely unknown, and no epidemiologic study has assessed the risk of cardiovascular disease associated with the use of combined hormone therapy in postmenopausal women. Cardiovascular risk or benefit associated with the use of postmenopausal hormones may involve several competing mechanisms, including effects on prostaglandins and vascular tone as well as atherosclerosis and thrombosis. (Arch Intern Med. 1993; 153:1421-1427)
- Published
- 1993
25. Dear doctor...regarding calcium channel blockers
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Stryer, Daniel B., Lurie, Peter, Bero, Lisa A., Kaplan, Norman M., MacCarthy, E. Paul, Psaty, Bruce M., Koepsell, Thomas D., Weiss, Noel S., Heckbert, Susan R., Siscovick, David S., Lemaitre, Rozenn N., Smith, Nicholas L., Wagner, Edward H., and Furberg, Curt D.
- Subjects
Calcium channel blockers -- Adverse and side effects ,Communication in medicine -- Ethical aspects - Published
- 1996
26. Myocardial infarction associated with antihypertensive drug therapy
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Feeman, W.E., Jr., Cooper, Richard S., Freeman, Vincent, Blandino, David A., Psaty, Bruce M., Heckbert, Susan R., Koepsell, Thomas D., Weiss, Noel S., Siscovick, David S., Lemaitre, Rozenn N., Smith, Nicholas L., Wagner, Edward H., Furberg, Curt D., Buring, Julie E., Glynn, Robert J., and Hennekens, Charles N.
- Subjects
Calcium channel blockers -- Adverse and side effects ,Heart attack -- Risk factors ,Drugs -- Controlled release - Published
- 1996
27. Temporal patterns of antihypertensive medication use among older adults, 1989 through 1992: an effect of the major clinical trials on clinical practice?
- Author
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Psaty, Bruce M., Koepsell, Thomas D., Yanez, N. David, Smith, Nicholas L., Manolio, Teri A., Heckbert, Susan R., Borhani, Nemat O., Gardin, Julius M., Gottdiener, John S., Rutan, Gale H., Siscovick, David S., and Furberg, Curt D.
- Subjects
Antihypertensive drugs -- Evaluation ,Coronary heart disease -- Prevention ,Stroke (Disease) -- Prevention ,Thiazides -- Usage ,Diuretics -- Usage - Abstract
Major clinical trials, which found that low-dose thiazide diuretics reduced the risk of stroke and coronary heart disease, influenced the use of the antihypertensive medicine for older adults in clinical practice, especially among women. The portion which began diuretic therapy rose from 35.9% to 47.5%, following the publication of the clinical trials. The number of patients beginning antihypertensive drug therapy were 157 for the first study period, 142 for the second, and 120 for the third. Among patients who were continuous users of hypertensive medicine, the use of beta-blockers and diuretics decreased over the study period of three years. The use of calcium channel blockers increased in each of the three study periods, however the rate of increase dropped between the first study period and the third., Objective. - To describe the changing patterns of antihypertensive medication use in the years immediately before and after the publication of the results of three major clinical trials of the treatment of hypertension in older adults. Design. - In this cohort study, adults 65 years or older were examined annually on four occasions between June 1989 and May 1992, and the use of antihypertensive medications was assessed by inventory at each visit. The four visits defined the boundaries of three study periods. For each study period, participants receiving antihypertensive therapy were either continuous users (n = 1667, 1643, and 1605, respectively) or starters (n = 157, 142, 120) of hypertensive therapy. The large clinical trials that convincingly proved the efficacy and safety of low-dose diuretic therapy in older adults were published during the latter parts of period 2 and the early parts of period 3. Results. - Among starters, the proportion initiating therapy on diuretics increased from 35.9% in period 2 to 47.5% in period 3, significantly so among women (P=.04). The proportions initiating other drugs displayed no significant trends. Among continuous users, the use of diuretics, [beta]-blockers, and vasodilators generally decreased over the 3-year period, while the use of calcium channel blockers and angiotensin-converting enzyme inhibitors increased significantly in each of the three periods (P
- Published
- 1995
28. Risk of Recurrent Coronary Events in Relation to Use and Recent Initiation of Postmenopausal Hormone Therapy
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Heckbert, Susan R.
- Subjects
Hormone therapy -- Adverse and side effects ,Heart attack -- Risk factors - Published
- 2001
29. Hormone Replacement Therapy, Prothrombotic Mutations, and the Risk of Incident Nonfatal Myocardial Infarction in Postmenopausal Women
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Psaty, Bruce M., Smith, Nicholas L., Lemaitre, Rozenn N., Vos, Hans L., Heckbert, Susan R., LaCroix, Andrea Z., and Rosendaal, Frits R.
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Heart attack -- Risk factors ,Gene mutations -- Health aspects ,Hormone therapy -- Adverse and side effects - Abstract
Postmenopausal women who have hypertension, use hormone replacement therapy, and have a gene mutation that predisposes them to produce blood clots have over 10 times the risk of having a heart attack compared to women with none of those risk factors. This was the conclusion of a study of 955 postmenopausal women, 232 of whom had a heart attack.
- Published
- 2001
30. Surrogate End Points, Health Outcomes, and the Drug-Approval Process for the Treatment of Risk Factors for Cardiovascular Disease
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Psaty, Bruce M., Weiss, Noel S., Furberg, Curt D., Koepsell, Thomas D., Siscovick, David S., Rosendaal, Frits R., Smith, Nicholas L., Heckbert, Susan R., Kaplan, Robert C., Lin, Danyu, Fleming, Thomas R., and Wagner, Edward H.
- Subjects
Clinical trials -- Methods ,Cardiovascular diseases -- Risk factors - Abstract
Surrogate end points are often used in clinical trials of drugs to treat cardiovascular disease. Ideally, patients in a clinical trial should be followed until they die from the disease. However, this would take so long and require so many patients that doctors began using surrogate end points. Surrogate end points are usually physiological measurements such as blood cholesterol levels. If a drug lowers blood cholesterol levels, doctors assume it will also lower mortality rates from heart disease. However, the withdrawal of the anti-obesity drug dexfenfluramine illustrates the dangers of doing short-term clinical trials that focus on surrogate end points.
- Published
- 1999
31. Antihypertensive Drug Therapies and the Risk of Ischemic Stroke
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Klungel, Olaf H., Heckbert, Susan R., Longstreth, W. T. Jr, Furberg, Curt D., Kaplan, Robert C., Smith, Nicholas L., Lemaitre, Rozenn N., Leufkens, Hubert G. M., de Boer, Anthonius, and Psaty, Bruce M.
- Subjects
Stroke (Disease) -- Prevention ,Hypertension -- Drug therapy ,Antihypertensive drugs -- Evaluation ,Health - Abstract
Background: The relative effectiveness of various antihypertensive drugs with regard to the reduction of stroke incidence remains uncertain. Objective: To assess the association between first ischemic stroke and use of antihypertensive drugs. Methods: A population-based case-control study was performed among enrollees of the Group Health Cooperative of Puget Sound. Case patients included pharmacologically treated hypertensive patients who sustained a first ischemic stroke (fatal or nonfatal; n = 380) between July 1, 1989, and December 31, 1996. Control subjects were a random sample of treated hypertensive enrollees without a history of a stroke (n = 2790). Medical record review and a telephone interview of consenting survivors were used to collect information on risk factors for stroke. Computerized pharmacy records were used to assess antihypertensive drug use. Results: Among 1237 single-drug users with no history of cardiovascular disease, the adjusted risk of ischemic stroke was higher among users of a [Beta]-blocker (risk ratio [RR], 2.03; 95% confidence interval [CI], 1.0-53.94), calcium channel blocker (RR, 2.30; 95% CI, 1.16-4.56), or angiotensin-converting enzyme inhibitor (RR, 2.79; 95% CI, 1.47-5.27) than among users of a thiazide diuretic alone. Among 673 single-drug users with a history of cardiovascular disease, the RRs were 1.22 (95% CI, 0.63-2.35), 1.18 (95% CI, 0.59-2.33), and 1.45 (95% CI, 0.70-3.02) among users of a [Beta]-blocker, calcium channel blocker, and angiotensin-converting enzyme inhibitor, respectively, compared with users of a thiazide diuretic alone. Conclusions: In this study of pharmacologically treated hypertensive patients, antihypertensive drug regimens that did not include a thiazide diuretic were associated with an increased risk of ischemic stroke compared with regimens that did include a thiazide. These results support the use of thiazide diuretics as first-line antihypertensive agents.
- Published
- 2001
32. Use of Calcium Channel Blockers and Risk of Hospitalized Gastrointestinal Tract Bleeding
- Author
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Kaplan, Robert C., Heckbert, Susan R., Koepsell, Thomas D., Rosendaal, Frits R., and Psaty, Bruce M.
- Subjects
Calcium channel blockers -- Adverse and side effects ,Gastrointestinal bleeding -- Risk factors ,Gastrointestinal system ,Health - Abstract
Background: We conducted a case-control study of the association between calcium channel blocker use and gastrointestinal (GI) tract bleeding in hypertensive members of a health maintenance organization. Methods: Case patients (n = 174) were treated hypertensive health maintenance organization members hospitalized for GI tract bleeding between January 1992 and December 1994. Case patients were identified using computerized diagnosis codes and were confirmed by medical record review. Control subjects (n = 771) were treated hypertensive members selected from ongoing studies at the health maintenance organization. Computerized pharmacy data and medical records were used to assess medication use and other risk factors for GI tract bleeding. Results: Compared with [Beta]-blocker users, calcium channel blocker users had an age-, sex- and calendar year-adjusted relative risk (RR) of GI tract bleeding of 2.60 (95% confidence interval [CI], 1.71-3.96). The RR associated with calcium channel blocker use was 2.05 (95% CI, 1.33-3.17) after further adjustment for number of recent visits, diastolic blood pressure, chronic congestive heart failure, and duration of hypertension. No significant dose-response relationship was observed. Compared with [Beta]-blocker users, angiotensin-converting enzyme inhibitor users had an RR of 1.22 (95% CI, 0.75-1.97). Calcium channel blocker use tended to be more strongly associated with risk of lower GI tract bleeding (RR, 2.56; 95% CI, 1.08-6.05) than with risk of upper GI tract bleeding (RR, 1.54; 95% CI, 0.91-2.59) or peptic ulcer-related bleeding (RR, 1.17; 95% CI, 0.62-2.21), although these results were compatible with chance. Conclusions: Calcium channel blocker use might be associated with an elevated risk of GI tract bleeding. These findings require confirmation in randomized studies. Arch Intern Med. 2000;160:1849-1855
- Published
- 2000
33. Types of Myocardial Infarction Among Human Immunodeficiency Virus-Infected Individuals in the United States.
- Author
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Crane, Heidi M., Paramsothy, Pathmaja, Drozd, Daniel R., Nance, Robin M., Delaney, J. A. Chris, Heckbert, Susan R., Budoff, Matthew J., Burkholder, Greer A., Willig, James H., Mugavero, Michael J., Mathews, William C., Crane, Paul K., Moore, Richard D., Eron, Joseph J., Napravnik, Sonia, Hunt, Peter W., Geng, Elvin, Hsue, Priscilla, Rodriguez, Carla, and Peter, Inga
- Published
- 2017
- Full Text
- View/download PDF
34. Assessing and Refining Myocardial Infarction Risk Estimation Among Patients With Human Immunodeficiency Virus: A Study by the Centers for AIDS Research Network of Integrated Clinical Systems.
- Author
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Feinstein, Matthew J., Nance, Robin M., Drozd, Daniel R., Hongyan Ning, Delaney, Joseph A., Heckbert, Susan R., Budoff, Matthew J., Mathews, William C., Kitahata, Mari M., Saag, Michael S., Eron, Joseph J., Moore, Richard D., Achenbach, Chad J., Lloyd-Jones, Donald M., and Crane, Heidi M.
- Published
- 2017
- Full Text
- View/download PDF
35. Association of Intensive vs Standard Blood Pressure Control With Regional Changes in Cerebral Small Vessel Disease Biomarkers: Post Hoc Secondary Analysis of the SPRINT MIND Randomized Clinical Trial.
- Author
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Rashid, Tanweer, Li, Karl, Toledo, Jon B., Nasrallah, Ilya, Pajewski, Nicholas M., Dolui, Sudipto, Detre, John, Wolk, David A., Liu, Hangfan, Heckbert, Susan R., Bryan, R. Nick, Williamson, Jeff, Davatzikos, Christos, Seshadri, Sudha, Launer, Lenore J., and Habes, Mohamad
- Published
- 2023
- Full Text
- View/download PDF
36. Evaluation of a Prediction Model for the Development of Atrial Fibrillation in a Repository of Electronic Medical Records.
- Author
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Kolek, Matthew J., Graves, Amy J., Meng Xu, Bian, Aihua, Teixeira, Pedro Luis, Shoemaker, M. Benjamin, Parvez, Babar, Hua Xu, Heckbert, Susan R., Ellinor, Patrick T., Benjamin, Emelia J., Alonso, Alvaro, Denny, Joshua C., Roden, Dan M., Moons, Karel G. M., Shintani, Ayumi K., Harrell Jr., Frank E., and Darbar, Dawood
- Published
- 2016
- Full Text
- View/download PDF
37. Alendronate, osteoporosis, and atherosclerosis
- Author
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Heckbert, Susan R., Li, Guo, Cummings, Steven R., Smith, Nicholas L., and Psaty, Bruce M.
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Alendronate -- Complications and side effects ,Osteoporosis -- Development and progression ,Osteoporosis -- Care and treatment ,Atherosclerosis -- Risk factors ,Muscle contraction -- Abnormalities ,Muscle contraction -- Risk factors ,Health - Published
- 2008
38. Atrial fibrillation, obesity, and obstructive sleep apnea
- Author
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Arias, Miguel A., Sanchez, Ana M., Alonso-Fernandez, Alberto, Garcia-Rio, Francisco, Dublin, Sascha, Lumley, Thomas, Glazer, Nicole L., Psaty, Bruce M., French, Benjamin, Wiggins, Kerri L., Smith, Nicholas L., and Heckbert, Susan R.
- Subjects
Obesity -- Complications and side effects ,Sleep apnea syndromes -- Development and progression ,Sleep apnea syndromes -- Risk factors ,Sleep apnea syndromes -- Care and treatment ,Atrial fibrillation -- Causes of ,Atrial fibrillation -- Risk factors ,Health - Published
- 2007
39. Genetic Investigation Into the Differential Risk of Atrial Fibrillation Among Black and White Individuals.
- Author
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Roberts, Jason D., Donglei Hu, Heckbert, Susan R., Alonso, Alvaro, Dewland, Thomas A., Vittinghoff, Eric, Yongmei Liu, Psaty, Bruce M., Olgin, Jeffrey E., Magnani, Jared W., Huntsman, Scott, Burchard, Esteban G., Arking, Dan E., Bibbins-Domingo, Kirsten, Harris, Tamara B., Perez, Marco V., Ziv, Elad, and Marcus, Gregory M.
- Published
- 2016
- Full Text
- View/download PDF
40. Lower Risk of Cardiovascular Events in Postmenopausal Women Taking Oral Estradiol Compared With Oral Conjugated Equine Estrogens.
- Author
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Smith, Nicholas L., Blondon, Marc, Wiggins, Kerri L., Harrington, Laura B., van Hylckama Vlieg, Astrid, Floyd, James S., Hwang, Melody, Bis, Joshua C., McKnight, Barbara, Rice, Kenneth M., Lumley, Thomas, Rosendaal, Frits R., Heckbert, Susan R., and Psaty, Bruce M.
- Published
- 2014
- Full Text
- View/download PDF
41. Hormone Replacement Therapy for Secondary Prevention of Coronary Heart Disease
- Author
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Pan, Cynthia X., Boal, Jeremy, Banks, Emily, Beral, Valerie, Ong, Paul J.L., Sorensen, Morten B., Hayward, Christopher S., Webb, Carolyn M., Collins, Peter, Sullivan, Jerome L., Heckbert, Susan R., Weiss, Noel S., Psaty, Bruce M., Vandenbroucke, Jan P., Hulley, Stephen, Grady, Deborah, Vittinghoff, Eric, Bush, Trudy, Furberg, Curt, Herrington, David, Riggs, Betty, and Petitti, Diana B.
- Subjects
Hormone therapy -- Health aspects ,Estrogen -- Health aspects ,Coronary heart disease -- Prevention - Published
- 1999
42. Estrogen and heart disease: alternatives to a paradigm in crisis
- Author
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Sullivan, Jerome L., Hsia, Judith, Manson, JoAnn E., Johnson, Karen C., Hendrix, Susan L., Heckbert, Susan R., Crawford, Sybil, Eaton, Charles B., and Kostis, John B.
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Estrogen -- Dosage and administration ,Estrogen -- Research ,Hormone therapy -- Research ,Heart diseases -- Prevention ,Postmenopausal women -- Health aspects ,Postmenopausal women -- Research ,Health - Published
- 2006
43. Atrial Fibrillation and the Risk of Sudden Cardiac Death.
- Author
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Chen, Lin Y., Sotoodehnia, Nona, Bůžková, Petra, Lopez, Faye L., Yee, Laura M., Heckbert, Susan R., Prineas, Ronald, Soliman, Elsayed Z., Adabag, Selcuk, Konety, Suma, Folsom, Aaron R., Siscovick, David, and Alonso, Alvaro
- Subjects
ATRIAL fibrillation ,CARDIAC arrest ,POPULATION ,CARDIAC patients ,ATRIAL arrhythmias - Abstract
The article presents a study that examined the association between atrial fibrillation (AF) and increased risk of sudden cardiac death (SCD).The study reveals the link between incident AF and increased risk of SCD and non-SCD in the general population. It proposes additional research to identify predictors of SCD in patients with AF.
- Published
- 2013
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44. Prediction of Critical Illness During Out-of-Hospital Emergency Care.
- Author
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Seymour, Christopher W., Kahn, Jeremy M., Cooke, Colin R., Watkins, Timothy R., Heckbert, Susan R., and Rea, Thomas D.
- Subjects
CATASTROPHIC illness ,MEDICAL triage ,EMERGENCY medical services ,HOSPITAL emergency services - Abstract
The article discusses a study which investigated the out-of-hospital predictors of critical illness which may improve triage decisions and facilitate regionalization of critical care. The population-based cohort study involved an emergency medical services (EMS) system in greater King County, Washington. Nontrauma, non-cardiac arrest adult patients who were transported to a hospital from 2002 to 2006 were assessed by the authors. The association between the development of critical illness during hospitalization and the score on a prediction rule is cited.
- Published
- 2010
- Full Text
- View/download PDF
45. Association of Genetic Variations With Nonfatal Venous Thrombosis in Postmenopausal Women.
- Author
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Smith, Nicholas L., Hindorff, Lucia A., Heckbert, Susan R., Lemaitre, Rozenn N., Marciante, Kristin D., Rice, Kenneth, Lumley, Thomas, Bis, Joshua C., Wiggins, Kerri L., Rosendaal, Frits R., and Psaty, Bruce M.
- Subjects
MEDICAL research ,HUMAN genetic variation ,BIOLOGICAL variation ,VENOUS thrombosis ,PERIMENOPAUSE ,MENOPAUSE ,DISEASE risk factors ,THROMBOPLASTIN ,GENES - Abstract
The article presents information on a medical study done to research the association of genetic variations and nonfatal venous thrombosis in postmenopausal women. According to the article, although the roles of clotting proteins that influence fibrin production have already been researched, this particular study focuses on the role of genetic variation in the risk of venous thrombosis in a perimenopausal and postmenopausal women. The study shows that the only gene associated with the risk is the tissue factor pathway inhibitor gene.
- Published
- 2007
- Full Text
- View/download PDF
46. Esterified Estrogens and Conjugated Equine Estrogens and the Risk of Venous Thrombosis.
- Author
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Smith, Nicholas L., Heckbert, Susan R., Lemaitre, Rozenn N., Reiner, Alex P., Lumley, Thomas, Weiss, Noel S., Larson, Eric B., Rosendaal, Frits R., and Psaty, Bruce M.
- Subjects
- *
ESTROGEN replacement therapy , *HORMONE therapy for menopause , *VENOUS thrombosis risk factors , *MEDICAL research , *HORMONE therapy , *THROMBOSIS risk factors , *HEALTH risk assessment - Abstract
Context Clinical trial evidence indicates that estrogen therapy with or without progestins increases venous thrombotic risk. The findings from these trials, which used oral conjugated equine estrogens, may not be generalizable to other estrogen compounds. Objective To compare risk of venous thrombosis among esterified estrogen users, conjugated equine estrogen users, and nonusers. Design, Setting, and Participants This population-based, case-control study was conducted at a large health maintenance organization in Washington State. Cases were perimenopausal and postmenopausal women aged 30 to 89 years who sustained a first venous thrombosis between January 1995 and December 2001 and controls were matched on age, hypertension status, and calendar year. Main Outcome Measure Risk of first venous thrombosis in relation to current use of esterified or conjugated equine estrogens, with or without concomitant progestin. Current use was defined as use at thrombotic event for cases and a comparable reference date for controls. Results Five hundred eighty-six incident venous thrombosis cases and 2268 controls were identified. Compared with women not currently using hormones, current users of esterified estrogen had no increase in venous thrombotic risk (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.69-1.22). In contrast, women currently taking conjugated equine estrogen had an elevated risk (OR, 1.65; 95% CI, 1.24-2.19). When analyses were restricted to estrogen users, current users of conjugated equine estrogen had a higher risk than current users of esterified estrogen (OR, 1.78; 95% CI, 1.11-2.84). Among conjugated equine estrogen users, increasing daily dose was associated with increased risk (trend P value = .02). Among all estrogen users, concomitant progestin use was associated with increased risk compared with use of estrogen alone (OR, 1.60; 95% CI, 1.13-2.26). Conclusion Our finding that conjugated equine estrogen but not esterified estrogen... [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
47. Diuretic Therapy, the α-Adducin Gene Variant, and the Risk of Myocardial Infarction or Stroke in Persons With Treated Hypertension.
- Author
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Psaty, Bruce M., Smith, Nicholas L., Heckbert, Susan R., Vos, Hans L., Lemaitre, Rozenn N., Reiner, Alexander P., Siscovick, David S., Bis, Joshua, Lumley, Thomas, Longstreth, Jr, W. T., and Rosendaal, Frits R.
- Subjects
DIURETICS ,MYOCARDIAL infarction treatment ,THERAPEUTICS ,HYPERTENSION ,CLINICAL medicine - Abstract
Context: A genetic variant in α-adducin has been associated with renal sodium reabsorption and salt-sensitive hypertension. Whether this genetic variant modifies the effect of diuretic therapy on the incidence of myocardial infarction (MI) and stroke is unknown. Objectives: To estimate the interaction between α-adducin and diuretic therapy on the risk of MI or stroke. Specifically, we hypothesized that in participants with treated hypertension, the risk of MI or stroke associated with diuretic use would be lower in carriers of the adducin variant than in carriers of the adducin wild-type genotype. Design, Setting, and Participants: Population-based case-control study of patients enrolled in a health maintenance organization, treated pharmacologically for hypertension, and genotyped as homozygous carriers of the adducin wild-type genotype or carriers of 1 or 2 copies of the Trp460 variant allele. Cases had a first nonfatal MI (n = 206) or stroke (n = 117) between January 1995 and December 1998. Controls (n = 715) were a stratified random sample of pharmacologically treated hypertensive patients who were matched to MI cases by age, sex, and calendar year. Main Outcome Measure: Risk of the combined outcome of first nonfatal MI or stroke. Results: The adducin variant was present in more than one third of the participants. Among the 653 carriers of the adducin wild-type genotype, diuretic therapy was not associated with the risk of MI or stroke (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.78-1.52). Among the 385 carriers of the adducin variant allele, diuretic therapy was associated with a lower risk of the combined outcome of MI and stroke than other antihypertensive therapies (OR, 0.49; 95% CI, 0.32-0.77). The OR in carriers of the adducin variant was less than half of the OR in carriers of the wild-type genotype (P = .005). The case-control synergy index (SI) was 0.45 (95% CI, 0.26-0.79) for the combined outcome of MI and stroke. The point... [ABSTRACT FROM AUTHOR]
- Published
- 2002
- Full Text
- View/download PDF
48. Risk of recurrent coronary events in relation to use and recent initiation of postmenopausal...
- Author
-
Heckbert, Susan R., Kaplan, Robert C., Weiss, Noel S., Psaty, Bruce M., Danyu Lin, Furberg, Curt D., Starr, Jacqueline R., Anderson, Gail D., and LaCroix, Andrea Z.
- Subjects
- *
CORONARY disease , *HORMONE therapy for menopause , *MYOCARDIAL infarction - Abstract
Discusses results of a study assessing the risk of recurrent coronary events in relation to use and recent initiation of postmenopausal hormone therapy in women who survived a first myocardial infarction. Percent risk of coronary event during the first 60 days after starting hormone therapy; Percent reduction of coronary event risk with prolonged hormone use.
- Published
- 2001
- Full Text
- View/download PDF
49. Use of Administrative Data to Estimate the Incidence of Statin-Related Rhabdomyolysis.
- Author
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Floyd, James S., Heckbert, Susan R., Weiss, Noel S., Carrell, David S., and Psaty, Bruce M.
- Subjects
- *
RHABDOMYOLYSIS , *STATINS (Cardiovascular agents) , *SIMVASTATIN , *MEDICINE , *ANTICHOLESTEREMIC agents - Abstract
The article focuses on a study on the incidence of statin-related rhabdomyolysis with the use of administrative data. A computerized pharmacy data was used to estimate the total person-years of statin use by statin type and dose among the enrollees of Group Health Cooperative (GHC). A total of 22 cases of statin-related rhabdomyolysis were validated among statin users with an ICD-9 code. The researchers concluded that the results could prompt a warning about the use of high-dose simvastatin.
- Published
- 2012
50. Long-term Outcomes of Left Anterior Fascicular Block in the Absence of Overt Cardiovascular Disease.
- Author
-
Mandyam, Mala C., Soliman, Elsayed Z., Heckbert, Susan R., Vittinghoff, Eric, and Marcus, Gregory M.
- Subjects
CARDIOVASCULAR diseases ,HEART conduction system ,FIBROSIS ,HEART block ,ATRIAL fibrillation ,CORONARY disease ,BLOOD transportation ,BIOMARKERS ,DISEASES - Abstract
The article discusses a research study conducted on long-term consequences of left anterior fascicular block (LAFB) in the absence of overt cardiovascular disease. It mentions that conductions system fibrosis causes blocks in the conduction pathway of blood and such blocks can occur in the absence of other cardiovascular disease. It further mentions that LAFB can be considered as the biological marker for several disease including left heart fibrosis, atrial fibrillation (AF) and congestive heart failure (CHF). It also mentions that results of the study were not able to prove the connection between the conduction block and other coronary heart diseases.
- Published
- 2013
- Full Text
- View/download PDF
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