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Objectives This study sought to assess the relationship between central pressure profiles and cardiovascular events (CVEs) in a large community-based sample. Background Experimental and physiologic data mechanistically implicate wave reflections in the pathogenesis of left ventricular failure and cardiovascular disease, but their association with these outcomes in the general population is unclear. Methods Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 5,960 participants in the Multiethnic Study of Atherosclerosis. The central pressure waveform was separated into forward and reflected waves using a physiologic flow waveform. Reflection magnitude (RM = [Reflected/Forward wave amplitude] × 100), augmentation index ([Second/First systolic peak] × 100) and pulse pressure amplification ([Radial/aortic pulse pressure] × 100) were assessed as predictors of CVEs and congestive heart failure (CHF) during a median follow-up of 7.61 years. Results After adjustment for established risk factors, aortic AIx independently predicted hard CVEs (hazard ratio [HR] per 10% increase: 1.08; 95% confidence interval [CI]: 1.01 to 1.14; p = 0.016), whereas PPA independently predicted all CVEs (HR per 10% increase: 0.82; 95% CI: 0.70 to 0.96; p = 0.012). RM was independently predictive of all CVEs (HR per 10% increase: 1.34; 95% CI: 1.08 to 1.67; p = 0.009) and hard CVEs (HR per 10% increase: 1.46; 95% CI: 1.12 to 1.90; p = 0.006) and was strongly predictive of new-onset CHF (HR per 10% increase: 2.69; 95% CI: 1.79 to 4.04; p Conclusions Arterial wave reflections represent a novel strong risk factor for CHF in the general population.

Background: The average age of first childbirth is increasing in the United States, as well as the proportion of women who choose not to have children or have a smaller family size. Previous research identified lower parity in women with IBD compared to the general population due to disease-related pregnancy concerns. IBD management has changed over the past decade with the addition of biologic therapies, potentially altering IBD-related pregnancy concerns in women with IBD. We sought to explore disease-related pregnancy concerns and their effect on parity and future reproductive planning in a subset of women with IBD. Methods: Female reproductive age Crohn's and ulcerative colitis patients in an academic practice were identified by electronic database query, sent an opt-out letter, and then contacted for phone survey. Questions included demographics, medical and reproductive history, and plans for future pregnancy. Women were asked if IBD has affected their decision to become pregnant and, if so, a qualitative response on specific concerns was recorded. Qualitative data was coded and frequencies and proportions calculated. We analyzed quantitative data with Stata V11 (College Station, TX) and used Chi-square and Wilcoxon rank-sum tests, as appropriate. Results: 121 female participants (31% response rate) were predominately white (85%), had at least some college education, and a mean age of 34.2 years (SD 6.2). 60% had Crohn's, 30% had IBD-related surgery, 36% were on biologic therapy, and 30% on immunomodulators. 43% had at least one child, 58% desire a future pregnancy, and 54% reported IBD-related pregnancy concerns. Of the 70 women who desire a future pregnancy, the median parity was significantly higher in those with IBD-related concerns (0, range 0-3) compared to those without concerns (0, range 0-2) [Table 1]. IBD-related concerns did not affect the parity in women without a desire for future pregnancy [Table 1]. Women who desire a future pregnancy were more concerned about adverse pregnancy outcomes than those who do not and only four women (3.3%) identified IBD-related concerns that led to a smaller family size than desired [Table 2]. Conclusion: Reproductive planning is multi-faceted for every woman. These data suggest IBD-related concerns are less likely to affect a woman's planned family size than previously reported. The concern for adverse pregnancy outcomes is more common in women with IBD desirous of future pregnancy, suggesting a need for targeted counseling to moderate risk perception. Comparison of participant parity by future pregnancy desire and IBD-related pregnancy concerns