Showing papers by "Alan Rozanski published in 2014"
TL;DR: Four initiatives are proposed to meet the challenge of translating growing epidemiological evidence into cardiology practice, including promulgating greater awareness of the potency of psychosocial risks factors and overcoming a current "artificial divide" between conventional and Psychosocial risk factors.
123 citations
TL;DR: Long-term mortality risk varies markedly in accordance with baseline CAD risk factors and functional capacity among patients with normal exercise SPECT-MPI studies.
36 citations
TL;DR: Asymptomatic subjects with a 0 CAC score and a positive family history of CHD are at increased risk for CVD and CHD events compared with those without a family historyof CHD, although absolute event rates remain low.
Abstract: Although a coronary artery calcium (CAC) score of 0 is associated with a very low 10-year risk for cardiac events, this risk is nonzero. Subjects with a family history of coronary heart disease (CHD) has been associated with more subclinical atherosclerosis than subjects without a family history of CHD. The purpose of this study was to assess the significance of a family history for CHD in subjects with a CAC score of 0. The Multi-Ethnic Study of Atherosclerosis cohort includes 6,814 participants free of clinical cardiovascular disease (CVD) at baseline. Positive family history was defined as reporting a parent, sibling, or child who had a heart attack. Time to incident CHD or CVD event was modeled using the multivariable Cox regression; 3,185 subjects were identified from the original Multi-Ethnic Study of Atherosclerosis cohort as having a baseline CAC score of 0 (mean age 58 years, 37% men). Over a median follow-up of 10 years, 101 participants (3.2%) had CVD events and 56 (1.8%) had CHD events. In age- and gender-adjusted analyses, a family history of CHD was associated with an ∼70% increase in CVD (hazard ratio 1.73, 95% confidence interval 1.17 to 2.56) and CHD (hazard ratio 1.72, 95% confidence interval 1.01 to 2.91) events. CVD events remained significant after further adjustment for ethnicity, risk factors, and baseline medication use. In conclusion, asymptomatic subjects with a 0 CAC score and a positive family history of CHD are at increased risk for CVD and CHD events compared with those without a family history of CHD, although absolute event rates remain low.
28 citations
TL;DR: In this paper, the authors evaluated the incidence of ischemia in patients with dyspnea compared with patients with chest pain referred for stress testing and assessed the outcomes of such patients.
Abstract: Previous studies have suggested that patients with dyspnea referred for stress testing have high mortality. However, it is not clear whether this is explained by high rates of ischemia. The aim of the present study was to evaluate the incidence of ischemia in patients with dyspnea compared with patients with chest pain referred for stress testing and assess the outcomes of such patients. We systematically searched the electronic databases, MEDLINE, PubMed, EMBASE, and the Cochrane Library, until December 2012 to identify studies of patients with known or suspected coronary artery disease undergoing stress testing. We extracted data on group-specific incidence of stress-induced ischemia and all-cause mortality. In our analyses, we identified and included 6 studies that evaluated a total of 5,753 patients with dyspnea and 24,491 patients with chest pain as the clinical indication for stress testing. There was no statistically significant difference in the incidence of ischemia on stress imaging in patients with dyspnea compared with patients with chest pain (37.4% vs 30.2%, odds ratio 1.43, 95% confidence interval 0.99 to 2.06, p = 0.06). However, during the follow-up period, patients with dyspnea had higher all-cause mortality rates compared with patients with chest pain (annual mortality 4.9% vs 2.3%), with odds ratio of 2.57 (95% confidence interval 1.75 to 3.76, p
27 citations
TL;DR: The 4-year follow-up of 6808 individuals for the development of incident heart failure after an initial psychological and clinical evaluation that included measurement of optimism–pessimism according to the Revised Life Orientation Test predicted a lower risk for developing heart failure.
Abstract: People have characteristic mindsets, habitual ways of thinking that are the product of temperament, upbringing, life experiences, and other factors. One of the best characterized mindsets is that of optimism versus pessimism. According to a simple definition, optimists tend to have a general expectation of positive outcomes, whereas pessimists tend to expect negative outcomes. The value of optimism is clear. Optimism has been repeatedly shown to predict better success in many walks of life, including education, business, politics, and sports performance, and has been associated with more successful aging, higher quality of social relationships, greater resiliency, generally greater get-go, and more happiness.
Article see p 394
Initial medical investigations into the health benefits of optimism began with studies of individuals’ explanatory style about life events, as promulgated by Seligman. For instance, optimists tend to explain negative events as transient in nature, whereas pessimists tend to explain events in more permanent terms. In recent years, investigators have favored measuring dispositional optimism, as commonly assessed according to the Revised Life Orientation Test. This scale includes items such as “in uncertain times, I usually expect the best” and “I hardly ever expect things to go my way”. Notably, both explanatory-style and dispositional optimism have been demonstrated to predict better health outcomes.
In this issue of Circulation: Heart Failure , Kim et al1 report on the 4-year follow-up of 6808 individuals, with a mean age of 70 years, for the development of incident heart failure after an initial psychological and clinical evaluation that included measurement of optimism–pessimism according to the Revised Life Orientation Test. Even after thorough adjustment for clinical, demographic, behavioral, and psychological covariates, including depression, optimism predicted a lower risk for developing heart failure. A dose–response relationship was noted between increasing levels of optimism and decreasing incidence of heart failure. Overall, …
17 citations
01 Jan 2014
TL;DR: Asymptomatic subjects with a 0 CAC score and a positive family history of CHD are at increased risk for CVD and CHD events compared with those without a family historyof CHD, although absolute event rates remain high.
Abstract: Although a coronary artery calcium (CAC) score of 0 is associated with a very low 10-year risk for cardiac events, this risk is nonzero. Subjects with a family history of coronary heart disease (CHD) has been associated with more subclinical atherosclerosis than subjects without a family history of CHD. The purpose of this study was to assess the significance of a family history for CHD in subjects with a CAC score of 0. The Multi-Ethnic Study of Atherosclerosis cohort includes 6,814 participants free of clinical cardiovascular disease (CVD) at baseline. Positive family history was defined as reporting a parent, sibling, or child who had a heart attack. Time to incident CHD or CVD event was modeled using the multivariable Cox regression; 3,185 subjects were identified from the original Multi-Ethnic Study of Atherosclerosis cohort as having a baseline CAC score of 0 (mean age 58 years, 37% men). Over a median follow-up of 10 years, 101 participants (3.2%) had CVD events and 56 (1.8%) had CHD events. In age- and gender-adjusted analyses, a family history of CHD was associated with an w70% increase in CVD (hazard ratio 1.73, 95% confidence interval 1.17 to 2.56) and CHD (hazard ratio 1.72, 95% confidence interval 1.01 to 2.91) events. CVD events remained significant after further adjustment for ethnicity, risk factors, and baseline medication use. In conclusion, asymptomatic subjects with a 0 CAC score and a positive family history of CHD are at increased risk for CVD and CHD events compared with those without a family history of CHD, although absolute event rates remain
17 Mar 2014
TL;DR: A conversation between a student and a mentor does not happen very often in adult life as mentioned in this paper, and it does not seem like the student has thought about this a whole lot, either.
Abstract: “Tell me, Johnnie, are you reaching your potential?” “What?” “Johnnie, you and I and everybody else have hidden potential. What percent do you think you are reaching?” “I don’t know. Probably just a small fraction.” “Johnnie, it does not seem like you have thought about this a whole lot. Let’s discuss it”. Have you ever been challenged by such a question? This conversation between student and mentor does not happen very often in adult life.