Showing papers by "Chris T. Longenecker published in 2020"
TL;DR: This year's edition of the Statistical Update includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association’s 2020 Impact Goals.
Abstract: Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovas...
5,078 citations
TL;DR: The American Heart Association pledges support in 5 key areas: professional healthcare worker education and training, technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention, access to essential medications and technologies, research, and advocacy to increase global awareness, resources, and capacity.
Abstract: Rheumatic heart disease (RHD) affects ≈40 million people and claims nearly 300 000 lives each year. The historic passing of a World Health Assembly resolution on RHD in 2018 now mandates a coordina...
26 citations
TL;DR: In Uganda, HIV infection, PCF volume and density are associated with abnormal cardiac structure and function.
Abstract: Objectives To examine the relationship between pericardial fat (PCF) and cardiac structure and function among HIV-infected patients in the sub-Saharan African country of Uganda. People living with HIV (PLHIV) have altered fat distribution and an elevated risk for heart failure. Whether altered quantity and radiodensity of fat surrounding the heart relates to cardiac dysfunction in this population is unknown. Methods One hundred HIV-positive Ugandans on antiretroviral therapy were compared with 100 age and sex-matched HIV-negative Ugandans; all were >45 years old with >1 cardiovascular disease risk factor. Subjects underwent ECG-gated non-contrast cardiac CT and transthoracic echocardiography with speckle tracking strain imaging. Multivariable linear and logistic regression models were used to explore the association of PCF with echocardiographic outcomes. Results Median age was 55% and 62% were female. Compared with uninfected controls, PLHIV had lower body mass index (27 vs 30, p=0.02) and less diabetes (26% vs 45%, p=0.005). Median left ventricular (LV) ejection fraction was 67%. In models adjusted for traditional risk factors, HIV was associated with 10.3 g/m2 higher LV mass index (LVMI) (95% CI 3.22 to 17.4; p=0.005), 0.87% worse LV global longitudinal strain (GLS) (95% CI −1.66 to −0.07; p=0.03) and higher odds of diastolic dysfunction (OR 1.96; 95% CI 0.95 to 4.06; p=0.07). In adjusted models, PCF volume was significantly associated with increased LVMI and worse LV GLS, while PCF radiodensity was associated with worse LV GLS (all p Conclusions In Uganda, HIV infection, PCF volume and density are associated with abnormal cardiac structure and function.
22 citations
Emory University1, Case Western Reserve University2, Mulago Hospital3, University of Cape Town4, University of Western Australia5, College of Health Sciences, Bahrain6, University of California, San Francisco7, University of Tennessee Health Science Center8, Cincinnati Children's Hospital Medical Center9
TL;DR: The GAS pharyngeal carriage rates seen in Uganda are higher than the most recent pooled results globally, 12% (range 6-28%).
17 citations
TL;DR: An assessment of how human-centered design guided the adaptation of a nurse-led intervention to reduce CVD risk among people living with HIV to enhance the effectiveness and scalability of an integrated HIV/CVD intervention.
15 citations
TL;DR: It is shown for the first time that African PHIV have evidence of CVD risk and structural vascular changes despite viral suppression, and the findings suggest that intestinal barrier dysfunction may be involved in the pathogenesis of subclinical vascular disease in this population.
Abstract: Introduction: The risk of cardiovascular disease (CVD) and its mechanisms in children living with perinatally acquired HIV (PHIV) in sub-Saharan Africa has been understudied.
Methods: Mean common carotid artery intima-media thickness (IMT) and pulse wave velocity (PWV) were evaluated in 101 PHIV and 96 HIV negative children (HIV-). PHIVs were on ART, with HIV-1 RNA level ≤400 copies/mL. We measured plasma and cellular markers of monocyte activation, T-cell activation, oxidized lipids and gut integrity.
Results: Overall median (Q1; Q3) age was 13 years (11; 15) and 52% were females. Groups were similar by age, sex and BMI. Median ART duration was 10 years (8; 11). PHIVs had higher waist-hip ratio, triglycerides, and insulin resistance (p≤ 0.03). Median IMT was slightly thicker in PHIVs compared to HIV- children (1.05 mm vs 1.02 mm for mean IMT and 1.25 vs 1.21 mm for max IMT; p<0.05), while PWV did not differ between groups (p=0.06). In univariate analyses, lower BMI and oxidized LDL, and higher waist-hip ratio, hsCRP and zonulin correlated with thicker IMT in PHIV (p≤0.05). After adjustment for age, BMI, sex, CD4 cell count, triglycerides, and separately adding sCD163, sCD14 and hsCRP, higher levels of intestinal permeability as measured by zonulin remained associated with IMT (β=0.03 and 0.02 respectively, p≤0.03).
Conclusions: Our study shows for the first time that African PHIV have evidence of CVD risk and structural vascular changes despite viral suppression. Our findings suggest that intestinal barrier dysfunction may be involved in the pathogenesis of subclinical vascular disease in this population.
12 citations
United States Department of Health and Human Services1, Case Western Reserve University2, University of Washington3, University of California, Los Angeles4, Duke University5, University of Rochester Medical Center6, Semel Institute for Neuroscience and Human Behavior7, University of Texas Southwestern Medical Center8, Rockefeller University9
TL;DR: The PRECluDE consortium supported by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute catalyzes implementation research on proven-effective interventions for co-occurring heart, lung, blood, and sleep diseases and conditions among PLWH.
12 citations
Columbia University1, University of Western Australia2, Telethon Institute for Child Health Research3, Case Western Reserve University4, University Hospitals of Cleveland5, University of London6, University of Washington7, Dartmouth College8, Cincinnati Children's Hospital Medical Center9, University of Cincinnati10
TL;DR: The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations, which has important implications for the sensitivity and specificity of rheumatic fever diagnosis.
Abstract: Objective Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda Design This was an observational cross-sectional study Setting This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute Patients Participants (aged 0–50 years) were recruited Of 428 participants, 22 were excluded from analysis, and 183 (444%) of the remaining were children aged 5–15 years Main outcome measures ASO was measured in-country by nephelometric technique ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80% upper limit values were established Results The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL Conclusions The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis
12 citations
TL;DR: ARF persists within rheumatic heart disease–endemic communities in Africa, despite the low rates reported in the literature, and early data collection has enabled refinement of the study design to best capture the incidence of ARF.
Abstract: Background Despite the high burden of rheumatic heart disease in sub‐Saharan Africa, diagnosis with acute rheumatic fever (ARF) is exceedingly rare. Here, we report the results of the first prospec...
11 citations
TL;DR: Compared with men, women of reproductive age with rheumatic heart disease in Uganda have lower rates of appropriate anticoagulant prescription but also lower mortality rates.
Abstract: Background Rheumatic heart disease disproportionately affects women of reproductive age, as it increases the risk of cardiovascular complications and death during pregnancy and childbirth. In sub-Saharan Africa, clinical outcomes and adherence to guideline-based therapies are not well characterized for this population. Methods and Results In a retrospective cohort study of the Uganda rheumatic heart disease registry between June 2009 and May 2018, we used multivariable regression and Cox proportional hazards models to compare comorbidities, mortality, anticoagulation use, and treatment cascade metrics among women versus men aged 15 to 44 with clinical rheumatic heart disease. We included 575 women and 252 men with a median age of 27 years. Twenty percent had New York Heart Association Class III-IV heart failure. Among patients who had an indication for anticoagulation, women were less likely than men to receive a prescription of warfarin (66% versus 81%; adjusted odds ratio, 0.37; 95% CI, 0.14-0.96). Retention in care (defined as a clinic visit within the preceding year) was poor among both sexes in this age group (27% for men, 24% for women), but penicillin adherence rates were high among those retained (89% for men, 92% for women). Mortality was higher in men than women (26% versus 19% over a median follow-up of 2.7 years; adjusted hazard ratio, 1.66; 95% CI, 1.18-2.33). Conclusions Compared with men, women of reproductive age with rheumatic heart disease in Uganda have lower rates of appropriate anticoagulant prescription but also lower mortality rates. Retention in care is poor among both men and women in this age range, representing a key target for improvement.
6 citations
TL;DR: Examination of the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention found three themes emerged across sites and disciplines: healthcare payers substantially shape preventative cardiovascular care in HIV clinics, and grant-based services enable tailored cardiovascular disease Prevention, but sustainability is limited by sponsor priorities.
Abstract: People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. Clinical Trial Registration Number:
NCT03643705
.
TL;DR: Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced pulmonary artery hypertension (PAH), however, evidence of impaired ventilation is found suggesting a non-cardiopulmonary etiology for dyspnea.
Abstract: Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO2) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO2 slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO2 measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO2 (p = 0.02, p = 0.03). Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.
TL;DR: While perceptions of ASCVD risk modestly influence some behaviors, additional barriers and insufficient cues to action result in suboptimal physical activity, dietary intake, and smoking rates.
Abstract: Background People living with HIV (PLHIV) are at elevated risk of developing atherosclerotic cardiovascular disease (ASCVD). PLHIV do not engage in recommended levels of ASCVD prevention behaviors, perhaps due to a reduced perception of risk for ASCVD. We examined how HIV status influences knowledge, beliefs, and perception of risk for ASCVD and ASCVD prevention behaviors. Methods and results We conducted a mixed-methods study of 191 PLHIV and demographically similar HIV-uninfected adults. Participants completed self-reported surveys on CVD risk perceptions, adherence to CVD medication (aspirin, antihypertensives, and lipid-lowering medication) and 3 dietary intake interviews. All wore an accelerometer to measure physical activity. A subset of PLHIV (n = 38) also completed qualitative focus groups to further examine the influence of HIV on knowledge, perception of risk for ASCVD, and behavior. Participants They were approximately 54 (±10) years, mostly men (n = 111; 58%), and African American (n = 151, 83%) with an average 10-year risk of an ASCVD event of 10.4 (±8.2)%. PLHIV were less likely to engage in physical activity (44% vs 65%, P 0.05). HIV status did not influence ASCVD risk perceptions (P > 0.05) and modestly influenced physical activity and smoking. Conclusions Although perceptions of ASCVD risk modestly influence some behaviors, additional barriers and insufficient cues to action result in suboptimal physical activity, dietary intake, and smoking rates. However, PLHIV have high adherence to ASCVD medications, which can be harnessed to reduce their high burden of ASCVD.
TL;DR: Efforts to reduce CVD morbidity in historically marginalized racial and ethnic groups with HIV must address participation in clinical research, social determinants of health and translation of research into clinical practice.
TL;DR: Findings suggest that future research should focus on developing interventions to enhance patient–provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies.
Abstract: Background After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. Methods Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. Results Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. Conclusion Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.