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Articles by D Conen
Total Records ( 3 ) for D Conen
  D Conen , K. M Rexrode , M. A Creager and P. M Ridker
 

Background— The metabolic syndrome (MetS) is associated with incident myocardial infarction and stroke and is linked with subclinical inflammation; however, prospective data pertaining to MetS and future peripheral artery disease (PAD) are sparse, with few studies examining the role of inflammation. We therefore evaluated the relationship between MetS, inflammation, and incident PAD.

Methods and Results— We conducted a prospective cohort study among 27 111 women free of baseline cardiovascular disease who were participating in the Women’s Health Study. Subjects were followed for incident symptomatic PAD (n=114; median cohort follow-up 13.3 years). We used Cox proportional hazards models to compare PAD risk among women with and without MetS. We also evaluated relationships between MetS and subclinical inflammation as measured by high-sensitivity C-reactive protein and soluble intercellular adhesion molecule-1 and adjusted for these biomarkers in multivariable models. Women with MetS had a 62% increased risk of future PAD (hazard ratio 1.62, 95% confidence interval 1.10 to 2.38). After multivariable adjustment, MetS remained significantly associated with PAD (adjusted hazard ratio 1.48, 95% confidence interval 1.01 to 2.18), with a 21% risk increase per additional MetS-defining trait (adjusted hazard ratio 1.21, 95% confidence interval 1.06 to 1.39). In women with and without MetS, respectively, median levels of high-sensitivity C-reactive protein were 4.0 versus 1.5 mg/L (P<0.0001), and median levels of soluble intercellular adhesion molecule-1 were 374 versus 333 ng/mL (P<0.0001). When high-sensitivity C-reactive protein and soluble intercellular adhesion molecule-1 were added to multivariable models, risk associated with MetS was substantially attenuated and no longer significant (hazard ratio 1.14, 95% confidence interval 0.75 to 1.73).

Conclusions— MetS is associated with an increased risk of future symptomatic PAD in women. This risk appears to be mediated largely by the effects of inflammation and endothelial activation.

  D Conen , U. B Tedrow , N. R Cook , J. E Buring and C. M. Albert
 

Background— Few if any studies have assessed the relationship between birth weight and incident atrial fibrillation (AF).

Methods and Results— From 1993 to 2009, we prospectively followed 27 982 women who were >45 years of age and free of cardiovascular disease and AF at baseline. Information on birth weight was categorized into 5 different categories: <2.5, 2.5 to 3.2, 3.2 to 3.9, 3.9 to 4.5, and >4.5 kg. The primary outcome was time to incident AF. During 14.5 years of follow-up, 735 AF events occurred. Age-adjusted incidence rates for incident AF from the lowest to the highest birth weight category were 1.45, 1.82, 1.88, 2.57, and 2.55 events per 1000 person-years of follow-up. After multivariable adjustment, hazard ratios for incident AF across increasing birth weight categories were 1.0, 1.30 (95% confidence interval [CI], 0.96 to 1.75), 1.28 (95% CI, 0.96 to 1.69), 1.70 (95% CI, 1.23 to 2.37), and 1.71 (95% CI, 1.12 to 2.61) (P for linear trend=0.002). Adding body mass index, blood pressure, and diabetes mellitus at study entry did not have a large effect on these estimates (P for linear trend=0.004). In contrast, including height in the multivariable model substantially attenuated the relationship between birth weight and AF (P for linear trend=0.17), and additional adjustment for maximum weight in young adulthood further attenuated this association (multivariable-adjusted hazard ratio across birth weight categories, 1.0, 1.27 [95% CI, 0.94 to 1.71], 1.10 [95% CI, 0.83 to 1.46], 1.41 [95% CI, 1.01 to 1.96], and 1.29 [95% CI, 0.84 to 1.98]; P for linear trend=0.23).

Conclusions— Birth weight is significantly associated with incident AF among women, suggesting that early life determinants may play an important role in the pathogenesis of AF.

Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000479.

  D Conen , R. J Glynn , P. M Ridker , J. E Buring and M. A. Albert
  Aims

The aim of this study was to examine the association between socioeconomic status, blood pressure (BP) progression, and incident hypertension.

Methods and results

We included 27 207 female health professionals free of hypertension and cardiovascular disease at baseline. Participants were classified into five education and six income categories. The main outcome variables were BP progression at 48 months of follow-up and incident hypertension during the entire study period. At 48 months, 48.1% of women had BP progression. The multivariable adjusted relative risks [95% confidence intervals (CIs)] for BP progression were 1.0 (referent), 0.96 (0.92–1.00), 0.92 (0.88–0.96), 0.90 (0.85–0.94), and 0.84 (0.78–0.91) (P for trend <0.0001) across increasing education categories and 1.0 (referent), 1.01 (0.94–1.08), 0.99 (0.93–1.06), 0.97 (0.91–1.04), 0.96 (0.90–1.03), and 0.89 (0.83–0.96) across increasing income categories (P for trend = 0.0001). During a median follow-up of 9.8 years, 8248 cases of incident hypertension occurred. Multivariable adjusted hazard ratios (95% CI) were 1.0 (referent), 0.92 (0.86–0.99), 0.85 (0.79–0.92), 0.87 (0.80–0.94), and 0.74 (0.65–0.84) (P for trend <0.0001) across increasing education categories and 1.0 (referent), 1.07 (0.95–1.21), 1.07 (0.95–1.20), 1.06 (0.94–1.18), 1.04 (0.93–1.16), and 0.93 (0.82–1.06) (P for trend 0.08) across increasing income categories. In joint analyses, education but not income remained associated with BP progression and incident hypertension.

Conclusion

Socioeconomic status, as determined by education but not by income, is a strong independent predictor of BP progression and incident hypertension in women.

 
 
 
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