The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Facing Off Against Heart Disease

24th Annual Update 2012-2013 The staff members and fellows of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease include:

(Top row, left to right) Thura Abd, MD; Arthur Agatston, MD; Haitham Ahmed, MD; Nivee Amin, MD; Dominique Ashen, PhD, CRNP; Kevin Billups, MD; Michael J. Blaha, MD (Second row) Roger S. Blumenthal, MD; Chintan Desai, MD; Gary Gerstenblith, MD; Sherita Golden, MD; Rani Hasan, MD; Aaron Horne, MD; Steve Hsu, MD (Third row) Steven Jones, MD; Parag H. Joshi, MD; Seth S. Martin, MD; J. William McEvoy, MD; Rebeccah McKibben, MPH; Erin Michos, MD (Fourth row) Evan Muse, MD; Khurram Nasir, MD; Chiadi Ndumele, MD; Shay Ojeifo, MD; Birju Patel, MD; (Fifth row) Wendy Post, MD; Elizabeth Ratchford, MD; Jonathan Rubin, MD; Michael G. Silverman, MD (Sixth row) Rajesh Tota-Maharaj, MD; Seamus Whelton, MD; Omair Yousuf, MD (Seventh row) Michelle Zikusoka, MD Message from the Director Recalling an Outstanding Year, By the Numbers

his past year was a truly outstanding one for Irene’s philanthropy will also allow us to provide advanced the Johns Hopkins Ciccarone Center for the educational training for some of our postdoctoral TPrevention of Heart Disease. In fact, when I look cardiology fellows in cardiovascular epidemiology and back on 2013, several key numbers literally clinical trial design at the Bloomberg School stand out in my mind: 25, 10, 116, and 39. of Public Health. Drs. Parag Joshi, Seth Martin, and J. Bill McEvoy were named For starters, it is hard for me to believe that the inaugural Pollin Cardiovascular Prevention 25 years have passed since Henry Ciccarone, fellows this year. They are committed to a legendary athlete and lacrosse coach at becoming academic medicine leaders in their Hopkins, died of sudden cardiac death in 1988, chosen field of preventive cardiology. Irene’s after two previous heart attacks. During the magnificent generosity also will allow us to 18 months following his death, I worked with expand our educational and outreach efforts Coach Ciccarone’s family, friends, and colleagues at and play a lead role in implementing the new AHA/ACC/ Hopkins to develop a plan to establish a comprehensive NHLBI prevention guidelines throughout the Hopkins clinical and research center, where the dedication and medical system. perseverance of the clinicians and researchers would embody the great work ethic and accomplishments of this Irene’s gift is only the most recent example of her university icon. long-standing commitment to the Ciccarone Center. I first became aware of Irene’s dedication to combating I know that Coach Ciccarone, who was a close friend of through Sister to Sister (STS), mine and someone I idolized, would be proud of what an organization she formed in 1999 to provide free we’ve accomplished over the past quarter century and cardiovascular screenings and education for women. excited by all that is yet to come. His widow, Sue, and his One of our early collaborations involved helping to four sons, Henry Jr., Brent, John, and Steve, have been analyze some of the data STS had collected. Dr. Erin loyal supporters of our efforts. Michos did a superb job working with Irene and her group, and the result was an influential paper published in In 2013, we were the fortunate recipients of a generous the Journal of Women’s Health in 2008, with Irene serving gift that will certainly allow us to as the first author and Erin as senior author. build on our solid foundation well into the future. In January, my This study found that many seemingly healthy women long-time friend and colleague in have suboptimal lifestyle habits that put them at the field of innovative prevention increased risk for future heart attacks and strokes, strategies, Irene Pollin, despite having very low Framingham risk scores. It was donated $10 million to serve an eye-opening study that could not have been done as a transformational gift for the without the data collected at the STS health fairs — Ciccarone Center’s research and education missions. the brainchild of Irene Pollin.

Part of that gift was used to establish a professorship Discovering that there are limitations to the traditional in the name of her late son, Kenneth, or “Jay Jay,” who approaches to cardiovascular risk assessment also served died at the age of 13 months from congenital heart as the basis for much of our subsequent clinical research disease. And in July, I was installed as the inaugural projects at the Ciccarone Center. Which brings me to Kenneth Jay Pollin Professor of Cardiology. To have my another outstanding number for 2013: 116. As in, the name forever associated with the Pollin family is indeed number of articles co-authored by our staff a fabulous honor, and one which I share with all of my in the past 12 months (please turn to page 8). That’s a dedicated colleagues in the great Hopkins Division of record for us. Even better, two of the articles brought us Cardiology. national and international recognition. [ continued ] Message from the Director progression, clinical CVD, and death in a single long- asingle in death and CVD, clinical progression, CAC, across baseline lifestyle healthy a of benefits the to connect study first the was This behaviors. healthy three other the of benefits the negated smoking And outcomes. clinical the better the displays, one behaviors healthy more the that indicated study the fact, In behaviors. healthy no with those than rate showed diet, lower an 80% death Mediterranean-style a and weight, normal of maintenance exercise, regular avoidance, smoking as such habits, key lifestyle several followed who participants Moreover, study eight-year period. over an rate death total lower and risk, CVD lower CAC, of progression less with associated were habits lifestyle good that showed study The (MESA). 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We studied the association between lifestyle lifestyle between association the . We studied and Dr. and Michael , will lead to to lead , will led the first first the led for the Prevention of Heart Disease Disease Heart of Prevention the for Center Ciccarone Hopkins Johns Director, Cardiology of Professor Pollin Jay Kenneth The FNLA FACC, MD, FAHA, Blumenthal, S. Roger yours, Sincerely years. 25 next the for acourse we set as us join you will that I hope disease. cardiovascular of impact devastating the combating in done be to work more much so is there but mission, our we have fulfilled that say to proud Iam areality. into disease heart of prevention the for center research and clinical impactful and adynamic of dream 25-year-old the turn have helped who supporters and friends our of all to my thanks I’d extend to like 24). page to turn (please Sessions 2013 Scientific November the at AHA presentation for accepted being Center Ciccarone the of members by co-authored papers 39 of research acceptance record-setting the year: past the of number outstanding final our to led has This effectively. them analyze to Nick and Suellen Paleologos Suellen and Nick as such individuals from decade past over the support research incredible the to part large in thanks Finally, and nationally. locally both attention, media of abit quite garnered study the surprising, Not prevention. to approach 7” “Simple AHA’s the for key provide evidence and research, imaging atherosclerosis our of much for rationale the support findings, our to credibility gaveadded measurements CAC the in findings favorable The investigation. term datasets and obtained the skills skills the obtained and datasets research longitudinal large several we have created and Amato Katharine and Richard Foundation), Schafer Vivian Schafer Gomprecht Irv and Ginger Speno, Joe and Ozzie Cowan Ozzie Joe and , Ed and Marty Marty and Ed (left), (left), (and the PJ

Paul and and Paul , , News & Highlights

This past year has been a momentous one for the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, in terms of accomplishing our goals and continuing our work in creating excellent clinical care, educating health care practitioners, and studying better ways to prevent heart disease. Following is a brief overview of some of what we achieved.

Congrats to Michael Blaha, MD, who was named Assistant Professor of Medicine, Director of Clinical Research ­— and, thus, became an official staff member of the Ciccarone Center — in January. Photos by John Durand This year’s Heartfest honorees were (from left) Jerome In July, Irene Pollin, a passionate health advocate and founder and Tammy Schnydman, and Lynne and Dr. Edward Miller. of a national organization devoted to heart disease prevention in women, donated $10 million to the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Ms. Heartfest Turns 20 Pollin’s transformational gift establishes the Kenneth Jay Pollin On a cold Saturday evening in January 2013, members Professorship in Cardiology, expands the Center’s research of the Johns Hopkins Heart and Vascular Institute efforts, and provides advanced educational training for some had more than the start of a new year to celebrate. of our postdoctoral cardiology fellows in cardiovascular That night marked the return of “Heartfest,” the epidemiology and clinical trial design at the Bloomberg School popular gala event and fundraiser. Featuring “heart- of Public Health. “I see this gift to the Ciccarone Center as a healthy” cuisine prepared by 20 local restaurants and way to make a powerful impact on the knowledge and behavior caterers, complimentary wines and entertainment by of people to improve their health,” commented Ms. Pollin, who The Heart Attackers, a rock band composed of local established the Sister to Sister organization in 2000 to provide cardiologists, a cardiac surgeon and other medical free cardiovascular screenings and education for women. specialists, the event was held at Martin’s Valley Mansion in Cockeysville.

The centerpiece of this year’s Heartfest—the 20th celebration of the event and the first since 2008— was a ceremony honoring two distinguished Hopkins officials:Edward Miller, MD, former dean and CEO of Johns Hopkins Medicine, and Jerome Schnydman, past executive assistant to several Johns Hopkins University presidents, former Hopkins’ undergraduate

Photo by Guill Photo admissions director, and a member of the Irene Pollin formally presented her gift to (from left) Cardiology National Lacrosse Hall of Fame. The evening Chief Gordon Tomaselli, Dean Paul Rothman, President Ron featured a number of special guests, including Daniels, Dr. Blumenthal, and Hospital President Ron Peterson. Ron Peterson, president of Hopkins Hospital and Health System, Tim and Liz Rhode, cofounders Congratulations to our own Roger Blumenthal, MD, of the MAC (Maryland Athletic Club), Steve professor of medicine at the Johns Hopkins University Geppi, president and CEO of Diamond Comic School of Medicine and director of the Ciccarone Center, Distributors. Steve Valenti, MD, a former band who was named the inaugural endowed Kenneth Jay Pollin “regular,” performed with The Heart Attackers, Professor of Cardiology. A nationally recognized expert on who play hits from the 1960s to today and have the development, treatment and prevention of heart disease, been performing together since 1997. Proceeds from Blumenthal led the formation of the Ciccarone Center for the Heartfest raised more than $70,000 toward advances Prevention of Heart Disease at Johns Hopkins in 1990. in clinical care, research, and education. 1 Kudos also to Parag Joshi, MD, Seth Seth Martin, MD, was chosen Martin, MD, and J. Bill McEvoy, to present his research study, MD, who were named the first Pollin “HDL Cholesterol Subclasses and Cardiovascular Prevention fellows. Outcomes in Secondary Prevention: The endowment will support their the Lipoprotein Investigators

News & Highlights & News continuing commitment to becoming Collaborative,” at the Northwestern academic medicine leaders in the field Cardiovascular Young Investigators’ of preventive cardiology and allow all Forum, held September 2013 in Dr. Bill McEvoy three to pursue specialized training at Dr. Chintan Desai Chicago. the Bloomberg School of Health and obtain master’s degrees in cardiovascular epidemiology and clinical trials. Recently, Johns Hopkins cardiologists Chintan Desai, MD, and Roger Blumenthal, MD, were invited to provide expert In May, Sherita Golden, MD, an associate professor of commentary on preventing heart disease for “Raconteur,” a medicine at the Johns Hopkins University School of Medicine, Times of London magazine. A benefit of havingThe Times was appointed as the Hugh P. McCormick Family Professor of publish the article, “Stay Healthy with the ABCs of Heart Medicine in Endocrinology and Metabolism. Disease,” beyond spreading the word about the steps everyone can take to assess and reduce the risk of heart disease, is to raise Wendy Post, MD, whose areas of expertise include the visibility of Johns Hopkins Cardiology throughout Great cardiovascular disease, , Britain, commented Dr. Blumenthal. echocardiography, , preventive cardiology, risk factor modification, and stress testing, was promoted to full professor in June. Rewarding a Hard-working Alum Khurram Nasir, MD, received the Distinguished Rebeccah McKibben, a medical Alumnus award from the Johns Hopkins Bloomberg student at Johns Hopkins who is being mentored by Dr. Post, was School of Public Health. Dr. Nasir, who earned a awarded a grant for a predoctoral master’s in public health in 2001, was honored for his award from the American Heart efforts in publishing over 240 publications focusing on Association for funding to study early detection of subclinical cardiovascular disease subclinical atherosclerosis in persons and the initiation of lifelong prevention therapies. with HIV infection who are elite Rebeccah McKibben controllers, long-term nonprogressors, and virologic suppressors.

Over the past year, Kevin Billups, MD, a urologist with joint appointments in both urology and medicine, has focused much of his efforts developing the Men’s Health & Vitality Program, a unique program that focuses on the connection between sexual health and chronic disease. Working closely with colleagues in the Ciccarone Center, Dr. Billups uses three gender-specific markers (erectile dysfunction, testosterone deficiency, and lower urinary tract symptoms, associated with benign prostate enlargement) to engage men as a means to persuade them to be more proactive about preventive health. These three conditions are all closely associated with both sexual health and increased cardiometabolic risk. Dr. Khurram Nasir receives the Distinguished Alumnus award from Bloomberg School of Public Health Dean Dr. Mike Klag.

2 Stanley L. Blumenthal, MD, Preventive Infarction.” Kinya Seo took home third place for “cGMP-PKG Cardiology Research Awards Modulation of Myocyte Mechanical Response to Stretch: Role Since 2004, the annual Stanley L. Blumenthal, MD, Preventive of TRPC6 Channel Modulation in Dystrophic .” Cardiology Research Awards have been presented to the Hopkins postdoctoral fellows, graduate students, or residents Congratulations to all the winners! submitting the best abstracts to major research meetings, such Highlights & News as the American Heart Association or American College of Cardiology Scientific Sessions. These awards are bestowed following the division’s yearly cardiovascular research retreat Staff Spotlight: Haitham Ahmed, in May. MD, MPH This past year, Haitham Ahmed, MD, MPH, began his First place in the ORAL COMPETITION went to Sravanti cardiology fellowship by working with Michael Blaha, Kusuma for her presentation entitled, “Engineered Clinically- MD, and Roger Blumenthal, MD, to promote the relevant Vascular Networks from Human Pluripotent Stem findings of one of the most important papers we have Cells.” Tied for second place were Michael Silverman, MD, published. The study, “Low-Risk Lifestyle, Coronary for “Coronary Artery Calcium and Cardiovascular Events in Calcium, Cardiovascular Events and Mortality: Results Diabetes - Implications for Primary Prevention Therapies: from MESA,” which appeared in the July issue of The Multi-Ethnic Study of Atherosclerosis (MESA),” the American Journal of and Mark Ranek, MD, for “Protein Kinase G Regulates Epidemiology, investigated Cardioprotection through Destruction.” Mohamed Elshazly, which of the most common MD, took third for “Non-HDL Cholesterol, Guideline Targets, and Population Percentiles for Secondary Prevention healthy lifestyle habits in a Clinical Sample of 1.3 Million Adults.” provide the most protection from heart disease and The top prize in the POSTER COMPETITION IN how these habits prevent CLINICAL SCIENCE/EPIDEMIOLOGY went to disease progression over Grant Chow, MD, for “Hemodynamic Effects of Cardiac the years. Dr. Ahmed Resynchronization Therapy in the looked at the associations Immediate Post-infarct Period: of four habits — smoking Dr. Haitham Ahmed A Canine Model.” Kerunne avoidance, regular exercise, Ketlogetswe, MD, picked maintenance of normal weight, and a healthy up second for “Adiponectin Is Mediterranean-style diet — with coronary artery Associated with Subclinical calcium (CAC) incidence and progression, coronary Coronary Atherosclerosis in the heart disease (CHD) events and total mortality in Multicenter AIDS Cohort Study (MACS).” And third place went to a single large study (MESA), with a mean follow- Deeptankar DeMazumder, MD, up of almost eight years. Subjects who adopted all Dr. Grant Chow for his presentation “Entropy X four of these behaviors had an 80% lower death of Cardiac Rhythm Predicts Mortality in Patients with Heart rate than those with no healthy behaviors; benefits Failure.” were cumulative (i.e., the more healthy behaviors the better); and smokers, even if they exercised, ate For the POSTER COMPETITION IN BASIC SCIENCE, healthy, and maintained normal weight, were worse the top prize went to Peter Anderson for his presentation, off than people who did nothing else right but stayed “Precardiac Deletion of Numb and Numblike Identifies away from cigarettes. “All the factors we looked at Renewing Cardiac Progenitors and their Microenvironment.” are things you can change,” commented Dr. Ahmed, Second place went to Peter Rainer, for “Targeted Inhibition who was the lead author. “You can’t pick your family of Cardiomyocyte-Transforming Growth Factor Beta Induces history or change your age, but you have the ability to a Protective Endoplasmic Reticulum Stress Response and Prevents from Left Ventricular Rupture after Myocardial improve your own wellness and health.”

3 P.J. Schafer Cardiovascular Research Award Hopkins Cardiology is indebted to Paul and Vivian Schafer The P.J. Schafer Cardiovascular Research Award funds the and the Board of the P.J. Schafer Foundation for their hard efforts of clinical investigators seeking a better understanding work and generous contributions in support of cutting-edge of how to diagnose premature heart disease and prevent research geared to the prevention of sudden cardiac death, sudden cardiac death. Previous recipients of this prestigious which tragically took the life of their son, P.J. To make

News & Highlights & News award, which is given to a junior faculty member, include Drs. donations or sign up for the P.J. Schafer golf tournament, go to Erin Michos, Richard George, Saman Nazarian, Rhondalyn www.pjschafer.com. McLean, Oscar Cingolani and Chiadi Ndumele.

The 2013-2014 P.J. Schafer award More Than 110 winner is Michael J. Blaha, MD MPH, The Ciccarone Center continues to publish for his research in the prevention of heart important original research articles, editorials, and attacks and sudden cardiac death. The review articles in many of the world’s top cardiology, award will help Dr. Blaha continue his internal medicine, epidemiology, endocrinology, and primary work with the Ciccarone Center, genetics journals. Dr. Michael J. Blaha improving cardiovascular risk prediction through novel methods of early detection of atherosclerosis, From October 2012 to September 2013, the Center including the use of cardiac computed tomography. showed some amazing productivity, publishing more than 110 articles of significant basic and clinical Dr. Blaha, who represents the fourth generation of physicians research findings, commentaries, and review articles in his family, received his medical degree and a master’s in several leading medical journals, including: in clinical epidemiology and biostatistics from Vanderbilt • American Heart Journal (2 publications) University. Dr. Blaha completed his internal medicine • American Journal of Cardiology (6) residency at Johns Hopkins in 2009 before completing a • American Journal of Epidemiology (1) fellowship in cardiology at Johns Hopkins in 2012. He is a • American Journal of Hypertension (6) preventive cardiologist and researcher in clinical epidemiology • , & Vascular Biology (2) and has faculty appointments in both cardiology in the School • Atherosclerosis (6) of Medicine and in epidemiology at the Johns Hopkins • Circulation (2) Bloomberg School of Public Health. Dr. Blaha currently serves • Circulation: Arrhythmias & Electrophysiology (1) as the Director of Clinical Research for the Ciccarone Center. • Circulation: Cardiovascular Genetics (3) He also holds positions with both the Statistics and Fellow- • Clinical Cardiology (5) in-Training/Early Career Committees of the American Heart • Diabetes Care (4) Association and the Cardiometabolic Alliance through the • European Heart Journal (1) American College of Cardiology. • European Journal of Preventive Cardiology (2) • Heart (1) For five years, Dr. Blaha has worked on the Multi-Ethnic • Hypertension (1) Study of Atherosclerosis (MESA), an NIH-funded study that • International Journal of Cardiovascular Imaging (1) seeks to explain the distribution and progression of early • Journal of the American College of Cardiology (10) atherosclerosis amongst healthy people. He received two • Journal of the American College of Cardiology: Young Investigator Research Awards from the MESA Cardiovascular Imaging (2) steering committee for his work that was published in the • Journal of the American Medical Association (3) Lancet and Circulation journals. His work with MESA • Journal of the American Medical Association: motivated his plans to construct a consortium of institutions Internal Medicine (2) committed to understanding the appropriate use of cardiac • Journal of Clinical Endocrinology and Metabolism (1) computed tomography in clinical practice. This consortium • Journal of Hypertension (1) will produce data that should guide the appropriate, cost- • Mayo Clinic Proceedings (1) effective use of imaging in clinical practice. Dr. Blaha also • New England Journal of Medicine (1) runs the Heart-Smart Living blog on Yahoo! Health • PLoS One (3) (http://health.yahoo.net/experts/heartsmartliving), which helps spread the word nationally about living 4 healthy lifestyles. Thank You! The Ciccarone Center is indebted to the following individuals for their extraordinary assistance to and support of our clinical research activities over the past year:

Irene Pollin, MSW, Ph.D. (Hon) Mr. and Mrs. Jonathan L. Marcus Highlights & News Mr. and Mrs. Nicholas G. Paleologos Mr. and Mrs. Leonard J. Attman Mr. Mario Manuli Mr. and Mrs. Edward Casel Mrs. Virginia F. Gomprecht Mr. and Mrs. Michael L. Lenkin Mr. and Mrs. Richard Amato Mr. and Mrs. Rick Bastinelli Mr. and Mrs. Robert D. Taylor Mr. and Mrs. David Cordish CSX Corporation Mr. and Mrs. Louis J. Grasmick Mr. and Mrs. Thaddeus R. Shelly, III Mr. Robert F. McCarry Mr. and Mrs. Donald J. Shepard Mr. and Mrs. Joe Cowan Mr. and Mrs. Peter G. Angelos EJL, LLC. Mr. Stephen Geppi Mr. Gary T. Gill Mr. Dennis W. Townsend Dr. and Mrs. Tyler J. Gluckman Mr. David B. Townsend Mr. and Mrs. Henry I. Greenberg Cardiovascular Specialists of Central Rev. Marta D.V. Johnson Maryland, P.A. Alfred D. Johnson Jr., C.P.A. Mr. Richard F. Glancy, Jr. Mr. and Mrs. Ellis Nottingham Mr. and Mrs. John A. Heyman Mr. and Mrs. Morris W. Offit Dr. and Mrs. Hollis Seunarine Mr. and Mrs. Carter C. Shepherd Ms. Carrie J. Lazorchak Dr. Caprice M. Uhlhorn

Much of the Ciccarone Center’s remarkable success over the past year — including the creation of several large longitudinal research datasets and the record-setting 39 research papers co-authored by our staff accepted for presentation at the November 2013 AHA Scientific Sessions — could not happen without their very generous support.

In August, Atherotech Diagnostics Lab, a leading clinical VLDL dataset has 1.4 million data points representing reference laboratory specializing in cardiometabolic unique individuals, with more than 3 million data points testing and disease management solutions, announced anticipated. Steven R. Jones, MD, Director of Inpatient it had formed a strategic research collaboration with the Cardiology at Johns Hopkins, believes the company’s Johns Hopkins Ciccarone Center for the Prevention of mission blends nicely with his work at the Ciccarone Heart Disease. The partnership pairs Atherotech’s Very Center: “Our research group’s emphasis is on high-impact, Large Database of Lipids (VLDL) with the Ciccarone clinically relevant research.” Center’s cardiac research capabilities. The project’s goal is to generate new knowledge through research, and translate Congrats to J. Bill McEvoy, MD, who upon completing that knowledge into clinical practice in the fight against his clinical fellowship period earlier this year, was awarded cardiovascular disease. Atherotech is reportedly one of the 2013 Johns Hopkins Medicine Osler Housestaff–Fellow the few companies to consistently assess cholesterol-rich Teaching Award. Also, over the summer, Dr. McEvoy risk with directly measured LDL, HDL and subclasses; presented at Medical Grand Rounds at his alma mater, the triglyceride-rich risk in remnant lipoproteins; and hereditary National University of Ireland, Cork Campus, as well as risk with Lp(a) — all of which are represented in the total the Irish Cardiac Society meeting, and was invited to give a VLDL database of 8 million samples. The current research lecture to the Irish Atherosclerosis Society. 5 What Is the Ciccarone Center?

Since 1990, the mission of the Ciccarone Center Research for the Prevention of Heart Disease has been As part of Johns Hopkins, the Ciccarone Center for three-fold: the Prevention of Heart Disease is committed to • T o create excellent clinical care for people at risk conducting cutting-edge research on atherosclerosis of developing heart disease and risk factors for heart disease. We conduct research • T o educate health care practitioners about how on two levels: to better identify and care for patients at risk of • Clinical research studies of cardiovascular disease developing heart disease involving informed, consenting adults, and • To establish rigorous research programs to study • Basic research and experiments at the cellular better prevention of heart disease and subcellular levels to decipher the molecular reactions leading to atherosclerosis. Relentless pursuit of these goals over the past two decades has led to the creation of one of the fastest A Personalized, Comprehensive growing clinical and research programs at Johns Approach Hopkins, which is highly regarded for its innovative The Ciccarone Center specializes in managing adults and effective approaches to cardiovascular disease who are at high risk for future cardiovascular disease prevention and treatment. because of the presence of multiple cardiac risk factors (such as hypertension, dyslipidemia, diabetes, Clinical Care smoking, sedentary lifestyle, or overweight status) or a The trademark of the Ciccarone Center is its history of known cardiovascular or peripheral arterial comprehensive approach, which involves both global disease. assessment and aggressive management of multiple risk factors (not just single risk factors, such as high The Ciccarone Center’s personalized, comprehensive or high cholesterol) contributing to approach to lifestyle and medical management can the development and progression of atherosclerosis. slow the progression of cardiovascular disease and Our clinical center is dedicated to: decrease one’s future risk of a heart attack, stroke, • The detection and management of individuals bypass surgery, angioplasty, or stenting. We also at risk for accelerated atherosclerosis (primary sponsor research that includes both clinical trials and prevention) to prevent or delay the onset of basic molecular studies. cardiovascular disease, and • The management of patients with established Several groups of patients have been of particular (secondary prevention) to interest to the Ciccarone Center: reduce recurrent cardiovascular events and • Women and ethnic minorities decrease mortality. • Patients with metabolic disorders, in particular inherited dyslipidemias, the metabolic syndrome, Education and diabetes Our educational efforts are aimed at the medical • Patients with the accelerated atherosclerosis community and the general public. The Ciccarone • Persons with a family history of coronary heart Center also serves as a model for teaching the art disease or stroke of prevention of cardiovascular disease to fellows, • Persons with recurrent but no residents, and students at the Johns Hopkins School established cardiovascular disease of Medicine and the Bloomberg School of Public • Heart and renal transplant patients Health. State-of-the-Art Testing Our physicians and nurse practitioner are also We are especially interested in individuals who lecturers for medical and nursing students and develop cardiovascular disease before the age of physicians at Hopkins and at national meetings. 65. We have special expertise in the screening and Hopkins Medicine also organizes meetings to address management of asymptomatic family members of educational issues for the public. persons with premature atherosclerotic disease. Our team may selectively employ state-of-the-art testing to help identify factors contributing to heart disease 6 clustering in families. For an individual patient, we may use the latest Our assessment techniques to measure lipoproteins (total cholesterol, high-density lipoprotein-cholesterol [HDL-C], LDL-C, and triglyceride levels) and apolipoproteins (Lp[a], apolipoprotein B) as well as Mission nontraditional risk factors, such as high-sensitivity We have built The Johns Hopkins C-reactive protein (hsCRP), and measurements of lipoprotein size and number. However, for many Ciccarone Center for the Prevention of individuals these emerging risk factors are often Heart Disease with the following goals What Is the Ciccarone Center? not needed to optimize their management in a cost- in mind: effective manner.

Advanced Diagnostic Tools 1. Provide a center dedicated to Among asymptomatic adults with no history of clinical patient care and the cardiovascular disease, we may use a 64-slice or global assessment of risk factors a 320-slice multidetector computed tomography (MDCT) scan of the chest to measure the amount for cardiovascular disease, which of coronary artery calcification. The presence of enables patients to receive: elevated coronary artery calcification (e.g. > 75th • the latest information on the percentile for one’s age and gender) or thickened carotid is a sign of accelerated atherosclerosis prevention of atherosclerotic for one’s age and may lead to more aggressive vascular disease, attempts at comprehensive risk factor changes • comprehensive management of through both medical management and lifestyle modification. Occasionally, a cardiac CT angiogram risk factors for cardiovascular may also be indicated in patients with atypical chest disease, and pain and inconclusive stress test results. After an • high-quality care that is initial comprehensive evaluation, we can inform a patient whether his/her management might be integrated into the other health changed by some of the more sophisticated laboratory promotional resources of Johns and diagnostic testing that we can provide. Hopkins. Improving Lifestyle Habits Dominique Ashen, PhD, CRNP, a nurse practitioner 2. Create a center at Johns Hopkins who specializes in helping people improve their for the education of health care lifestyle habits, assists patients with behavior changes providers in the area of prevention such as: • Following healthier diets of cardiovascular disease. Teaching • Maintaining a prudent body weight by our physicians and nurse • Smoking cessation practitioner broadly targets • Maintaining a regular aerobic program • Coping better with stress Hopkins nurses, medical students, fellows, and physicians as well as We also refer patients to the Johns Hopkins the community at large. Clinical Exercise Center as well as to the state-of- the-art Maryland Athletic Club (MAC) Healthy Start program to optimize their lifestyle habits. We 3. Foster cardiovascular research, encourage all individuals with known cardiovascular including both clinical trials and disease, peripheral arterial disease, diabetes, or basic molecular studies. congestive heart failure to participate in a supervised exercise program. 7 Original Research — Publications

A listing of the publications by Summary: Although high-sensitivity 4. Yeboah J, Carr JJ, Terry JG, the staff of The Johns Hopkins C-reactive protein (hsCRP) is involved Ding J, Zeb I, Liu S, Nasir K, Post Ciccarone Center for the in the immunologic process that W, Blumenthal RS, Budoff MJ. Prevention of Heart Disease, triggers vascular remodeling and Computed tomography-derived from October 2012 through plaque deposition and is associated cardiovascular risk markers, incident September 2013 with increased cardiovascular disease cardiovascular events, and all-cause (CVD) risk, definitive randomized mortality in nondiabetics: the Multi- 1. Ahmed HM, Blaha MJ, Nasir evidence for its role as a causative Ethnic Study of Atherosclerosis. K, Jones SR, Rivera JJ, Agatston factor in atherothrombosis is lacking. European Journal of Preventive A, Blankstein R, Wong ND, Lakoski This article reviews four distinct points Cardiology. 2013 May 20. S, Budoff MJ, Burke GL, Sibley CT, from the literature to better understand Summary: This study reveals that the Ouyang P, Blumenthal RS. Low- the current state and application of addition of coronary artery calcium to risk lifestyle, coronary calcium, hsCRP in clinical practice, and we the Framingham risk score provides cardiovascular events, and mortality: highlight recommendations from superior discrimination, especially Results from MESA. American societies and important considerations in intermediate-risk individuals, Journal of Epidemiology. 2013 when using hsCRP to guide treatment compared with the addition of several Jul;178(1):12-21. decisions in the primary prevention computed tomography risk markers. Summary: Unhealthy lifestyle habits setting. are a major contributor to coronary 5. Hsu S, Ton VK, Ashen MD, artery disease (CAD). The purpose 3. Chrispin J, Martin SS, Gluckman TJ, Kohli P, of the study was to investigate the Martin SS, Sisson SD, Blumenthal RS, Blaha associations of smoking, weight Hasan RK, MJ. A clinician’s guide to the ABCs maintenance, physical activity, and Joshi PH, of cardiovascular disease prevention: Mediterranean-style diet with coronary Minder CM, The Johns Hopkins Ciccarone Center calcium, cardiovascular events, and McEvoy JW, for the Prevention of Heart Disease mortality. We discovered that, over Kohli P, and American College of Cardiology the course of Johnson AE, Cardiosource approach to the Million Wang L, Hearts Initiative. Clinical Cardiology. nearly 8 years, Dr. Jonathan Chrispin a combination Blaha MJ, 2013 Jul;36(7):383-93. of regular Blumenthal RS. Landmark lipid- Summary: As part of an initiative that exercise, healthy lowering trials in the primary aims to prevent 1 million myocardial diet, smoking prevention of cardiovascular disease. infarctions and avoidance, Clinical Cardiology. 2013 strokes over the and weight Sept;36(9):516-23. next 5 years, maintenance Summary: Over the past 25 years, we present lipid-lowering therapies have been the simply Dr. Omair Yousuf contributed to lower coronary developed that are proven to not only organized calcium incidence, slower calcium lower cholesterol, but also to decrease “ABCDE” progression, and lower all-cause adverse cardiovascular events and approach mortality. CVD mortality. This review highlights for guiding some key clinical trials encompassing a consistent several classes of lipid-lowering comprehensive 2. Yousuf O, Mohanty BD, Martin Dr. Libin Wang SS, Joshi PH, Blaha MJ, Nasir K, medications that have provided approach to Blumenthal RS, Budoff MJ. High- clinicians with an evidence-based managing sensitivity C-reactive protein and framework for managing their patients’ cardiovascular risk in daily cardiovascular disease: A resolute cardiovascular risk. clinical practice. We summarize belief or an elusive link? Journal of the recommendations related to each topic American College of Cardiology. 2013 and reference landmark trials and data Jul;62(5);397-408. that support our approach.

8 6. Pandey AK, Pandey S, Blaha MJ, 7. Martin SS, Blaha MJ, Elshazly 8. Budoff MJ, Agatston A, Feldman T, Ozner M, MB, Brinton EA, Toth PP, McEvoy Young R, Lopez Santos RD, Budoff MJ, Blumenthal JW, Joshi PH, Kulkarni KR, Mize VA, Kronmal RS, Nasir K. Family history of PD, Kwiterovich PO, Defilippis RA, Nasir K, coronary heart disease (CHD) and AP, Blumenthal RS, Jones SR. Blumenthal RS, markers of subclinical cardiovascular Friedewald estimated versus directly Detrano RC, disease: Where do we stand? measured low-density lipoprotein Bild DE, Guerci Atherosclerosis. 2013 Jun;228(2):285- cholesterol and treatment implications. AD, Liu K, Shea 94. Journal of the American College of S, Szklo M, Dr. Khurram Nasir Summary: Family history of coronary Cardiology. 2013 Aug;62(8):732-9. Post W, Lima J, artery disease is associated with Summary: This study discovered that, Bertoni A, Wong ND. Progression of Original Research — Publications markers of subclinical atherosclerosis, compared with direct measurement, coronary calcium and incident CHD and this relationship remains the Friedewald equation tends to events: MESA (Multi-Ethnic Study statistically significant after adjusting underestimate low-density lipoprotein of Atherosclerosis). Journal of the for traditional risk factors. Our data cholesterol (LDL-C) and, therefore, American College of Cardiology. 2013 suggest these individuals should be warrants additional evaluation in Mar 26;61(12):1231-9. considered strongly as candidates for high-risk patients. Achieving non- Summary: This study concluded assessment of subclinical CVD to high-density lipoprotein cholesterol that progression of coronary artery further refine risk and treatment goals. (HDL-C) targets are important to calcium (CAC) is associated with an reach in the secondary prevention increased risk for future heart disease setting. events, even after controlling for other potentially confounding factors.

Staff Spotlight: Steven R. Jones, MD 9. Madanieh R, Hasan RK, This past year was a busy one for Steven R. Jones, MD. In addition to Anusionwu OF, Blumenthal RS, submitting a large number of abstracts to the American Heart Association’s Blaha MJ. Cardiovascular disease prevention: Matching evidence- Annual Scientific Sessions and other meetings, Dr. Jones, Director of based algorithms with individualized Inpatient Cardiology at Johns Hopkins, led a team of Hopkins investigators care. Clinical Pharmacology and (including Seth Martin, MD, Parag Joshi, MD, Therapeutics. 2013 Apr;93(4):321-3. J. Bill McEvoy, MD, and Michael Blaha, MD) to Summary: Because appropriate use of move the Very Large Database of Lipids (VLDL) statins in primary prevention remains project into phase 2. The goal of the project, a a matter of debate, we reviewed several strategies for statin allocation, collaboration between Atherotech Diagnostics including strict “evidence-based” Lab, a leading clinical reference laboratory adherence to randomized controlled specializing in cardiometabolic testing and disease clinical trial entry criteria and more management solutions, and the Ciccarone Center, “personalized” risk assessments. is to generate knowledge through research and Dr. Steven Jones translate that knowledge into clinical practice in 10. DeFilippis AP, Blaha MJ, Martin SS, Reed RM, Jones SR, the fight against cardiovascular disease. VLDL studies are rapidly moving Nasir K, Blumenthal RS, Budoff forward with a total of 17 studies either reported or actively in progress. MJ. Nonalcoholic fatty liver disease Also last year, Dr. Jones assembled a working group of investigators from and serum lipoproteins: the Multi- several major cardiovascular disease studies, including the Framingham Ethnic Study of Atherosclerosis. Study, the Jackson Heart Study, the TRIUMPH post MI registry, and the Atherosclerosis. 2013 Apr;227(2):429- Intermountain Heart Study, to study lipid and lipoproteins, collectively 36. Summary: This study found that, calling it the Lipoprotein Investigators Collaboration (LIC). Phase 1 of LIC after adjustment for multiple metabolic centers on investigation of HDL and HDL subfractions; phase 2 focuses risk factors, adiposity, and measures remnant lipoproteins. Finally, Dr. Jones, accompanied by Dr. Blaha, Khurram of insulin resistance, there may be a Nasir, MD, and Peter Toth, MD, spent a week in Brazil participating in two link between nonalcoholic fatty liver major sub-studies of the English Longitudinal Study on Ageing (ELSA), an disease and dyslipidemia. international, interdisciplinary data resource on health, economic position and quality of life as people age. 9 11. Vranian MN, Keenan T, Blaha 13. Whelton S, Chow GV, Ashen 16. Graham G, Blaha MJ, Budoff MJ, Silverman MG, Michos ED, MD, Blumenthal RS. Dyslipidemia MJ, Rivera JJ, Agatston A, Raggi Minder CM, Blumenthal RS, Nasir management for secondary prevention P, Shaw LJ, Berman D, Rana JS, K, Meneghelo RS, Santos RD. Impact in women with cardiovascular disease: Callister T, Rumberger JA, Min J, of fitness versus obesity on routinely What can we expect from non- Blumenthal RS, Nasir K. Impact of measured pharmacologic strategies? Current coronary artery calcification on all- cardiometabolic Cardiovascular Risk Reports. 2012 cause mortality in individuals with and risk in young, Oct;6(5):443-449. without hypertension. Atherosclerosis. healthy adults. Summary: In this review, we examine 2012 Dec;225(2):432-7. American the effect of non-pharmacologic Summary: This study found that the

Original Research — Publications Journal of therapy — i.e., diet and lifestyle addition of CAC scores contributed Cardiology. modification — on lipids as part of significantly in predicting mortality, 2013 Apr the secondary prevention strategy of in addition to traditional risk factors 1;111(7):991-5. Dr. Michael Silverman cardiovascular disease in women. alone, among those with and without Summary: hypertension. Although fitness and obesity are 14. Ndumele CE, Matsushita K, Astor independently associated with B, Virani SS, Mora S, Williams EK, 17. Joshi PH, Blaha MJ, Blumenthal cardiometabolic risk, and their effects Hoogeveen RC, Blumenthal RS, RS, Blankstein R, Nasir K. What is are additive, obesity is more strongly Sharrett AR, Ballantyne CM, Coresh J. the role of calcium scoring in the age associated with this risk when fitness Apolipoproteins do not add prognostic of coronary computed tomographic and obesity are discordant. These information beyond lipoprotein angiography? Journal of Nuclear findings underscore the need for weight cholesterol measures among Cardiology. 2012 Dec;19(6):1226-35. loss in obese patients and suggest an individuals with obesity and insulin Summary: Available data suggest unmeasured benefit of fitness. resistance syndromes: The ARIC that in low-to-intermediate risk Study. European Journal of Preventive symptomatic patients, CAC scanning 12. Ton VK, Martin SS, Blumenthal Cardiology. 2012 Oct 29. may serve as an appropriate gatekeeper RS, Blaha MJ. Comparing the Summary: Among individuals to further testing with either coronary new European cardiovascular with obesity and insulin resistance computed tomographic angiography, disease prevention guideline with syndromes, apolipoproteins did functional imaging, or invasive prior American Heart Association not provide prognostic information coronary angiography. guidelines: an editorial review. Clinical regarding CHD risk beyond that Cardiology. 2013 May;36(5):E1-6. provided by non-HDL-C and HDL-C. 18. McEvoy JW, Blaha MJ, Rivera Summary: Despite some minor JJ, Budoff MJ, Khan AN, Shaw disagreements on the weight of 15. Joshi PH, LJ, Berman DS, Raggi P, Min recommendations in certain areas, Kalyani RR, JK, Rumberger JA, Callister TQ, CVD prevention experts across Blumenthal RS, Blumenthal RS, Nasir K. Mortality two continents agree on one thing: Donner TW. rates in smokers and nonsmokers in the prevention Cardiovascular presence or absence of coronary artery works in effects of calcification. Journal of the American halting the noninsulin, College of Cardiology Cardiovascular progression of glucose-lowering Imaging. 2012 Oct;5(10):1037-45. atherosclerosis agents: Need for Dr. Parag Joshi Summary: This study found and decreasing more outcomes that smokers with any CAC had disease burden data. American Journal of Cardiology. significantly higher mortality than over a lifetime. 2012 Nov 6;110(9 Suppl):32B-42B. smokers without CAC; however, Summary: This comprehensive review the absence of CAC might not be article provides recommendations, as useful a “negative risk factor” in based on current data, for a therapeutic active smokers, because this group has Dr. Khue Ton approach with noninsulin, glucose- mortality rates similar to nonsmokers lowering agents for the prevention of with mild-to-moderate atherosclerosis. cardiovascular events in patients with type 2 diabetes.

10 19. Keenan T, Blaha MJ, Nasir 21. Tota-Maharaj R, Blaha MJ, 24. Makadia S, Harrington C, K, Silverman MG, Tota-Maharaj McEvoy JW, Blumenthal RS, Muse Blumenthal RS. Which serum R, Carvalho JA, Conceição RD, ED, Budoff MJ, Shaw LJ, Berman cholesterol markers should I use to Blumenthal RS, Santos RD. Relation DS, Rana JS, Rumberger J, Callister lower my of uric acid to T, Rivera J, Agatston A, Nasir K. patient’s serum levels of Coronary artery calcium for the cardiovascular high-sensitivity prediction of mortality in young adults risk? C-reactive protein, <45 years old and elderly adults >75 Cardiology triglycerides, years old. European Heart Journal. Today. March and high-density 2012 Dec;33(23):2955-62. 2013. lipoprotein Summary: The value of CAC for Summary: Original Research — Publications cholesterol and to Dr. Rajesh Tota- predicting mortality extends to both We reviewed Dr. Colleen Harrington hepatic steatosis. Maharaj elderly patients and those < 45 years the strengths American old. Elderly persons with no CAC have and limitations of LDL-C, non- Journal of Cardiology. 2012 Dec a lower mortality rate than younger HDL-C, apolipoprotein B, and 15;110(12):1787-92. persons with high CAC. advanced lipoprotein testing in Summary: High uric acid levels were cardiovascular risk prediction. associated with increased triglycerides, 22. Tota-Maharaj R, McEvoy high-density lipoprotein cholesterol, JW, Blaha MJ, Silverman MG, 25. Patel C, Blumenthal RS, Martin and hepatic steatosis, independent of Nasir K, Blumenthal RS. Utility of SS. Lipid-modifying therapy. In: Bhatt metabolic syndrome and obesity, and coronary artery calcium scoring in the D, ed. Atherothrombosis in Clinical with increased hsCRP independently evaluation of patients with chest pain. Practice. New York, NY: Oxford of metabolic syndrome. Critical Pathways in Cardiology. 2012 University Press. September 2013. Sep;11(3):99-106. Chapter 7:95-109. 20. Mann DM, Shimbo D, Cushman Summary: Although further Summary: This comprehensive M, Lakoski S, Greenland P, research is needed, carefully review goes over the evidence base Blumenthal RS, Michos ED, Lloyd- selected patients presenting to the for the upcoming National Cholesterol Jones DM, emergency department with a normal Education Program guidelines. Muntner P. electrocardiogram, normal cardiac C-reactive biomarkers, and no CAC may be 26. Ashen MD, Blumenthal RS, protein level and considered for early discharge without Sperling L. Vegetarian diets in the incidence of further testing. cardiovascular prevention. Current eligibility for Treatment Options in Cardiovascular statin therapy: 23. Barth AS, Abd TT, Blumenthal Medicine. Forthcoming 2013. the multi- RS, Blaha MJ. Comparative Summary: This article reviews the ethnic study of effectiveness of risk markers for strengths and limitations of the various atherosclerosis. cardiovascular risk assessment in types of vegetarian diets and variations Clinical intermediate-risk individuals: coronary of them. Cardiology. 2013 Jan;36(1):15-20. artery calcium versus “the rest”? Summary: Findings from this study Current Cardiovascular Imaging suggest that many patients with an Reports. 2013;6:203-210. elevated hsCRP level may not receive Summary: We evaluated four large the benefits of statins if hsCRP is not population-based cohort studies incorporated into the NCEP screening regarding the net reclassification strategy. index (NRI) among intermediate risk patients. We concluded that the coronary artery calcium score was the strongest marker for clinical risk prediction and is the most likely to influence future clinical outcomes.

11 27. Martin SS, Johnson AE, Blumenthal RS. Use of high Staff Spotlight: Chiadi E. Ndumele, MD, MHS sensitivity C-reactive protein for risk In July 2013, Chiadi E. Ndumele, MD, MHS, a faculty member in the assessment. In: Ballantyne C, ed. Division of Cardiology and a PhD candidate in the Cardiovascular Clinical Lipidology; A Companion Epidemiology program at the Johns Hopkins Bloomberg School of Public to Braunwald’s Heart Disease. Health, was selected as a recipient of a Robert Philadelphia, PA: W.B. Saunders; Forthcoming 2013. Wood Johnson Foundation’s Amos Medical Summary: We present a state-of-the- Faculty Development Program award. This art review of the use of blood-based outstanding career development award (only

Original Research — Publications biomarkers to refine cardiovascular eight are given out nationwide each year) will risk prediction. fund salary and project support for a period of four years. The Harold Amos Medical Faculty 28. Martin SS, Blumenthal RS. Disorders of lipid metabolism. In: Development Program, formerly known as the Aronow WS, Fleg JL, Rich MW, eds. Minority Medical Faculty Development Program, Cardiovascular Disease in the Elderly. was created to increase the number of faculty Boca Raton, FL: CRC Press; 2013; Dr. Chiadi Ndumele from historically disadvantaged backgrounds who Chapter 5:121-142. can achieve senior rank in academic medicine and who will encourage Summary: This chapter examines the and foster the development of succeeding classes of such physicians and evidence base for selective use of lipid- lowering agents in adults over the age dentists. Four-year postdoctoral research awards are offered to physicians of 65. who are committed to developing careers in academic medicine and to serving as role models for students and faculty of similar background. 29. Elshazly MB, Martin SS, Blaha “I am grateful to my outstanding research mentors and career advisers, MJ, Joshi PH, Toth PP, McEvoy including Drs. Joseph Coresh, Gary Gerstenblith, Roger Blumenthal and JW, Al-Hijji MA, Kulkarni KR, Wendy Post, for their wonderful guidance and support,” commented Kwiterovich PO, Blumenthal RS, Jones SR. Non-HDL cholesterol, Dr. Ndumele. guideline targets, and population percentiles for secondary prevention in a clinical sample of 1.3 million 30. Minder CM, Blumenthal 32. Qureshi W, Blaha MJ, Nasir adults: the very large database of RS, Blaha MJ. Statins for primary K, Al-Mallah MH. Gender lipids (VLDL-2 Study). Journal of the prevention of cardiovascular disease. differences in coronary plaque American College of Cardiology. 2013 Current Opinion in Cardiology. 2013 composition and burden detected in Aug 7. Sep;28(5):554-60. symptomatic patients referred for Summary: There is significant patient- Summary: This article reviews coronary computed tomographic level discordance between non-HDL-C the extensive evidence supporting angiography. International Journal and LDL-C percentiles at lower values the selective use of lipid-lowering of Cardiovascular Imaging. 2013 of LDL-C and higher triglycerides. therapy in intermediate to high-risk Feb;29(2):463-9. Current non-HDL-C cut-points for individuals. Summary: This study found that high-risk patients should be lowered to symptomatic women have a lower match percentiles of LDL-C cut-points. 31. Martin SS, Blaha MJ, Jones prevalence of obstructive coronary Relatively small absolute reductions SR. Nonfasting lipids: there is the artery disease and are less likely to in non-HDL-C cut-points population and then there is the have mixed coronary plaque compared result in substantial patient. JAMA Internal Medicine. to symptomatic men. Future studies reclassification of 2013 May 27;173(10):936-7. are needed to determine the prognostic patients to higher Summary: This article implications of these findings. treatment categories reviews the rationale for the with potential measurements of lipids in the implications for non-fasting state. risk assessment and treatment.

12 33. Maroules CD, Blaha MJ, El- 35. Rosendorf C, Lackland DT, 38. Al-Hijji M, Martin SS, Joshi Haddad MA, Ferencik M, Cury RC. Allison M, Aronow WS, Black HR, PH, Jones SR. Effect of equivalent Establishing a successful coronary CT Blumenthal RS, Cannon CP, de on-treatment apolipoprotein levels on angiography program in the emergency Lemos JA, Elliott WJ, Gersh BJ, Gore outcomes (from the AIM-HIGH and department: Official writing of the JH, Levy D, Long JB, O’Gara PT, HPS2-THRIVE). American Journal of Fellow and Resident Leaders of the Oparil S, White WB. Treatment of Cardiology. 2013 Aug 30. Society of Cardiovascular Computed hypertension in the prevention and Tomography (FiRST). management of ischemic heart disease 39. Patel J, Abd T, Blumenthal RS, Journal of Cardiovascular — a scientific statement Nasir K, Superko R. What role does Computed Tomography. from the AHA, ACCF, genetics play in the variability in

2013 May;7(3):150-6. and ASH. Circulation. response to statin therapy? Current Original Research — Publications Summary: Recent Forthcoming 2013. Atherosclerosis Reports. Forthcoming multicenter trials have 2013. reported that coronary 36. Swiger KJ, Manolac Summary: We examine the role of CT angiography is safe, RJ, Blumenthal RS, Blaha certain genetic polymorphisms in reduces time to diagnosis, MJ, Martin SS. Statins affecting the response to statin therapy. facilitates discharge, and and cognition; a systematic may lower overall cost Dr. Kristopher Swiger review and meta-analysis 40. Ashen MD, Nell-Dybdahl CL, compared with routine of short- and long-term Sperling L, care. This study provides a 10-step cognitive effects. Mayo Clinic Blumenthal approach for establishing a successful Proceedings. 2013 October 1. RS. coronary CT angiography program in Summary: In patients without Development the emergency department. baseline cognitive dysfunction, short- of a center for term data are most compatible with no prevention of 34. Ahmed HM, Elshazly MB, adverse effect of statins on cognition, cardiovascular Blaha MJ, Martin SS, Kulkarni K, while long-term data appear to support disease. Jones SR. Ratio of dense to buoyant a beneficial role in the prevention of American LDL subclass is associated with dementia. Society of LDL density phenotype (VLDL-5). Preventive Dr. Dominique Ashen The Open Chemical and Biomedical 37. Blumenthal RS, Ndumele Cardiology Methods Journal. Forthcoming 2013. CE, Martin SS. ASKNOT what Primer on Prevention. Forthcoming Summary: Dense LDL phenotypes CRP can do for you. Journal of the 2013. are associated with increased American College of Cardiology. 2013 Summary: We discuss the key atherogenicity, and are commonly Aug;62(8):730-1. components of various types of evaluated for the purposes of Summary: This editorial examines preventive cardiology centers that atherosclerosis research and the extent to which can be put together in academic and cardiovascular risk discrimination. measurements private practice settings. In this study we examined the ability of vascular of LDL subclasses, expressed as a 41. Tam LM, Joonseok K, ratio of dense-to-buoyant subclass can improve Blumenthal RS, Nasir K, (LLDR), to predict LDL density cardiovascular risk Al-Mallah MH, Blaha MJ. phenotype. Further research is prediction. Absolute coronary artery needed to investigate the relationship calcium score is the best between lipoprotein density and size, predictor of non-calcified plaque and whether LLDR provides more involvement in patients with cardiovascular risk discrimination than low calcium scores (1–100). LDL density phenotype. Atherosclerosis. 2013 Sep. 230;1:76–79. Summary: This study looked at the predictors on non-calcified plaque in persons with mild coronary calcification.

13 14 Original Research — Publications changes in electrocardiograms. in changes various with associated was range, normal the even within population, general levels the in hormone Summary 12;8(4):e59489. Apr One ofScience Library Public survey. examination nutrition and health national third the from findings parameters: electrocardiographic and hormones Thyroid E. Guallar Tomaselli E, GF, Blasco-Colmenares 4 (aorta) artery. acentral with compared (carotid) for aperipheral association level, astronger with physical activity and blocker use nodal atrioventricular of independent stiffness arterial increased an with associated is rate heart resting ahigher that suggest Summary: Hypertension of Study Atherosclerosis.Ethnic Multi- stiffness: arterial aortic and carotid with rate heart of resting RS Blumenthal WG, Polak JF, Hundley DA, JA, Lima Bluemke Al-Mallah MH, Blankstein R, 43 aging. cardiovascular successful with persons in atherosclerosis subclinical and of inflammation Summary: 2013.Forthcoming Research Experimental and Clinical Aging octogenarians. among burden atherosclerosis coronary with associated independently is protein A R Blumenthal OR, Coelho W, MJ Blaha Nadruz RD, Santos AA, Soares WM, Freitas LA, 42. Quaglia 4. Zhang Y, WS 4. Zhang Post , . . Nasir K Nasir , Whelton SP Whelton Nasir K Nasir : Variation in thyroid thyroid : Variation in Results from this study study this from Results measures We examined , Sposito AC. C-reactive , . 2013 Sep;62(3):477-84. Blaha MJ Blaha , Dr. Seamus Whelton Dr. Seamus , Cheng A, A, , Cheng . Association . Association , Agatston Agatston . 2013 2013 . . , cohort with stage 3of disease. the stage with cohort a progressionmulti-ethnic in disease kidney of chronic predictor important an was hypertension assessment, rate filtration glomerular estimated the in C inclusionof the cystatin with that, concluded study Summary Jul;27(7):421-6. Hypertension ofHuman Journal Atherosclerosis. of Study Ethnic Multi- the cohort: amulti-racial in progression disease kidney chronic and WS MG, Post Shlipak SheaS, H, Kramer 45. Bloomfield BC, Astor GS, Yi SS, conference in Houston in June of 2012. of June in Houston in conference disparities health inaugural Society’s the at Disorders Endocrine in Disparities Health on Statement Scientific Society Endocrine the presented She conference. management diabetes inpatient international an at Program Management Diabetes Inpatient Hopkins Johns the for model implementation the present to Brazil, Paulo, Sao to Dr. traveled Golden Year A20 Journey.” Career: Also, ADiabetologist’s of Facets “Multiple entitled TN, Nashville, Research, and Studies Graduate of School College Medical Meharry at Day Research Student 57th Annual the during Lecture Memorial Pulliam A. James the Dr. delivered Golden March, In Hopkins. from Johns physician-scientists female four other along with Investigation, Clinical for Society American the to elected was Dr. Golden addition, In diabetes. for cure a find to efforts research supports Co., & McCormick of executive by aformer TheMetabolism. professorship, funded of Medicine in and Endocrinology P. Hugh the Professor Family McCormick as appointed was ofSchool Medicine, University Hopkins Johns the at medicine Dr. an Golden, associate professor of May, In recollection. and election, selection, words: three in up summed be can MD, Golden, 2012-2013 the of Sherita for year Highlights academic MD Golden, Sherita Spotlight: Staff . Blood pressure : This : This . 2013 2013 . combination with clopidogrel. with combination alone orin aspirin on patients in events cardiovascular and platelet response receptor-1 in Summary: CM, Damcott RB, Horenstein JR, JP,46. Lewis O’Connell Ryan K, platelet endothelial aggregation aggregation platelet endothelial Gibson Q, Pollin TI, Mitchell Mitchell TI, Q, Pollin Gibson Genetics Circulation. Cardiovascular Cardiovascular Circulation. cardiovascular outcomes. outcomes. cardiovascular platelet aggregation and and platelet aggregation with associated PEAR1is in Dr. Sherita Golden Golden Dr. Sherita Shuldiner AR. Genetic variation variation Genetic AR. Shuldiner CJ, Johnson JA, Gurbel PA, JA,CJ, Gurbel Johnson N, Herzog W,N, Herzog Y, Gong Pepine Post WS Bliden KP, Post Tanner K, Parsa A, Tantry US, Tantry A, Parsa Tanner K, R, Pakzy BD, AL, Beitelshees may be a determinant of adeterminant maybe Common genetic variation variation genetic Common . 2013 Apr;6(2):184-92. , Faraday Faraday , 47. Thanassoulis G, Campbell CY, 49. Frazier-Wood AC, Manichaikul 51. Smith JG, Avery CL, Evans DS, Owens DS, Smith JG, Smith AV, A, Aslibekyan S, Borecki IB, Goff Nalls MA, Meng YA, Smith EN, Peloso GM, DC, Hopkins PN, Lai CQ, Ordovas Palmer C, Tanaka T, Mehra R, Butler Kerr KF, JM, Post WS, Rich SS, Sale MM, AM, Young T, Buxbaum SG, Kerr Pechlivanis Siscovick D, Straka RJ, Tiwari HK, KF, Berenson GS, Schnabel RB, Li S, Budoff MJ, Tsai MY, Rotter JI, Arnett DK. G, Ellinor PT, Magnani JW, Chen W, Harris TB, Genetic variants associated with Bis JC, Curb JD, Hsueh WC, Rotter JI, Malhotra R, VLDL, LDL and HDL particle size Liu Y, Newman AB, Limacher MC, O’Brien KD, differ with race/ethnicity. Human North KE, Reiner AP, Quibrera PM, Kamstrup Genetics. 2013 Apr;132(4):405-13. Schork NJ, Singleton AB, Psaty BM, PR, Summary: Our findings suggest that Soliman EZ, Solomon AJ, Srinivasan Original Research — Publications Nordestgaard the genetic underpinnings of mean SR, Alonso A, Wallace R, Redline BG, lipoprotein diameter differ by race/ S, Zhang ZM, Post WS, Zonderman Tybjaerg- Dr. Catherine Campbell ethnicity. As lipoprotein diameters AB, Taylor HA, Murray SS, Ferrucci Hansen are modifiable, this may lead new L, Arking DE, Newton-Cheh C, et A, Allison MA, Aspelund T, Criqui strategies to modify lipoprotein al.; CARe and COGENT consortia. MH, Heckbert SR, Hwang SJ, Liu Y, profiles during the reduction of insulin Impact of ancestry and common Sjogren M, van der Pals J, Kälsch H, resistance that are sensitive to race/ genetic variants on QT interval in Mühleisen TW, Nöthen MM, Cupples ethnicity. African Americans. Circulation. LA, Caslake M, Di Angelantonio Cardiovascular Genetics. 2012 E, Danesh J, Rotter JI, Sigurdsson 50. Hacıoğlu Y, Gupta M, Choi TY, Dec;5(6):647-55. S, Wong Q, Erbel George RT, Deible CR, Jacobson LP, Summary: This study tested the R, Kathiresan S, Witt MD, Palella FJ, Post WS, Budoff hypotheses that African ancestry Melander O, Gudnason MJ. Use of cardiac CT angiography and common genetic variants are V, O’Donnell CJ, imaging in an epidemiology study: associated with prolonged duration Post WS; CHARGE the Methodology of the Multicenter of cardiac repolarization, a central Extracoronary AIDS Cohort Study cardiovascular pathophysiological determinant of Calcium Working disease substudy. Anatolian Journal of arrhythmia. However, no difference Group. Genetic Cardiology. 2013;13(3):207-14. in duration of cardiac repolarization associations with Summary: This study concluded with global genetic indices of African- valvular calcification that cardiac CT angiography may American ancestry was noted. and aortic stenosis. New serve as a reference for use in future England Journal of Medicine. 2013 Feb epidemiology studies aiming to assess 52. Asselbergs FW, Guo Y, van Iperen 7;368(6):503-12. coronary atherosclerosis and cardiac EP, Sivapalaratnam S, Tragante V, Summary: Genetic variation in the anatomy Lanktree MB, Lange LA, Almoguera lipoprotein(a) locus, mediated by in low-risk B, Appelman YE, Barnard J, Baumert lipoprotein(a) levels, is associated populations J, Beitelshees AL, Bhangale TR, Chen with aortic valve calcification across while YD, Gaunt TR, Gong Y, Hopewell JC, multiple ethnic groups and with minimizing Johnson T, Kleber ME, Langaee TY, incident clinical aortic stenosis. radiation Li M, Li YR, Liu K, McDonough CW, exposure. Meijs MF, Middelberg RP, Musunuru 48. Horenstein RB, Mitchell BD, Post K, Post WS, et al. Large-scale gene- WS, Lütjohann D, von Bergmann centric meta-analysis across 32 studies K, Ryan KA, Terrin M, Shuldiner identifies multiple lipid loci. American AR, Steinle NI. The ABCG8 G574R Journal of Human Genetics. 2012 Nov variant, serum plant sterol levels, and 2;91(5):823-38. cardiovascular disease risk in the Summary: This large meta-analysis Old Order Amish. Arteriosclerosis, of lipid phenotypes with the use Thrombosis, and Vascular Biology. of a dense gene-centric approach 2013 Feb;33(2):413-9. identified multiple single nucleotide Summary: Although the G574R polymorphisms not previously described variant is associated with moderately in established lipid genes and several elevated plant sterol levels, carriers previously unknown loci, suggesting of the 574R allele had modestly that a focused genotyping approach can lower levels of carotid wall thickness further increase the understanding of 15 compared with non-carriers. heritability of plasma lipids. 53. Fox ER, Musani SK, 55. Shah SA, Herrington 57. Lai S, Fishman EK, Gerstenblith Barbalic M, Lin H, Yu DM, Howard TD, Divers G, Brinker J, Tai H, Chen S, Li J, B, Ogunyankin KO, J, Arnett DK, Burke Tong W, Detrick B, Lai H. Vitamin D Smith NL, Kutlar A, GL, Kao WH, Guo X, deficiency is associated with coronary Glazer NL, Post WS, Siscovick DS, Chakravarti artery calcification in cardiovascularly et al. Genome-wide A, Lima JA, Psaty BM, asymptomatic African Americans with association study of Tomaselli GF, Rich SS, HIV infection. cardiac structure and Bowden DW, Post W. Vascular systolic function in Associations between Health and Risk African Americans: NOS1AP single nucleotide Management.

Original Research — Publications the Candidate polymorphisms (SNPs) and 2013;9:493-500. Gene Association QT interval duration in four Summary: These Resource (CARe) study. Circulation. racial/ethnic groups in the data suggest that, Cardiovascular Genetics. 2013 Multi-Ethnic Study of Atherosclerosis in order to reduce Feb;6(1):37-46. (MESA). Annals of Noninvasive the risk for Summary: In the largest genome- Electrocardiology. 2013 Jan;18(1):29- coronary artery wide association study of cardiac 40. disease in HIV- Dr. Gary Gerstenblith structure and function to date in Summary: QT is a risk factor for infected African- African-Americans, researchers sudden cardiac death. This study Americans, vitamin D levels should identified 4 genetic loci related to left used the Multi-Ethnic Study of be closely monitored. These data also ventricular mass, interventricular Atherosclerosis to examine association suggest that clinical trials should be septal wall thickness, left ventricular of QT with NOS1AP variants in an conducted to examine whether vitamin internal diastolic diameter, and ejection ethnically diverse cohort. D supplementations reduce the risk of fraction, which reached genome-wide CAD in this population. significance. 56. Elbers CC, Guo Y, Tragante V, van Iperen EP, Lanktree MB, Castillo BA, 58. Andersson LG, Wu KC, 54. McClelland RL, Jorgensen NW, Chen F, Yanek LR, Wojczynski MK, Wieslander B, Loring Z, Frank Post WS, Szklo M, Kronmal RA. Li YR, Ferwerda B, Ballantyne CM, TF, Maynard C, Gerstenblith G, Methods for estimation of disparities Buxbaum SG, Chen YD, Chen WM, Tomaselli GF, Weiss RG, Wagner in medication use in an observational Cupples LA, Cushman M, Duan Y, GS, Ugander M, Strauss DG. Left cohort study: results from the Multi- Duggan D, Evans MK, Fernandes JK, ventricular mechanical dyssynchrony Ethnic Study of Atherosclerosis. Fornage M, Garcia M, Garvey WT, by cardiac magnetic resonance is Pharmacoepidemiology and Drug Glazer N, Gomez F, Harris TB, Halder greater in patients with strict vs. Safety. 2013 May;22(5):533-41. I, Howard VJ, Keller MF, Kamboh nonstrict electrocardiogram criteria Summary: Evaluating disparities in MI, Kooperberg C, Kritchevsky SB, for left bundle-branch block. American health care is an important aspect of LaCroix A, Liu K, Liu Y, Musunuru Heart Journal. 2013 Jun;165(6):956-63. understanding differences in disease K, Newman AB, Onland-Moret NC, Summary: This study found there risk. The purpose of this study is Ordovas J, Peter I, Post W, Redline S, was no significant difference between to describe the methodology for Reis SE, Saxena R, Schreiner PJ, Volcik patients with nonstrict left bundle- estimating such disparities, to KA, Wang X, Yusuf S, Zonderland branch block and non-left bundle- provide improved AB, Anand SS, Becker DM, Psaty branch block. The greater observed disparity B, Rader DJ, Reiner AP, Rich SS, LV dyssynchrony may explain why estimation in a Rotter JI, Wilson JG, Keating BJ, patients with strict left bundle-branch large multi-ethnic et al. Gene-centric meta-analysis block have a better response to cardiac cohort study. of lipid traits in African, East resynchronization therapy. Asian and Hispanic populations. Public Library of Science One. 2012;7(12):e50198. Summary: Meta-analyses of European populations has successfully identified genetic variants in over 100 loci associated with lipid levels. This study seeks to expand our knowledge in other ethnicities, 16 which remains limited. 59. Strauss DG, Loring Z, Selvester RG, Wagner GS, Ugander M, Strauss 61. Hays AG, Stuber M, Hirsch GA, Yu RH, Gerstenblith G, Tomaselli G, DG. Localization of myocardial scar J, Schär M, Weiss RG, Gerstenblith Weiss RG, Wagner GS, Wu KC. Right, in patients with cardiomyopathy G, Kelle S. Non-invasive detection but not left, bundle branch block is and left bundle branch block of coronary endothelial response associated with large anteroseptal scar. using electrocardiographic to sequential handgrip exercise in Journal of the American College of Selvester QRS scoring. Journal coronary artery disease patients and Cardiology. 2013 May 22. pii: S0735- of Electrocardiology. 2013 May- healthy adults. Public Library of 1097(13)01985-2. Jun;46(3):249-55. Science One. 2013;8(3):e58047. Summary: This study concluded that Summary: This study describes Summary: This study showed that right bundle branch block patients have the diagnostic performance of coronary endothelial function does significantly greater scar size than left electrocardiographic criteria based not change with repeated isometric Original Research — Publications bundle branch block patients. on the Selvester QRS scoring system, handgrip stress in CAD patients or first in localizing myocardial scar healthy subjects. 60. Wieslander B, Wu KC, Loring and second in screening for any non- Z, Andersson LG, Frank TF, septal scar in patients with strictly 62. Loring Z, Strauss DG, Gerstenblith Gerstenblith G, Tomaselli GF, Weiss defined left bundle branch block. G, Tomaselli GF, Weiss RG, Wu KC. Cardiac MRI scar patterns differ by sex in an implantable Staff Spotlight: Elizabeth V. Ratchford, MD cardioverter-defibrillator and cardiac resynchronization therapy cohort. Heart In addition to managing her many duties at Johns Hopkins, Elizabeth Rhythm. 2013 May;10(5):659-65. Ratchford, MD, spent much of the past year directing the development of Summary: The findings from this the Johns Hopkins Center for Vascular study, which showed that the extent of Medicine, which provides clinical, research, and myocardial scar is less in women than teaching collaborations, as well as vascular men, may have important implications for the future study of gender disparities ultrasound laboratory services, to the in outcomes from implantable Ciccarone Center and its patients. A recent cardioverter-defibrillators and cardiac joint venture between the centers was resynchronization therapy. “Prevention of Cardiovascular Disease in Operational Firefighters after 40,” a pilot study 63. Hare JM, Fishman JE, Gerstenblith to develop a cost-effective program for G, et al. Comparison of allogeneic Dr. Elizabeth Ratchford vs autologous bone marrow–derived cardiovascular disease (CVD) risk assessment mesenchymal stem cells delivered by and risk reduction for firefighters. CVD accounts for 45% of deaths among transendocardial injection in patients on-duty firefighters, and early detection and treatment of CVD risk factors with ischemic cardiomyopathy: the may prevent death and disability. Working with Dominique Ashen, PhD, POSEIDON randomized trial. The CRNP, Dr. Ratchford focused on the detection of subclinical atherosclerosis Journal of the American Medical (CVD without symptoms) and primary prevention of CVD (avoiding its Association. 2012 Dec 12;308(22):2369- 79. initial occurrence) in firefighters through risk assessment and risk reduction, Summary: This study showed that, in which are two of the cornerstones of the Johns Hopkins Ciccarone Center aggregate, an injection of mesenchymal for the Prevention of Heart Disease. The study, funded by the National stem cells as a therapy for patients with Fallen Firefighters Foundation, includes measurement of carotid intimal- ischemic cardiomyopathy favorably medial thickness in the vascular laboratory, as well as a coronary artery affected their functional capacity, quality calcium scan and blood tests. Firefighters then participated in a 6-month of life, and ventricular remodeling. comprehensive lifestyle-modification program with Dr. Ashen to learn the 64. Assayag M, Saada A, Gerstenblith keys to controlling CVD risk factors and the importance of a healthy diet, G, Canaana H, Shlomai R, Horowitz aerobic exercise, maintenance of a normal weight, and tobacco cessation. M. Mitochondrial performance in heat The initial results of the study were presented at the Society for Vascular acclimation—a lesson from ischemia/ Medicine 2013 Annual Meeting and Scientific Sessions held in June 2013. reperfusion and calcium overload insults in the heart. American Journal of Physiology: Regulatory, Integrative and Comparative Physiology. 2012 Oct 15;303(8):R870-81. 17 65. McLean RC, Baird SW, Becker 69. Ashen MD, Blumenthal RS. 72. Auchincloss AH, Mujahid MS, LC, Townsend SN, Gerstenblith G, Cardiac complications of obesity. In: Shen M, Michos ED, Whitt-Glover Kass DA, Tomaselli GF, Schulman SP. Mullin GE, Cheskin LJ, Matarese LE MC, Diez Roux AV. Neighborhood Response to catecholamine stimulation (eds). Integrative Weight Management. health-promoting resources and of polymorphisms of the beta-1 and New York, NY: Springer Press. obesity risk (the multi-ethnic study beta-2 adrenergic receptors. American Forthcoming 2013. of atherosclerosis). Obesity. 2013 Journal of Cardiology. 2012 Oct Mar;21(3):621-8. 1;110(7):1001-7. 70. Blondon Summary: Results of this study Summary: This study concludes that M, Sachs M, show that altering the residential beta receptor gene variants significantly Hoofnagle AN, environment so that healthier

Original Research — Publications influence inotropic and chronotropic Ix JH, Michos behaviors and lifestyles can be easily responses to beta-agonist exposure in ED, Korcarz chosen may be a precondition for patients on beta blocker therapy. C, Gepner sustaining existing healthy behaviors AD, Siscovick and for adopting new healthy 66. Nasir K, Martin SS, Virani S. DS, Kaufman behaviors. Discordance: Can we capitalize on it JD, Stein JH, to better personalize atherosclerosis Kestenbaum Dr. Erin Michos 73. Smith BM, Kawut SM, Bluemke treatment? Atherosclerosis. 2013 B, de Boer IH. DA, Basner RC, Gomes AS, Hoffman Aug;229(2):504-6. 25-Hydroxyvitamin D and parathyroid E, Kalhan R, Lima JA, Liu CY, hormone are not associated with Michos ED, Prince MR, Rabbani L, 67. Martin SS, Ou FS, Newby LK, carotid intima-media thickness or Rabinowitz D, Shimbo D, Shea S, Barr Sutton V, Adams P, Felker GM, Wang plaque in the Multi-Ethnic Study RG. Pulmonary hyperinflation and TY. Patient- and trial-specific barriers of Atherosclerosis. Arteriosclerosis left ventricular mass: the Multi-Ethnic to participation in cardiovascular Thrombosis & Vascular Biology. 2013 Study of Atherosclerosis COPD Study. randomized clinical trials. Journal of Jun 27. Circulation. 2013 Apr 9;127(14):1503- the American College of Cardiology. Summary: This study shows that 11. 2013 Feb 19;61(7):762-9. the consistent lack of association Summary: Pulmonary hyperinflation, Summary: This study quantitatively of vitamin D and parathyroid as measured by residual lung volume examined the association of hormone with carotid intima-media or residual lung volume to total lung patient- and trial-specific factors thickness and plaque suggests that capacity ratio, is associated with with participation in cardiovascular these hormones may influence greater left ventricular mass, an randomized clinical trials. cardiovascular risk through pathways important predictor of heart failure and not reflected by carotid atherosclerosis. cardiovascular mortality. 68. Martin SS, Gosch K, Kulkarni KR, Spertus JA, 71. Smith BM, Prince MR, Hoffman 74. Lutsey PL, Mathews R, Ho PM, EA, Bluemke DA, Liu Michos ED. Vitamin Maddox TM, Newby CY, Rabinowitz D, D, calcium, and LK, Alexander KP, Hueper K, Parikh M, atherosclerotic risk: Wang TY. Modifiable Gomes AS, Michos ED, evidence from factors associated with Lima J, Barr RG. Impaired serum levels and failure to attain low- left ventricular filling in supplementation density lipoprotein COPD and emphysema: Is studies. Current cholesterol goal it the heart or the lungs?: Atherosclerosis at 6 months after The Multi-Ethnic Study of Reports. 2013 acute myocardial Atherosclerosis (MESA) Jan;15(1):293. infarction. COPD Study. Chest. 2013 Jun Summary: This review summarizes American Heart 13. evidence of the relationship between Journal. 2013 Jan;165(1):26-33.e3. Summary: These findings vitamin D, calcium supplements, and Summary: Findings from this study support a mechanism of upstream cardiovascular disease, and comments support targeted interventions in pulmonary causes of under-filling on the recent Institute of Medicine the transition of acute myocardial of the left ventricle in COPD and in recommendations regarding use of infarction care to promote affordable patients with emphysema on computed these nutrients. statin prescription at discharge, tomography. medication persistence and adherence, and cardiac rehabilitation participation. 18 75. Michos ED, Gottesman RF. 79. Vazquez-Figueroa JG, Rinehart 81. Joshi PH, Rinehart S, Vazquez Vitamin D for the prevention of S, Qian Z, Joshi PH, Sharma A, Lee G, Qian Z, Sharma A, Anderson H, stroke incidence and disability: J, Anderson H, Murrieta L, Wilmer Murrieta L, Flockhart N, Karmpaliotis Promising but too early for prime time. C, Carlson H, Taylor K, Ballard W, D, Kalynych A, Asztalos B, Elashoff European Journal of Neurology. 2013 Karmpaliotis D, Kalynych A, Brown M, Blanchard J, Rosenberg S, Brown Jan;20(1):3-4. C 3rd, Voros S. Prospective validation C, Voros S. A peripheral blood that vulnerable plaque associated with gene expression score is associated 76. Michos ED, Abraham TP. The role major adverse outcomes have larger with plaque volume and phenotype of echocardiography for cardiovascular plaque volume, less dense calcium, by intravascular ultrasound with risk assessment of the asymptomatic and more non-calcified plaque by radiofrequency backscatter analysis: individual. Journal of the American quantitative, three-dimensional Results from the ATLANTA Study. Original Research — Publications Medical Association: Internal measurements using intravascular Cardiovascular Diagnosis and Medicine. 2013 Jul 22. ultrasound with radiofrequency Therapy. 2013 Mar; 3(1):5-14. backscatter analysis: Results from Summary: This study found that 77. DeMazumder D, Lake DE, Cheng the ATLANTA I Study. Journal plaque characteristics that are thought A, Moss TJ, Guallar E, Weiss RG, of Cardiovascular Translational to be associated with higher risk (ie, Jones SR, Tomaselli GF, Moorman Research. 2013 May 22. “vulnerable plaques”) were associated JR. Dynamic Summary: Intermediate coronary with higher gene expression scores, analysis lesions associated with major adverse probably due to the inflammatory of cardiac cardiovascular events at 12 months nature of the genes included in the rhythms for have more plaque, less dense calcium, score. discriminating and more non-calcified plaque, atrial particularly fibrofatty tissue, as 82. McEvoy JW, Blaha MJ, Rivera fibrillation measured by intravascular ultrasound JJ, Budoff MJ, Khan AN, Shaw from lethal with radiofrequency backscatter. LJ, Berman DS, Raggi P, Min ventricular JK, Rumberger JA, Callister TQ, arrhythmias. Dr. Deeptankar 80. Joshi PH, Xu H, LeStrange R, Blumenthal Circulation: DeMazumder Flockhart N, Kirkland B, Vazquez G, RS, Nasir Arrhythmias & Electrophysiology. Qian Z, Sharma A, Marvasty I, Bhatt K. Mortality 2013 Jun 1;6(3):555-61. K, Brown C, Rinehart S, Miller J, rates in Voros S. The M235T single nucleotide smokers and 78. Bays HE, Toth PP, Kris-Etherton polymorphism in the angiotensinogen nonsmokers in PM, Abate N, Aronne LJ, Brown WV, gene is associated with coronary artery the presence Gonzalez-Campoy JM, Jones SR, calcium in patients with a family or absence Kumar R, La Forge R, Samuel VT. history of coronary artery disease. of coronary Obesity, adiposity, and dyslipidemia: A Atherosclerosis. 2013 Feb;226(2):433-9. artery consensus statement from the National Summary: The main finding of this Dr. Michael Blaha calcification. Lipid Association. Journal of Clinical study, aimed at using CAC as a tool to Journal of the American College of Lipidology. 2013 Jul-Aug;7(4):304-83. discover new risk factors Cardiology: Cardiovascular Imaging. Summary: The goal for atherosclerosis, was 2012 Oct; 5(10): 1037-45. of this statement is to that a variation of the better define the effect of angiotensinogen gene adiposity on lipoproteins, was the most significant how the pathos of excessive predictor of CAC in this body (adiposopathy) population. contributes to dyslipidemia, and how therapies such as appropriate nutrition, increased physical activity, weight-management drugs, and bariatric surgery might be expected to impact dyslipidemia.

19 83. Rubin J, Nambi V, Chambless Summary: This study found that, 91. Rubin J, LE, Steffes MW, Juraschek SP, among non-estrogen users, baseline Golden SH. Coresh J, Sharrett AR, Selvin E. sex steroids were not associated with Hypoglycemia Hyperglycemia and arterial stiffness: reductions in weight or waistline in non-critically the Atherosclerosis Risk in the circumference. ill, hospitalized Communities study. Atherosclerosis. patients with 2012 Nov;225(1):246-51. 87. Kim C, Golden SH, Kong S, Nan diabetes: Summary: Findings from this study B, Mather K, Barrett-Connor E; for the evaluation, showed that elevated hemoglobin Diabetes Prevention Program Research prevention, and A1c is associated with measures of Group. Does hormone therapy management. Original Research — Publications increased arterial stiffness, even affect blood pressure in the Diabetes Hospital Dr. Jonathan Rubin after accounting for arterial wall Prevention Program? Menopause. Practice. thickness, which is consistent with Forthcoming 2013. 2013 Feb;41(1):109-16. the hypothesis that hyperglycemia contributes to arterial stiffness beyond 88. Golden SH, Sanchez BN, Wu 92. Golden SH, Kalyani RR, Donner its effects on atherosis and suggests M, Champaneri S, Diez Roux AV, T. Christopher Dyer Saudek, MD: that hyperglycemia is associated with Seeman T, Wand GS. Relationship diabetes expert and implantable insulin altered material within the arterial between the cortisol awakening pump pioneer. Diabetes Care. 2013 wall. response and other features of the Mar 36(3):495-7. diurnal cortisol rhythm: The Multi- 84. Golden SH, Hsu H, Astor BC, Ethnic Study of Atherosclerosis. 93. Alvarez A, Faccioli J, Guinzbourg Malhotra S, Wand GS, Wasserman Psychoneuroendocrinology. 2013 Jul M, Castex MM, Bayón C, Masson BA. Association of depressive 25. pii: S0306-4530(13)00249-7. W, Bluro I, Kozak A, Sorroche P, symptoms and anti-depressants Summary: Researchers for this Capurro L, Grosembacher L, Proietti with body mass index and waist study conclude that bedtime cortisol A, Finkelsztein C, Costa L, Day PF, circumference in elderly men and showed the strongest correlation with Cagide A, Litwak LE, Golden SH. women: The ARIC Carotid MRI total cortisol area under the curve, Endocrine and inflammatory profiles Study. The Open Obesity Journal. suggesting it may be a marker of daily in type 2 diabetic patients with and Forthcoming 2013. cortisol exposure. without major depressive disorder. BMC Research Notes. 2013 Feb 85. Cooper LA, Boulware LE, Miller 89. Draznin B, Gilden J, Golden SH, 14;6:61. ER, Golden SH, Carson KA, Noronha Inzucchi SE; PRIDE investigators. Summary: This study found that G, Huizinga MM, Roter DL, Yeh HC, Pathways to quality inpatient diabetic patients with depression Bone LR, Levine DM, Hill-Briggs management of hyperglycemia and are more F, Charleston J, Kim MT, Wang NY, diabetes: A call to action. Diabetes likely to have Aboumatar HJ, Halbert JP, Ephraim Care. 2013 July: 36(7):1807-14. cardiovascular PL, Brancati FL. Summary: This paper outlines events, and Creating a trans- eight aspects of inpatient glucose different factors disciplinary research management (four as system-based can determine center to reduce issues and four as patient-based issues) this high cardiovascular in which randomized clinical trials association. health disparities are needed, and urges further progress Dr. Aaron Horne in Baltimore, in the science of inpatient diabetes Dr. Nivee Amin Maryland: Lessons management. learned. American Journal of Public Health. Forthcoming 2013. 90. Golden SH, Kim C, Barrett- Connor E, Nan B, Kong S, Goldberg 86. Kim C, Barrett-Connor E, R; the Diabetes Prevention Program Randolph JF, Kong S, Nan B, Mather Research Group. The association of K, Golden SH and the Diabetes elective hormone therapy with changes Prevention Program Research Group. in lipids among glucose intolerant Sex steroid levels and response to postmenopausal women in the diabetes weight loss interventions among prevention program. Metabolism. 2013 postmenopausal women in the May 6. Diabetes Prevention Program. Obesity. 20 2013 Jun 26. 94. Champaneri S, Xu X, Carnethon 97. Fitzpatrick SL, Lai BS, Brancati 100. Salameh MJ, Ratchford EV. MR, Bertoni AG, Seeman T, DeSantis FL, Golden SH, Hill-Briggs F. Peripheral Artery Disease. In: AS, Diez Roux A, Shrager S, Golden Metabolic syndrome risk profiles Amsterdam E, Blumenthal RS, SH. Diurnal salivary cortisol is among African American adolescents: Wong ND, eds. American Society associated with body mass index and national health and nutrition of Preventive Cardiology Primer of waist circumference: the multiethnic examination survey, 2003-2010. Preventive Cardiology. New York, study of atherosclerosis. Obesity. 2013 Diabetes Care. 2013 Feb;36(2):436-42. NY: Demos Medical Publishing. Jan;21(1):E56-63. Summary: These findings provide Forthcoming 2013. Summary: Researchers showed that plausible evidence that approximately higher body mass index and waistline 19% and 16% of African-American 101. Makadia S, Blaha MJ, Keenan

circumference are associated with boys and girls, respectively, are at T, Ndumele C, Jones S, DeFilippis Original Research — Publications neuroendocrine dysregulation, which high risk for having the metabolic A, Martin is present in a large population sample, syndrome. SS, Kohli P, and only partially explained by other Conceicao covariates. 98. Kim C, Golden SH, Mather KJ, RD, Carvalho Laughlin GA, Kong S, Nan B, Barrett- JA, Nasir K, 95. Kan C, Silva N, Golden SH, Rajala Connor E, Randolph JF Jr; Diabetes Blumenthal U, Timonen M, Stahl D, Ismail K. A Prevention Program Research Group. RS, Santos systematic review and meta-analysis of Racial/ethnic differences in sex R. Relation the association between depression hormone levels among postmenopausal of hepatic and insulin resistance. women in the diabetes Dr. Andrew DeFilippis steatosis to Diabetes Care. 2013 prevention program. Journal atherogenic Feb:36(2):480-9. of Clinical Endocrinology dyslipidemia. American Journal of Summary: This study and Metabolism. 2012 Cardiology. 2013 Sep 5. found that a small Nov;97(11):4051-60. Summary: This article looks at the but significant cross- Summary: This study found relationship between fatty liver and sectional association that, among postmenopausal atherogenic lipid profiles. was observed women, there were significant between depression race/ethnicity differences in 102. Subedi BH, Tota-Maharaj and insulin baseline sex hormones and R, Silverman MG, Minder CM, resistance, despite changes in sex hormones. Martin SS, Ashen MD, Blumenthal heterogeneity between studies. RS, Blaha MJ. The role of statins in 99. Orchard TJ, Temprosa M, diabetes treatment. Diabetes Spectrum, 96. Kim C, Kong S, Laughlin GA, Barrett-Connor E, Fowler SE, Summer Edition 2013:156-164. Golden SH, Mather KJ, Nan B, Goldberg RB, Golden SH, Mather Summary: Diabetes is considered Randolph JF Jr, Edelstein SL, Labrie KJ, Marcovina SM, Montez M, a risk equivalent for coronary heart F, Buschur E, Barrett-Connor E; for Ratner RE, Saudek CD, Sherif disease (CHD). The use of statins The Diabetes Prevention Program H, Watson KE; and the Diabetes for primary and secondary prevention Research Group. Reductions in glucose Prevention Program Outcomes Study in patients with diabetes is well among postmenopausal women who Research Group. Long-term effects established and supported by robust use and do not use estrogen therapy. of the Diabetes Prevention data from randomized, Menopause. 2012 Nov 19. Program interventions on controlled trials and cardiovascular risk factors: national guidelines. It is a report from the DPP reasonable to match the Outcomes Study. Diabetes intensity of statin therapy Medicine. 2013 Jan;30(1):46- with patients’ baseline CVD 55. risk. Summary: This study investigated the long-term Dr. Steve Hsu differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group. 21 103. Abd TT, Blaha MJ, Dr. Martin Goes on the Air Blumenthal Seth Martin, MD, recently appeared on the local Fox News affiliate TV RS, Joshi PH. station to discuss a new study, conducted by members of the Ciccarone Cardiovascular Center, which found that disease risk statins do not adversely affect prediction – integration memory. In fact, the study, into clinical published in the Mayo Clinic Dr. Thura Abd practice. Proceedings on October 1,

Original Research — Publications Current Cardiovascular Risk Reports. 2013, shows that statins taken 2013 Aug 29. for more than one year may Summary: This study examined the prevent dementia. “Because strengths and limitation of various cardiovascular risk prediction of their effect on arteries to algorithms. reduce plaque and prevent strokes, it makes sense that 104. Martin SS, Blaha MJ, statins could be protective in the brain against dementia,” commented Blumenthal RS. Let’s not be so quick Dr. Martin, a Pollin Cardiovascular Prevention Fellow and the study’s senior to stop statins: Expert opinion on the author. importance of awareness of reporting bias and outstanding questions in studies. Cardiology Today. October 2012. 106. Jackson G, Nehra A, Miner M, 109. Marine JE, Shetty V, Chow GV, Summary: Researchers examined a Billups KL, Burnett AL, et al. The Wright J, Gerstenblith G, Najjar SS, study linking statins to fatigue and assessment of vascular risk in men Lakatta EG, Fleg JL. Prevalence and found that it lacked several elements with erectile dysfunction: the role of prognostic significance of exercise- expected of a high-quality randomized the cardiologist and general physician. induced non-sustained ventricular controlled trial and suffered from International Journal of Clinical in asymptomatic multiple potential sources of bias. Practice. 2013 May 28. volunteers: The Baltimore Summary: Endothelial dysfunction Longitudinal Study of Aging. Journal 105. Nehra A, Jackson G, Miner M, appears to be the physiologic link of the American College of Cardiology. Billups KL, between erectile dysfunction and 2013 Aug 13;62(7)595-600. Burnett AL, et cardiovascular disease. Appropriate Summary: This longitudinal al. Diagnosis control of risk factors can lower the cohort analysis suggests that brief and treatment risk of both conditions. asymptomatic runs of exercise-induced of erectile non-sustained ventricular tachycardia, dysfunction 107. Rezaeian P, Razipour A, Li D, Zeb in the absence of clinical heart disease, for I, Baskett M, Post WS, Budoff MJ. are not uncommon in men, older reduction of Reproducibility of measurements by adults, and those with hypertension, cardiovascular multi-detector computed tomography: but are not associated with increased risk. The Intra- and inter-reader measures mortality after adjusting for baseline Journal of Dr. Kevin L. Billups for epicardial and intra-thoracic risk factors. These findings do not Urology. 2013 adipose tissue. Academic Radiology. necessarily apply to patients with Jun;189(6):2031-8. Forthcoming 2013. known structural heart disease. Summary: Erectile dysfunction is a marker of increased cardiovascular 108. DeFilippis AP, Oloyede OS, 110. McEvoy JW, Blumenthal risk in younger men and in men with Andrikopoulou E, Saenger AK, RS, Blaha MJ. Statin therapy for diabetes. Lifestyle improvements Palachuvattil JM, Fasoro YA, Guallar hyperlipidemia. The Journal of the and treatment of dyslipidemia and E, Blumenthal RS, Kickler TK, Jaffe American Medical Association. hypertension are very important to AS, Gerstenblith G, Schulman SP, 2013;310(11):1184-5. lower cardiovascular risk. Rade JJ. Platelet COX-1-independent TxA2 generation in patients with acute coronary syndromes. Circulation Journal. 2013 Aug 27. 22 management ofhypertension. HRR measureinthepreventionand needed todeterminetheusefulnessof of prehypertension.Furtherstudiesare associated withearlyandlatestages delayed HRRwasindependently patients undergoing stresstesting Summary Hypertension. Forthcoming2013. stress testing. American Journalof prehypertension duringexercise associated withearlyandlatestage Delayed heartraterecoveryisstrongly Conceiçao RD, A, BlumenthalRSMenegheloRS, Shaharyar S,BlahaMJ,Agatston 1 Forthcoming 2013. and design.ClinicalCardiology HM, ElshazlyMBSwiger KJ , PP, JoshiPH,McEvoyJWAhmed 112. MartinSS,BlahaMJToth of Hypertension.Forthcoming2013. increased cardiovascularrisk. hemodynamic indicesinpatientsat sleep apneaanddiurnalnon-dipping DC, RedlineS,MehraR.Obstructive EF, PatilSP, PunjabiNM,Babineau RS, QuanSF, GottliebDJ,Lewis Rueschman M, 111. SeifF, PatelSR, Walia HK, Dr. McEvoy Bill 13. Aneni E,RobersonLL, : Among asymptomatic : Among

Bhatt DL, Nasir K,SantosRD. large database SR. Very RS, Jones Blumenthal J, CannonCP, KR, Chimera PO, Kulkarni Kwiterovich Michos ED, Rationale of lipids: Blumenthal Journal .

Circulation of Study Multi-Ethnic Atherosclerosis. the from therapy for statin implications disease: atherosclerotic cardiovascular incident and calcium, artery coronary K Nasir MJ, Budoff P,, Ouyang RS Blumenthal Jones SR, R, 115. 2013. College ofCardiology. Forthcoming (MESA). TheJournalofthe American Ethnic Studyof Atherosclerosis preventive pharmacotherapy:Multi- events –implicationsfortheuseof atherosclerosis, andcardiovascular K. Polypilltherapy, subclinical Blumenthal RS,AgatstonANasir Blankstein R,Budoff M, Vargas J, 114. BittencourtM, on the prestigious American Heart Association statistics committee. committee. statistics Association Heart American prestigious the on serves also and Prevention, Stroke and Disease Heart on Council Advisory State (Maryland) the on serve to nominated recently was Dr. Blaha programs. fellowship and residency his complete to Hopkins Johns at Dr. under Blumenthal trained degrees, master’s and medical his received he where Vanderbilt, at Alpha Omega Alpha of president elected was and Dame Notre at Science of College the from first graduated who Dr. Blaha, Yahoo for Health. Living” Smart “Heart on blog a writes and overall, articles 75 scientific authored has disease), cardiovascular and (obesity syndrome metabolic on books two published 2012, In he attacks. heart prevent people help and arteries coronary in blockages detect to tests imaging of role the on debate national sparked The as journals high-profile such in published studies, research important several conducted has Dr. Blaha Disease. Heart of Prevention the for Center Ciccarone Hopkins Johns the at Research Clinical of Director named was recently Dr. Blaha prevention, disease heart in star rising anational career. Considered short his in much accomplished nonetheless has stroke, and disease heart preventing for advocate apassionate MPH, MD, Blaha, 33, Michael Only MD, MPH Blaha, J. Michael Spotlight: Staff Agatston A Agatston Martin SS, Blaha MJ Blaha SS, Martin . Forthcoming 2013.. Forthcoming , Rivera JJ, Virani SS, SS, JJ, Virani , Rivera

and Lancet . Dyslipidemia, . Dyslipidemia, Blaha MJ, , Blankstein JAMA , that recently recently , that stroke. and attack person’s for heart risk a profile for measuring standard the than would accurate more be that of arteries, the hardening to lead can of blood form that fat “bad” so-called the cholesterol, lipoprotein low-density develop for calculating method anew Summary: Association Medical American ofthe Journal lipid profile. standard the levels from cholesterol lipoprotein low-density for estimating Friedewald equation of anovel vsthe method Comparison Jones SR RS, Blumenthal MB, 116. Martin SS, Blaha MJ, Elshazly Elshazly MJ, Blaha SS, Martin Toth PP, Kwiterovich PO, . 2013;310(19):2061-2068.. This study sought to to sought study This Dr. Michael Blaha .

23 Original Research — Publications Original Research — Presentations

A listing of the late-breaking 4. Aladin A, Whelton SP, Blaha MJ, 10. Toth PP, Hamon S, Jones SR, clinical research data Keteyian SJ, Juraschek SP, Kuzniecky Joshi PH, Martin SS, Pordy R, presented at major cardiology JR, Schairer JR,; Zhong Y, Al-Mallah Hanotin C. Alirocumab, a proprotein meetings by the faculty and MH , Michos ED. Resting heart rate is convertase Subtilisin/Kexin Type fellows of the Johns Hopkins associated with increased risk for all- 9 (PCSK9) monoclonal antibody Ciccarone Center for the cause mortality even after considering reduces cholesterol concentrations of exercise capacity: The Fit Project. serum remnant lipoprotein fractions, Prevention of Heart Disease, very low-density lipoproteins and during the course of 2013. 5. Manalac RJ, triglycerides. Martin SS, Presentations at the 2013 Blaha MJ, Toth 11. Zikusoka M, Deal J, Jacobson Scientific Sessions of the PP, Kulkarni LP, Palella Jr FJ, Budoff M, Witt American Heart Association KR, Nasir MD, Kingsley LA, Brown T, Post (AHA), November 16-20; Dallas, K, Virani SS, WS. Traditional lipid and advanced TX. Blumenthal lipoprotein associations with RS, Jones SR. subclinical atherosclerosis of persons 1. Agarwal S, Deo R, Tomaselli G, Correlates and living with and without HIV: The Matsushita K, Post WS, Shilpak M, cut-points of Multicenter AIDS Cohort Study Dr. Raoul Manalac Calkins H, Sotoodehnia N, Soliman the triglyceride/ (MACS). E, Tereschenko L, Rosamond W, HDL cholesterol Coresh J. Chronic kidney disease ratio: The Very Large Database of 12. Miller Jr E, Li X, Zikusoka M, and risk of sudden cardiac death: The Lipids 4 (VLDL-4). Palella F, Kingsley LA, Witt MD, Atherosclerosis Risks in Communities George RT, Jacobson LP, Budoff Study. 6. Swiger KJ, Martin SS, Blaha M, Post WS. Racial differences in MJ, Blumenthal RS, Gerstenblith plaque composition among HIV 2. Tereshchenko G, Nasir K, Toth PP, Jones SR. seropositive and seronegative men in LG, Zhang Y, Narrowing sex differences in the Multicenter Aids Cohort Study Feeny A, Han lipoprotein cholesterol subclasses (MACS). L, Arking D, following menopause: Insights from Stoodehnia N, the Very Large Database of Lipids 13. Oni ET, Singha P, Ali SS, Aboagye Siscovick D, (VLDL-10B). J, Muzaik W, Blaha MJ, Agatston A, Post WS, Blumenthal RS, Feldman T, Sololomon S, 7. Al-Hijji M, Martin SS, Blaha MJ, Conceicao RD, Meneghelo RS, Berger R, Joshi PH, Blumenthal RS, Toth PP, Carvalho JA, Santos RD, Nasir K. Dr. Wendy Post Guallar E, Jones SR. Lipid phenotypes at the Smoking worsens the risk of oxidative Coresh J, extremes of HDL cholesterol: The stress in individuals with hepatic Soliman E. Interval that estimates Very Large Database of Lipids Study 9 steatosis. overlap between depolarization and (VLDL-9). repolarization helps to discriminate 14. Oni ET, Aneni E, Karim A, between benign and malignant early 8. Toth PP, Massaro JM, Jones SR, Mazaik W, Feldman T, Blaha MJ, repolarization in black men. Griswold M, Lirette S, Martin SS, Martin SS, Agatston A, Blumenthal Joshi PH, and D’Agostino RA. RS, Conceiçao RD, Meneghelo RS, 3. McKibben RA, Grinspoon S, Li High-density lipoprotein cholesterol Carvalho JA, Santos RD, Nasir X, Palella F, Kingsley LA, Witt MD, subfractions and risk for cardiovascular K. Increased physical activity is Brown TT, Jacobson LP, Budoff M, events in the Framingham Offspring associated with lower risk of non- Post WS. Elevated levels of monocyte and Jackson heart studies: A meta- alcoholic fatty liver disease across the activation markers, soluble CD14 and analysis. spectrum of cardiometabolic risk. CD163, are associated with subclinical atherosclerosis in the Multicenter 9. Toth PP, Massaro JM, Jones SR, AIDS Cohort Study (MACS). Griswold M, Lirette S, Joshi PH, Martin SS, and D’Agostino RA. Remnant lipoprotein cholesterol fractions and risk for cardiovascular events in the Jackson and Framingham Offspring studies: A meta-analysis. 24 T, T, W, 1 weight individuals. normal but not in obese, and overweight in high sensitivity C-reactive protein lower of elevated with prevalence K Nasir JA, RD, Santos Carvalho Meneghelo RS, RD, Conceiçao SS Martin MJ, Blaha A, O, Karim 1 factors. risk disease cardiovascular of traditional independent disease liver non-alcoholic fatty with associated Prehypertension and hypertension are K Feldman T, Nasir RS, R, Santos J, Meneghelo Carvalho R, Conceicao SS, Martin MJ, Blaha S, Shaharyar ET, SS, Oni Ali 15. E, Aneni 1 RD. K Nasir Meneghelo RS, RD, JAM, Conceicao Carvalho T, T, W, syndrome. metabolic without persons in inflammation vascular subclinical with associated is Study on Healthy Aging. Aging. Healthy on Study Brazilian The population: ageriatric in inflammation systemic against protects K AC,Sposito Nasir RS Blumenthal SS, Martin MJ, Blaha RCS, RD, Santos Paula de LA, Quaglia WM, Freitas EC, O, Jamal Aneni S, 19. Shaharyar population. Brazilian middle-aged a in inflammation vascular subclinical K. Nasir RD, Santos Meneghelo RS, RD, JAM, Conceicao Carvalho 7. Jamal O, Oni E, Karim A, Maziak Maziak A, 7. Karim E, O, Jamal Oni 6. Shaharyar S, Roberson L, Jamal Jamal L, Roberson S, 6. Shaharyar 8. Ali SS, Oni E, Karim A, Maziak Maziak A, Karim E, SS, Oni 8. Ali . Physical activity is associated associated is . Physical activity Agatston A Agatston Agatston A Agatston

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25 Original Research — Presentations 26 Original Research — Presentations Data from the FIT Project. Project. FIT the from Data mortality: of all-cause prediction the in of capacity exercise age and interaction The AH. SJ, Mallah Al Keteyian JR, K Nasir 36. 36. death. all-cause of predictor strong as a lesions calcified main MJ. Budoff Left R, D, Nakanishi Y, Nozari R, Vahoumeni Homat A, Li MJ 35. Blaha S, Darabian follow-up. year atten scores calcium artery coronary on based ethnicity RS S MJ Blaha R, 34. Nakanishi follow-up. years atten scores calcium artery coronary on based gender by age and mortality RS Blumenthal S Whelton Li D, MJ R, Blaha 33. Nakanishi Project. FIT the from patients of 52,515 analysis an consecutive valueof capacity: exercise prognostic K W, J, Nasir Schairer Qureshi M, Alam J, Rubin M, 32. Al-Mallah project. FIT the from Data women? and men valuein prognostic havesame the fitness cardiorespiratory W, K Nasir S Whelton S, 31. Juraschek AH, Al-Mallah Blumenthal Blumenthal S, Darabian S, , Kalia , Blaha MJ Blaha , Budoff MJ. Mortality risks by by risks MJ., Budoff Mortality Blaha MJ Blaha Blaha MJ Blaha , , Schairer J, Alam M, Qureshi Qureshi M, J, Alam , Schairer Blumenthal RS Blumenthal , Kalia N, Darabian S, S, N, Darabian , Kalia Y,, Zhong RS Blumenthal . Racial differences in the the in differences . Racial , Keteyian S. Does S. Does , Keteyian , Zhong Y,, Zhong S Whelton , Budoff MJ. All-cause MJ., Budoff All-cause , Schairer Schairer , , Keteyian S, S, Keteyian Whelton S Whelton , Whelton Whelton , , , , J, Blankstein R, Budoff M, Wong M, Budoff R, N, J, Blankstein Atherosclerosis (MESA). based adults.Multi-EthnicStudyof of incidentstrokeinpopulation score isanindependentpredictor Herrington D. Coronary artery calcium MK, SaccoR,BlahaMJ,SzkloM, YeboahGibson AO, J, Arnan 39. (MESA). of Atherosclerosis and adiposity: The Multi-EthnicStudy the associationbetweensexhormones CAM. Qualitativesexdifferences in Vaidya D, Woodward M, Anderson SH, Allison MA,OuyangP, SzkloM, 38. Mongraw-ChaffinML, (MESA). of Study Multi-Ethnic Atherosclerosis events: The disease cardiovascular for predicting presence calcium artery coronary and plaque artery carotid to compared thickness intima-media carotid Increased JH. J, Stein Kaufman Liu Folsom K, GL, MJ, Burke AR, Budoff R, RF, Kronmal Gottesman MJ MC, Blaha Tattersall 37. Young AD, JC, Gepner Delaney R, 1. 1. CA. Francisco, 9-11, March (ACC), 2013; San Cardiology of College American the of Sessions Scientific 2013 the at Presentations Training Poster Awards. Poster Training Fellow Best and In of Overall Best (MESA).Atherosclerosis Winner of Study Multi-Ethnic The disease: Dr. Birju Patel Dr. Birju Joshi PH Joshi

, Patel B Patel , Blaha MJ Blaha RS Blumenthal A Agatston with alow with subjects in events term intermediate- calcium predicts artery Coronary cardiovascular cardiovascular of risk lifetime , , Post WS Post Nasir K Nasir Golden , Berry , , . 6. 6. Atherosclerosis (MESA). of Study Multi-Ethnic the in disease cardiovascular and resistin human of association The MA. RS RL, McClelland M, Cushman MH, K Nasir R Tota-Maharaj MJ Blaha 5. meta-analysis. and review A systematic PCI:and/or angiography for coronary femoral access versus Radial J. N, Miller N, Bennett RK 4. patients. of 2,276 analysis Retrospective hemorrhage: subarachnoid aneurysmal with patients among Cardiomyopathy of Takotsubo’scharacteristics 3. 3. disease. ischemic heart stable with patients in intervention coronary of percutaneous rates inappropriate reduce system health alarge in Hospitals GL. Grunkemeier L AG, Wang Tilkian MS, TJ Gluckman MA, Fine SC,2. Wilson Lipids Study (VLDL-2). Study Lipids of Database Very the Large from Insights LDL-C: and Non-HDL-C, ratio, of TC/HDL-C the percentiles population in Patient-level discordance P , , Budoff MJ, MJ, , Budoff Muse ED Muse Abd T Abd Hasan Hasan Elshazly M Elshazly Blaha M Blaha , Zerr KJ, Crawford L, Mulumudi Mulumudi L, Crawford KJ, , Zerr , Allison , Allison , Nassery Nassery , Blumenthal Blumenthal , Criqui Criqui , . Incidence and clinical clinical and . Incidence , Jones S Jones K, , Kulkarni , , Martin S, Martin Dr. Hasan Rani Dr. Evan Muse Dr. Evan , Joshi Joshi . 10. risk. cardiovascular intermediate with patients asymptomatic in calcium artery coronary and subfractions B of apolipoprotein Association S. VorosM, J, Rinehart Miller S, V, Ashmaig J, R, Warnick Lee N, Varghese Flockhart Z, Qian R, 9. population. offspring Framingham the in for CHD 12 on risk year remnants of lipoprotein Impact Collaboration. Investigators for Lipoprotein the R, 8. Toth PP, J, D’Agostino Massaro population. offspring Framingham the in for CHD risk on subfractions its and of HDL-C Impact Collaboration. Investigators for Lipoprotein the R, 7. Toth PP, J, D’Agostino Massaro Vitamin D Study (VLDL-3). DStudy Vitamin of Lipids- Database Very Large The subfractions: cholesterol lipoprotein SR 13. Study. Heart Jackson The Americans: African in infarction myocardial acute cholesterol predicts lipoprotein remnant Triglyceride-rich Taylor SR. KR, Jones H, Kulkarni M, S, Griswold Lirette MJ, Blaha PH, 12. (MESA). of Study Multi-Ethnic Atherosclerosis The men: women versus in failure heart incident and Leptin MA. Allison J, Hughes-Austin TB, Harris R, McClelland MH, Criqui K, Nasir RS, MP, Reilly AN, Qasim Blumenthal 11. scoring. calcium specific by lesion lesion geometries wider longer/ and lesion distributions, distal more lesions, artery coronary calcified have more insufficiency renal with patients risk S. Intermediate Rinehart N, Voros J, Miller S, J, Flockhart Varghese V, R, Pitts K, Lee Bhatt

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27 Original Research — Presentations Presentations at the 2013 6. Ketlogetswe K, Post WS, Li X, 5. Elshazly M, Conference on Retroviruses and Jacobson L, Palella F, Margolick Martin SS, Joshi Opportunistic Infections, JB, Kingsley LA, Witt MD, Budoff PH, Blaha MJ, March 2013; Atlanta, GA M, Brown TT. Adiponectin is Kulkarni KR, associated with subclinical coronary Jones SR.: Non 1. Post WS, Jacobson LP, Coley C, atherosclerosis in the Multicenter HDL cholesterol, Grinspoon S, Palella F, Kingsley AIDS Cohort Study (MACS). guideline targets, LA, Witt M, Brown T, Budoff M, and population Margolick J. Elite controllers and 7. Lake JE, Vo Q, Jacobson LP, Sacktor percentiles: coronary plaque in the Multicenter N, Post WS, Becker J, Palella FJ, The Very Large Dr. Mohammed Elshazly AIDS Cohort Study (MACS). Ragin A, and Brown T. Associations Database of Original Research — Presentations between regional fat deposition Lipids Study (VLDL-2). 2. Post WS, and neurocognitive function in the Jacobson LP, Multicenter AIDS Cohort Study 6. Sinha P, Rana JS, Oni ET, Aneni Li X, Palella F, (MACS). EC, Blumenthal RS, Agatston A, Kingsley LA, Blaha MJ, Blankstein R, Santos R, Witt M, Brown Nasir K. Family history of premature T, Plankey Presentations at the 2013 cardiac events and sub-clinical M, Budoff M, Arteriosclerosis, Thrombosis atherosclerosis in children and young Margolick J. and Vascular Biology (ATVB) adults: A systematic review. Age and Scientific Sessions, May 1-3, Dr. Michelle Zikusoka noncalcified 2013; Lake Buena Vista, FL. 7. Sinha P, Oni E, Jamal O, Blaha MJ, coronary plaque in the Multicenter Agatston A, Blumenthal RS, Nasir AIDS Cohort Study (MACS). 1. Jones SR, Martin SS, Joshi PH, K, Santos RD. Metabolic risk factors Elshazly M, Kulkarni KR, Toth predict non-alcoholic fatty liver disease 3. Monroe A, Zikusoka M, Fu PP. Correlates of the triglyceride/ among normal weight non diabetic W, Jacobson L, Witt M, Palella F, HDL cholesterol ratio: The Very Large individuals. Kingsley L, Post WS, Brown T. Ten Database of Lipids (VLDL-4). percent of HIV-infected men who are 8. Shaharyar S, Jamal O, Blaha MJ, not taking statins should be. 2. Jones SR, Martin SS, Joshi PH, Siddiqui SA, Agatston A, Blumenthal Blaha MJ, Elshazly M, Kulkarni RS, Nasir K, Santos RD. Vascular 4. Price J, Post WS, Seaberg E, Budoff KR, Toth PP. Characterization of inflammation and hepatic steatosis M, Kinglsey L, Palella F, Witt M, triglyceride-rich remnant lipoproteins among the overweight metabolically Thio C. Prevalence of and risk factors in the hypertriglyceridemic healthy individuals and normal weight for nonalcoholic fatty liver disease in Fredrickson-Levy dyslipidemic with cardiometabolic risk factor HIV+ and HIV- men in the Multicenter phenotypes without chylomicrons: clustering. AIDS Cohort The Very Large Database of Lipids Study (MACS). (VLDL-6). 9. Jamal O, Siddiqui SA, Blaha MJ, Shaharyar S, Agatston A, Blumenthal 5. Ketlogetswe 3. Jones SR, Martin SS, Joshi RS, Santos RD, Nasir K. Significant K, Post WS, PH, Blaha MJ, Elshazly Interaction of Smoking and Metabolic Li X, Jacobson M, Kulkarni KR, Toth PP. Syndrome for Subclinical Vascular L, Palella F, Characterization of lipoproteins in the Inflammation. Margolick JB, hypertriglyceridemic Fredrickson- Kingsley LA, Levy dyslipidemic phenotypes 10. Lindsay L, Siddiqui SA, Blaha Dr. Kerunne S. Witt MD, Budoff with chylomicrons: The Very Large MJ, Agatston A, Blumenthal RS, Ketlogetswe M, Brown TT. Database of Lipids (VLDL-7). Santos RD, Nasir K, Sposito AS. Osteoprotegerin The prevalence of the metabolically and RANK ligand are associated with 4. Elshazly M, Martin SS, Joshi PH, healthy obese phenotype in an aging subclinical coronary atherosclerosis in Blaha MJ, Kulkarni KR, Jones SR. population and its association with the Multicenter AIDS Cohort Study Relative population percentiles of LDL subclinical cardiovascular disease: The (MACS). cholesterol, non-HDL cholesterol and Brazilian Study on Healthy Aging. total cholesterol to HDL cholesterol: The Very Large Database of Lipids Study (VLDL-2). 28 operational firefighters. MD patients with metabolic syndrome. metabolic with patients in syndrome coronary for acute risk Bpredicts J. Apolipoprotein Miller S, PH, 2 Agatston Dr. Arthur J. Miller S, Rinehart Joshi PH, Varghese V,1. R, Pitts K, Bhatt 2013; 4, Amsterdam September Aug - 31 Sessions, Scientific 2013 (ESC) Cardiology of Society European the at Presentations 1. 15, 2013; OH. Cleveland, 13- June Medicine, Vascular for Society the of Sessions Scientific 2013 the at Presentations JA, EP,Havranek Toth PP, Li Y, Spertus TM, Maddox A, Kokhar K, Kulkarni 1. 15-17,May MD. 2013; Baltimore, Sessions, 2013 Stroke Scientific and Disease Cardiovascular in Research Outcomes and Care of Quality Association’s Heart Presentations at the American Named TopNamed Abstract. Scoring Prospective Multi-Center Registry. TRIUMPH The infarction: myocardial acute after mortality cholesterol and . Pitts R, Bhatt K, Varghese V, K, Bhatt R, Joshi . Pitts Ratchford EV Ratchford MJ Blaha PH, Joshi SS, Martin Jones SR Jones Qian Z, Odeh W, Lee J, Rinehart W, Odeh Z, J, Qian Rinehart Lee . Cardiovascular risk assessment in in assessment risk . Cardiovascular Qian Z, Odeh W, Odeh Z, J, Qian Lee . Remnant lipoprotein Ashen Ashen KA, , Carson

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29 Original Research — Presentations The Ciccarone Center – Uniting the Proud Traditions of Hopkins

The Ciccarone Center for the Prevention of Heart Disease was founded in 1989 in memory of Henry A. “Chic” Ciccarone, a legendary athlete and lacrosse coach at Johns Hopkins who died at age 50 after his third heart attack.

But he was more than that. In the way he led his teams and his life, Chic embodied all that Johns Hopkins itself represents: dedication, excellence, leadership.

With intense, energetic competitiveness, pride, and engaging, infectious humor, Chic compiled an extraordinary record of achievements in athletics. As a three- time All-American midfielder and team captain, he won nearly every major Hopkins lacrosse award and was named to the All-Time Hopkins lacrosse team upon his graduation in 1962.

In 1989, the friends and former players of Coach Ciccarone began raising funds for the development of a comprehensive program geared toward the prevention of coronary heart disease events. The Ciccarone Center sought to unite the proud traditions of Hopkins lacrosse and Hopkins Medicine.

We all have a stake in winning the battle against heart disease. By joining the team at the Ciccarone Center, by sharing our enthusiasm and dedication to it, your support of coronary disease prevention will protect your life and the lives of those you love.

Coach Henry Ciccarone (center), with his sons, Henry Jr. (left) and Brent. 30 How to Contact the Center

We see patients Monday through Friday at the Johns Hopkins Ciccarone Center at Green Spring Station and on Mondays at the Johns Hopkins Outpatient Center. Dr. Michos also sees patients at Odenton. At each location we can perform exercise stress tests, treadmill stress echo tests, echo Doppler tests, EKG’s, Holter monitors and refer patients for cardiac CT scans. Vascular ultrasound testing and consultations are available in White Marsh, Columbia, Odenton, and at Green Spring Station.

Appointments at the Johns Hopkins Ciccarone Center at Green Spring Station, 10755 Falls Road, Pavilion I Suite 360, Lutherville, MD 21093 location can be scheduled at 443-997-0275. (Drs. Blumenthal, Post, Ashen, Ratchford, Billups and Blaha)

Appointments at the Johns Hopkins Outpatient Center, 601 North Caroline Street, Baltimore, Maryland 21287, can be scheduled at 443-997-0270. (Drs. Jones, Ndumele, Blumenthal, and Martin)

Appointments at the Johns Hopkins Cardiology Center at Odenton, 1132 Annapolis Road, Suite 104, Odenton, MD 21113, can be scheduled at 410-874-1520. (Drs. Michos and Ratchford)

Appointments for Vascular Medicine consultations or vascular ultrasound testing can also be scheduled through Dr. Ratchford’s office at 443-997-0275. Support the Prevention of Heart Disease

Heart disease is America’s #1 killer – more give to the Ciccarone Center, you’re ensuring that, than cancer and accidents combined. Our goal if you or a loved one is at risk for heart disease or at the Ciccarone Center is to stop heart disease before stroke, you’ll have a program to help prevent it. Or if it develops, through an aggressive program of risk you already have heart disease, you’ll maximize your assessment and comprehensive lifestyle and medical opportunity for an active and enjoyable life. management. You can help support this program by contributing Like all pioneering medical programs, however, we to the future of heart disease research, education, and are in constant pursuit of funding to accelerate our patient care. Make a tax-deducible donation to the progress. We depend on the support of generous Ciccarone Center today and help save lives tomorrow. donors to thrive. Gifts may be made in the form of cash, check, credit The Johns Hopkins Ciccarone Center for the card, securities, real estate or personal property. For Prevention of Heart Disease has just completed its more information, please call the development office 31 22nd year of service and is going strong. When you at 443-287-7384. The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease www.hopkinsmedicine.org/heart 410.955.7376