Hahn, Joshua

The utilization of transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic stenosis (AS) with intermediate-to-high surgical risk for surgical aortic valve replacement (SAVR) [...]

Introduction: Theobromine is a naturally occurring substance found in cocoa products. Theobromine may have beneficial cardiovascular effects through various mechanisms. We used the NHANES database to analyze associations between theobromine consumption and cardiovascular health outcomes. Methods: The NHANES database represents a nationally representative population which was used to construct the study population from 1996-2016. We assessed multiple demographic factors and compared differences amongst those who consumed various amounts of theobromine to those who did not. The primary outcome measures were hypertension and lipid profiles. Results: Among 42,038 NHANES survey participants, 37569 and 4469 of the participants reported never consuming theobromine and consuming theobromine, respectively. Table 1 demonstrates baseline characteristics of those reporting no theobromine consumption in comparison to the theobromine consuming participants (100-400md/g and 400-850mg/d). Moderate to high amounts of theobromine consumption was observed in participants who were older with higher BMI and more education and were more likely to be tobacco users in comparison to those with no theobromine consumption (all p-values <0.05). Moderate to high theobromine consumption was also observed to be associated with a higher hemoglobin level, higher LDL cholesterol, lower HDL cholesterol, and prevalence of hypertension (all p-values <0.05). Conclusions: We observed that individuals who consumed moderate to high amounts of theobromine had associated improvements in lipid profile parameters as well as reduced blood pressure. Theobromine may represent a complementary non-pharmacologic supplementation to typical lifestyle modifications to improve cardiovascular outcomes. Further prospective studies are needed to better clarify this potential association.

Abstract Background Transcatheter mitral valve repair (TMVR) has become an important minimally invasive alternative to open surgical repair in patients with severe mitral regurgitation. As TMVR develops as an established practice, real-world outcome data is needed to guide clinical decision making as the body of literature on this topic is limited. In our study, we investigate TMVR outcomes in a large urban health system. Methods We retrospectively analyzed clinical data from the electronic health records of the extensive urban health system Mount Sinai Data Warehouse and analyzed all individuals who underwent TMVR. Baseline demographics were obtained as well as significant morbidity and mortality outcomes. Finally, multivariable analysis was used to determine associated characteristics with mortality. Results We identified 3533 patients who underwent TMVR from 2008 to 2018. The overall mortality was 3.7%. The most common comorbidities observed were heart failure (56%), pulmonary hypertension (26%), atrial fibrillation (26%) and CKD or ESRD (16%). After multivariable analyses, ischemic stroke (adjusted OR 3.46; 95% CI 1.93–5.97, p = &lt;0.001), CKD or ESRD (3.95; 2.72–5.75, p 0.01), aortic stenosis (2.23; 1.12–4.15, p&lt;0.001), and heart failure (8.18; 4.16–18.5, p&lt;0.001) were independently associated with mortality. Conclusion In all patients who underwent TMVR at a large urban health system, ischemic stroke, aortic stenosis, heart failure, CKD and ESRD were independently associated with mortality. Future prospective studies will be needed to further define these observed associations. Funding Acknowledgement Type of funding sources: None.

Abstract Background Pulmonary embolism (PE) is a life-threatening cardiovascular condition. Studies showed that PE patients were associated with disorders of lipid metabolism and had higher triglyceride and lower HDL-C levels compared with healthy. We conducted the genome-wide association study to identify novel loci contributing to PE. Methods We conducted a large-scale GWAS of PE in 5,466 PE cases and 461,219 controls of European ancestry from the UK Biobank (466,685 participants total). We used genome-wide summary statistics to test for enrichment of functional annotations using ENRICHR. Example pathways included in Enrichr for testing include membership of genes in pathway databases such as the Kyoto Encyclopedia of Genes and Genomes (KEGG), Wikipathway, PANTHER, BioCarta or NCI-Nature pathways. We analyzed the pathways using combined score and p-values which were well validated by comparing to several methods. For pathway analyses, we considered a nominal P-value threshold of 0.05. Results We identified genome-wide significant genetic associations in 63 independent genetic loci for PE (P&lt;5.0x10–7). Our findings for top pathways highlight that lipid metabolism (LIPC, LCAT, NPC2), caffeine metabolism (NAT2), and sudden cardiac death (ABCG8) related genetic loci play an important role in PE alongside genes already associated with coagulation-thrombosis pathway (VWF, THPO, PTPN11, INPP5D, UROS, HMBS) (all p-values p-values &lt;0.05). Conclusion Our findings uncovered unexpected novel factors of PE etiology, suggesting novel mechanistic concepts of PE pathophysiology. Funding Acknowledgement Type of funding source: None