Terry, James G

Abstract Rationale Pulmonary artery (PA) dilation on computed tomography (CT) has been associated with moderate-to-severe ­pulmonary hypertension (PH) using outdated diagnostic criteria. The association between PA size and mean PA pressure (mPAP) in mild PH and the prognostic implications of PA dilation remain unclear. Objectives To investigate associations between PA size, mPAP, and survival in subjects without significant lung disease aside from PH. Methods PA size on CT was measured for individuals with group 1 or 2 PH and matched controls in the Pulmonary Vascular Disease Phenomics cohort. Outcomes included mPAP on right heart catheterization (RHC) and time to heart and/or lung ­transplantation or death. Measurements and Main Results A total of 691 subjects were included, with 595 undergoing RHC. PA diameter and PA:aorta ratio demonstrated significant association with mPAP (ρ = 0.557 and 0.564, respectively). Size increased incrementally from no PH to mild PH to moderate-severe PH for PA diameter (27.64 [95% CI, 17.64-37.64] mm to 30.65 [95% CI, 18.99-42.31] mm to 36.00 [95% CI, 22.46-49.54] mm) and PA:aorta (0.89 [95% CI, 0.53-1.24] to 0.99 [95% CI, 0.63-1.35] to 1.19 [95% CI, 0.60-1.78]). PA diameter and PA:aorta demonstrated good discrimination of mPAP >20 mm Hg (area under the curve: 0.834 and 0.816, respectively). Transplant-free survival decreased across the continuum of PA diameter and PA:aorta (P <.001). Adjusted hazard ratio of third versus first quartile values was 2.36 (95% CI, 1.58-3.54) for PA diameter and 2.24 (95% CI, 1.52-3.30) for PA:aorta. Conclusions In subjects without significant lung disease outside of PH, PA size on CT was associated with increased mPAP and decreased transplant-free survival across the spectrum of PH severity and demonstrated modest diagnostic discriminatory ability using updated hemodynamic criteria.

Abstract Background Non‐alcoholic fatty liver disease (NAFLD) is recognized as a prevalent determinant of cardiometabolic diseases. The association between NAFLD and obesity warrants further research on how NAFLD modifies associations between body mass index (BMI) and Waist circumference (WC) with cardiometabolic risk (CMR). Objective This study assessed whether NAFLD modifies associations between BMI and WC with 5‐year changes in CMR in 2366 CARDIA study participants. Methods Non‐contrast CT was used to quantify liver attenuation, with ≤51 Hounsfield Units (HU) used to define NAFLD in the absence of secondary causes of excess liver fat. The dependent variable was the average Z score of fasting glucose, insulin, triglycerides [log], (−) high‐density lipoprotein cholesterol (HDL‐C), and systolic blood pressure(SBP). Multivariable linear regression was used to estimate the associations between BMI and WC with CMR. Effect modification by NAFLD was assessed by an interaction term between NAFLD and BMI or WC. Results The final sample had 539 (23%) NAFLD cases. NAFLD modified the association of BMI and WC with CMR (interaction p < 0.0001 for both). BMI and WC were associated with CMR in participants without NAFLD ( p < 0.001), but not among those with NAFLD. Participants with NAFLD and normal BMI and WC had CMR estimates that were higher than those without NAFLD in the obese categories. Among those without NAFLD the 5 years CMR change estimate was 0.09 (95% CI: 0.062, 0.125) for BMI ≥30 kg/m 2 compared to −0.06 (−0.092, −0.018) for BMI < 25 kg/m 2 , and among those with NAFLD, these estimates were 0.15 (0.108, 0.193) and 0.16 (−0.035, 0.363). Conclusions NAFLD modifies associations of BMI and WC with CMR. Compared with BMI and WC, NAFLD was more strongly associated with CMR. In the presence of NAFLD, BMI and WC were not associated with CMR. These findings have implications for clinical screening guidelines.

Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) in U.S. adults is over 30%, yet the role of lifestyle factors in the etiology of NAFLD remains understudied. We examined the associations of physical activity, by intensity and type, and television viewing with prevalent NAFLD. Methods: Cross-sectional analysis of a population-based sample of 2726 Black (49%) and White (51%) adults (Mean (SD) age, 50 (3.6) years; 57.3% female) from the CARDIA study. Exposures were aerobic activity by intensity (moderate, vigorous; hours/week); activity type (aerobic, muscle-strengthening; hours/week); and television viewing (hours/week), examined concurrently in all models and assessed by validated questionnaires. Our outcome was NAFLD (liver attenuation < 51 Hounsfield Units), measured by non-contrast computed tomography, after exclusions for other causes of liver fat. Covariates were sex, age, race, study center, education, diet quality, smoking status, alcohol consumption, and body mass index or waist circumference. Results: 648 participants had NAFLD. In the fully adjusted modified Poisson regression model, the risk ratios per interquartile range of each exposure were moderate-intensity aerobic activity, 1.10 (95% CI, 0.97–1.26); vigorous-intensity aerobic activity, 0.72 (0.63–0.82); muscle-strengthening activity, 0.89 (0.80–1.01); and television viewing, 1.20 (1.10–1.32). Relative to less active participants with higher levels of television viewing, those who participated in ≥2 h/week of both vigorous-intensity aerobic and muscle-strengthening activity and <7 h/week of television viewing had 65% lower risk of NAFLD (risk ratio = 0.35, 95% CI = 0.23–0.51). Conclusion: Adults who follow public health recommendations for vigorous-aerobic and muscle-strengthening activity, as well as minimize television viewing, are considerably less likely to have NAFLD than those who do not follow the recommendations and who have relatively high levels of television viewing.