Julius Gardin | Rutgers New Jersey Medical School (original) (raw)

Papers by Julius Gardin

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2012

Circulation, Nov 14, 2017

Introduction: Diabetes mellitus (DM) is an important risk factor for coronary heart disease (CHD)... more Introduction: Diabetes mellitus (DM) is an important risk factor for coronary heart disease (CHD) and has been considered to be a relatively stronger predictor for CHD in women than men. Angina pec...

Circulation, Nov 10, 2015

Introduction: The myocardial contraction fraction (MCF), the ratio of LV stroke volume (SV) to my... more Introduction: The myocardial contraction fraction (MCF), the ratio of LV stroke volume (SV) to myocardial volume (MV), is a volumetric measure of myocardial shortening. With 3D-echocardiography and MRI, MCF distinguished pathologic from physiologic hypertrophy and predicted incident CV events. However, the association between 2D echo-determined MCF and adverse CV outcomes is not known, nor has the premise that this ratio adequately captures the predictive information of its components, SV and MV, been tested. Methods: Using CHS data, we calculated MCF from 2-D guided M-mode echo dimensions to estimate LV volumes and SV. MV was estimated from the measurements of LV mass divided by myocardial density. Among individuals with a normal EF, Cox regression was used to examine the associations between MCF with incident heart failure (HF), cardiovascular disease (CVD), and all-cause mortality adjusting for clinical and echo parameters. We further examined the validity of the premise that log(SV) and log(MV) contribute in the expected ratio of 1: -1 with our outcomes of interest. Results: 1556 participants were identified with an EF ≥ 55% (age 72±5) that had baseline echo data and available covariate information. MCF averaged 58% (Range: 21-104%). After controlling for CV, clinical risk factors, echo variables and NT-proBNP, a 10% relative increase in MCF was significantly associated with reduced risk of HF, CVD and death. When included separately in the models, both MV and SV showed significant associations with CVD and death, however, only MV was significant for HF and the coefficients violated the 1:-1 ratio suggesting MCF is not the best way to model this relationship. Conclusions: Among older adults with normal EF, 2D-echo MCF was associated with a lower risk of adverse CV outcomes after adjustment for clinical factors, echo parameters, and NT-proBNP. However, MCF compared to its component measures might be inadequate for risk prediction in HF.

Journal of the American College of Cardiology, Mar 1, 2013

Background-Inflammatory factors and low HDL-C relate to CHD risk, but whether inflammation attenu... more Background-Inflammatory factors and low HDL-C relate to CHD risk, but whether inflammation attenuates any protective association of high HDL-C is unknown. Objective-Investigate inflammatory markers' individual and collective impact on the association of HDL-C with incident coronary heart disease (CHD). Methods-In 3,888 older adults without known cardiovascular disease (CVD), we examined if the inflammatory markers C-reactive protein (CRP), interleukin-6 (IL-6), and lipoproteinassociated phospholipase A2 (Lp-PLA 2) modify the relation of HDL-C with CHD. HDL-C, CRP, IL-6, and Lp-PLA 2 values were grouped as using gender-specific tertiles. Also, an inflammation index of z-score sums for CRP, IL-6, and Lp-PLA 2 was categorized into tertiles. We calculated CHD incidence for each HDL-C/inflammation group and performed Cox regression, adjusted for standard CVD risk factors and triglycerides to examine the relationship of combined HDL-Cinflammation groups with incident events. Results-CHD incidence (per 1,000 person years) was higher for higher levels of CRP, IL-6, and the index, and lower for higher levels of HDL-C. Compared to high HDL-C/low-inflammation categories (referent), adjusted HRs for incident CHD were increased for those with high HDL-C and high CRP (HR=1.50, p<0.01) or highest IL-6 tertile (HR=1.40, p<0.05), but not with highest

Journal of The American Society of Echocardiography, Jul 1, 1988

Journal of the American College of Cardiology, Jul 1, 1985

Diabetes and Vascular Disease Research, Nov 28, 2019

Diabetes mellitus and angina pectoris are important conditions in older persons. The utility of p... more Diabetes mellitus and angina pectoris are important conditions in older persons. The utility of pre-diabetes mellitus, diabetes mellitus and other risk factors as predictors of incident angina pectoris among older adults has not been characterized. We examined incident angina pectoris rates by sex and diabetes mellitus status in 4511 adults aged ⩾65 years without coronary heart disease at baseline from the Cardiovascular Health Study. Cox regression examined predictors of incident angina pectoris, including pre-diabetes mellitus or diabetes mellitus adjusted for sociodemographic characteristics and other risk factors, over 12.2 ± 6.9 years of follow-up. Overall, 39.1% of participants had pre-diabetes mellitus, 14.0% had diabetes mellitus and 532 (11.8%) had incident angina pectoris. Incident angina pectoris rates per 1000 person-years in those with neither condition, pre-diabetes mellitus, and diabetes mellitus were 7.9, 9.0 and 12.3 in women and 10.3, 11.2 and 14.5 in men, respectively. Pre-diabetes mellitus and diabetes mellitus were not independently associated with incident AP; however, key predictors of AP were male sex, low-density lipoprotein-cholesterol, triglycerides, systolic blood pressure, antihypertensive medication and difficulty performing at least one instrumental activity of daily living (all p < 0.05 to p < 0.01). In our cohort of older adult participants, while the incidence of AP is greater in those with diabetes mellitus, neither diabetes mellitus nor pre-diabetes mellitus independently predicted incident angina pectoris.

American Journal of Hypertension, Jun 21, 2019

BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) is individually associated with incident... more BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) is individually associated with incident hypertension (HTN) and cardiovascular disease (CVD) events. We hypothesize that the increases in hs-cTnT with increases in blood pressure will be related to higher incidence of CVD. METHODS The Cardiovascular Health Study is a longitudinal cohort of older adults. Those with hs-cTnT data and CVD risk factors at baseline and follow-up (2-3 years later) were stratified based on systolic blood pressure (SBP; optimal: <120 mm Hg, intermediate: 120-139 mm Hg, elevated: ≥140 mm Hg) and hs-cTnT (undetectable: <5 ng/l, detectable: 5-13 ng/l, elevated: ≥14 ng/l) categories. SBP and hs-cTnT were classified as increased or decreased if they changed categories between exams, and stable if they did not. Cox regression evaluated incident CVD events over an average 9-year follow-up. RESULTS Among 2,219 adults, 510 (23.0 %) had decreased hs-cTnT, 1,279 (57.6 %) had stable hs-cTnT, and 430 (19.4 %) had increased hs-cTnT. Those with increased hs-cTnT had a higher CVD risk with stable SBP (hazard ratio [HR]: 1.28 [1.04-1.57], P = 0.02) or decreased SBP (HR: 1.57 [1.08-2.28], P = 0.02) compared to those within the same SBP group but a stable hs-cTnT. In those with lower SBP at follow-up, there was an inverse relation between diastolic blood pressure (DBP) and risk of CVD events in those with increased hs-cTnT (HR: 0.44 per 10 mm Hg increase, P < 0.01). CONCLUSION An increase in hs-cTnT over time is associated with a higher risk of CVD even when the blood pressure is stable or decreases over time.

Journal of the American College of Cardiology, 1995

JAMA, May 10, 1995

To describe the changing patterns of antihypertensive medication use in the years immediately bef... more To describe the changing patterns of antihypertensive medication use in the years immediately before and after the publication of the results of three major clinical trials of the treatment of hypertension in older adults. In this cohort study, adults 65 years or older were examined annually on four occasions between June 1989 and May 1992, and the use of antihypertensive medications was assessed by inventory at each visit. The four visits defined the boundaries of three study periods. For each study period, participants receiving antihypertensive therapy were either continuous users (n = 1667, 1643, and 1605, respectively) or starters (n = 157, 142, 120) of hypertensive therapy. The large clinical trials that convincingly proved the efficacy and safety of low-dose diuretic therapy in older adults were published during the latter parts of period 2 and the early parts of period 3. Among starters, the proportion initiating therapy on diuretics increased from 35.9% in period 2 to 47.5% in period 3, significantly so among women (P = .04). The proportions initiating other drugs displayed no significant trends. Among continuous users, the use of diuretics, beta-blockers, and vasodilators generally decreased over the 3-year period, while the use of calcium channel blockers and angiotensin-converting enzyme inhibitors increased significantly in each of the three periods (P < .05). The decline of 2.7% in the prevalence of diuretic use in period 1 abated during period 2 (1.8% decline), and it slowed significantly (P = .03) to almost a complete halt during period 3 (0.2% decline). The rate of increase in the use of calcium channel blockers slowed significantly (P = .01) between period 1 (+6.7%) and period 3 (+2.8%). Although other factors such as cost may have been important, the temporal trends in antihypertensive drug therapy coincided in time with and may have reflected in part the influence of the major clinical trials on the patterns of clinical practice.

Journal of The American Society of Echocardiography, Mar 1, 1992

Circulation, Nov 8, 2022

Clinical Case: A 37-year-old transgender (TG) woman off gender-affirming hormonal therapy (GAHT) ... more Clinical Case: A 37-year-old transgender (TG) woman off gender-affirming hormonal therapy (GAHT) presented with substernal chest pain radiating to the left arm, worse with exertion and relieved with res. She was hypertensive and tachycardic on admission. Initial bloodwork revealed an elevated troponin I of 0.57 ng/mL, which peaked at 1.48 ng/mL. EKG on admission showed hyperacute T waves in the anterior leads without ST elevation (see Figure 1). She was diagnosed with non-ST elevation myocardial infarction (NSTEMI) and taken for left heart catheterization (LHC). Decision-Making: TTE showed preserved LVEF and basal inferior, basal inferolateral, basal anterolateral and mid-anterolateral hypokinesis. LHC showed proximal-to-mid right coronary artery (RCA) occlusion. After failed aspiration thrombectomy indicating calcified plaque, two overlapping drug-eluting stents (DES) were successfully deployed with restoration of flow. She was discharged home on aspirin, ticagrelor, atorvastatin, and carvedilol. Discussion: Despite a recent push to increase awareness, research and healthcare equality specific to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients, a significant gap persists. Specifically, stress, inflammation, dyslipidemia, and thromboembolism predispose this understudied population to increased coronary artery disease (CAD) and myocardial infarction (MI). Accordingly, greater effort needs to be taken to mitigate preventable cardiac morbidity and mortality in this patient population. Conclusion: CAD in LGBTQ+ adults is well studied. However, there are few published studies on CAD specifically among TG men and women. National cross-sectional data highlights this disproportionate risk of CAD and MI among TG men and women relative to their cisgender female and male peers, a healthcare disparity recently emphasized by the AHA. Consequently, care must be taken to eliminate these aforementioned inequalities.

Journal of the American College of Cardiology, Mar 1, 2022

Journal of the American College of Cardiology, Apr 1, 2016

Circulation, Jan 28, 2003

American Journal of Cardiology, Sep 1, 1988

To evaluate the effect of upright exercise on aortic peak flow acceleration and velocity, 60 norm... more To evaluate the effect of upright exercise on aortic peak flow acceleration and velocity, 60 normal subjects between 15 and 74 years of age were evaluated by continuous wave Doppler during treadmill stress testing using the Bruce protocol. Subjects were divided into 3 age groups, each with 20 subjects: group 1,21 f 4 years of age (mean f standard deviation), group 2,36 f 5 years and group 3,58 f 7 years. Periodic measurements of heart rate, blood pressure and Doppler blood flow velocity and acceleration were made before, during and after exercise. Continuous wave Doppler measurements were recorded from the suprasternal notch. The relation between Doppler aortic measurements and age, gender, normal heart rate and blood pressure responses during exercise, and exercise preconditioning, was evaluated. Age alone was significantly related (inversely) to immediate postexercise Doppler aortic peak blood flow peak acceleration (group 1,55 f 15, group 2, 46 & 11 and group 3,36 f 9 m/s*, p <O.OS) and peak velocity (1.1 f 0.2, 1.0 f 0.2 and 0.8 f 0.2 m/s, respectively, p <O.Ol). Gender, heart rate and blood pressure changes during exercise, as well as preconditioning, had no significant effect on these flow characteristics. Consequently, the effects of normal aging must be considered when using Doppler measurements of peak aortic acceleration and velocity in the evaluation of left ventricular function, e.g., to detect or exclude the presence of coronary artery disease.

Circulation, Aug 1, 1995

... Julius M. Gardin, MD; Lynne E. Wagenknecht, DrPH; Hoda Anton-Culver, PhD; John Flack, MD; Sam... more ... Julius M. Gardin, MD; Lynne E. Wagenknecht, DrPH; Hoda Anton-Culver, PhD; John Flack, MD; Samuel Gidding, MD; Tom Kurosaki, MS; Nathan D ... Background The objective of this study was to describe the distribution of echo left ventricular (LV) mass and its association with ...

American Journal of Epidemiology, Jun 15, 1994

The prevalence of subclinical atherosclerosis and cardiovascular disease was evaluated among the ... more The prevalence of subclinical atherosclerosis and cardiovascular disease was evaluated among the 5,201 adults aged &65 years in four communities participating in the Cardiovascular Health Study from June 1989 through May 1990. A combined index based on electrocardiogram and echocardiogram abnormalities, carotid artery wall thickness and stenosis based on carotid ultrasound, decreased ankle-brachial blood pressure, and positive response to a Rose Questionnaire for angina or intermittent claudication defined subclinical disease. The prevalence of subclinical disease was 36% in women and 38.7% in men and increased with age. Among women, low-density lipoprotein cholesterol, systolic blood pressure, blood glucose, and cigarette smoking were positively associated, and high-density lipoprotein cholesterol negatively associated, with subclinical disease. In men, systolic blood pressure, blood glucose, and cigarette smoking were independent risk factors in multiple logistic regression analyses. The risk factors for subclinical disease are, therefore, similar to those for clinical disease at younger ages, especially among women. It is possible that older individuals with subclinical disease are at very high risk of developing clinical disease and that more aggressive interventions to prevent clinical disease should be oriented to individuals with subclinical disease.