Browsing by Author "Dardari, Zeina"

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    Obesity Severity Phenotypes, Relevant Biomarkers, and Cardiovascular Disease: The Cross-Cohort Collaboration (CCC)
    (2025-05) Dardari, Zeina; Zhang, Jianjun; Bakoyannis, Giorgos; Nan, Hongmei; Staten, Lisa; Blaha, Michael
    The global obesity pandemic is well documented and continues to pose a major public health threat. In 2022, the World Health Organization (WHO) classified more than 2.5 billion adults worldwide as overweight, including 890 million with obesity. In the U.S., projections indicate that by 2030, 1 in 2 adults will have obesity (BMI ≥30 kg/m²), and 1 in 4 will have severe obesity (BMI ≥35 kg/m²). Obesity is a well-established risk factor for numerous diseases, including type 2 diabetes mellitus, hypertension, obstructive sleep apnea, fatty liver disease, osteoarthritis, cancer, and cardiovascular disease (CVD), such as coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF). Using the Cross Cohort Collaboration (CCC), a harmonized dataset of 24 U.S.-based prospective cohort studies, we examined the relationship between BMI and CVD outcomes across a broad BMI spectrum, with a focus on severe obesity (Class II: BMI 35.0–39.9 kg/m²; Class III: BMI ≥40.0 kg/m²). Our findings show that while obesity was associated with increased risk for all outcomes, stratifying obesity into sub-classes revealed that relative risk increases with obesity severity, even after accounting for traditional CVD risk factors. We also evaluated the long-term impact of central adiposity on multiple CVD subtypes, with particular attention to discordant adiposity groups (e.g., normal BMI with elevated central adiposity). Our findings underscore the need to identify and address central obesity, even among individuals with a normal BMI. These results support incorporating central adiposity measures as routine clinical assessments to improve cardiovascular risk stratification. Finally, we explored the relationship between obesity and subclinical markers of inflammation, thrombosis, and atherosclerosis to better understand underlying mechanisms. Our results demonstrated a positive, graded association between BMI and elevated levels of these markers, with the strongest associations observed in Class III obesity.
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    Serum albumin concentration as an independent prognostic indicator in patients with pulmonary arterial hypertension
    (Wiley, 2018) Snipelisky, David; Jentzer, Jacob; Batal, Omar; Dardari, Zeina; Mathier, Michael; Medicine, School of Medicine
    Background Serum albumin is a strong prognostic indicator for many disease processes, yet limited data exist regarding its prognostic relationship in pulmonary arterial hypertension (PAH). Our study aims to assess the relationship of hypoalbuminemia with disease severity and mortality in this population. Hypothesis Serum albumin concentrations are a predictor of outcomes in PAH. Methods A retrospective review of all patients with World Health Organization group 1 PAH evaluated between March 2001 and August 2008 was performed. Patients were stratified into groups based on serum albumin concentration ≤3.3 g/dL (hypoalbuminemia) vs >3.3 g/dL. Clinical, hemodynamic, and survival comparisons were compared between groups using Student t test and χ2 test, followed by univariate analysis and multivariate logistic regression. Results A total of 163/273 (59.7%) patients had a documented serum albumin concentration. Hypoalbuminemia was present in 41 (25.2%) patients and serum albumin ≤3.3 g/dL represented the lowest quartile of serum albumin. Patients with hypoalbuminemia had higher rates of renal dysfunction (26.8% vs 9.8%, P =0.0069) and hepatic dysfunction (29.3% vs 6.6%, P <0.001), and lower hemoglobin levels (11.6 vs 13.4 g/dL, P < 0.001). Hemodynamic and functional capacity assessments were comparable between groups. Independent predictors of mortality included low albumin levels (hazard ratio [HR]: 0.485, P = 0.008), high right atrial systolic area (HR: 1.062, P = 0.003), low Fick‐derived cardiac index (HR: 1.465, P = 0.016), and high New York Heart Association functional class (HR: 1.767, P = 0.042). Patients with hypoalbuminemia demonstrated a significantly lower survival rate at latest follow‐up (P = 0.01). Conclusions Lower serum albumin concentrations in patients with PAH are associated with higher mortality and can serve as a marker of disease severity in this patient population.