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Korre, Maria

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Korre

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Maria

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Korre, Maria
Author's Publications: search.filters.isAuthorOfPublication.3e8a8d90-db08-4da3-98bd-88a0a48b58c6

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    Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters
    (2017) Korre, Maria; Porto, Luiz Guilherme G.; Farioli, Andrea; Yang, Justin; Christiani, David; Christophi, Costas; Lombardi, David; Kovacs, Richard J.; Mastouri, Ronald; Abbasi, Siddique; Steigner, Michael; Moffatt, Steven; Smith, Denise; Kales, Stefanos
    Left ventricular (LV) mass is a strong predictor of cardiovascular disease (CVD) events; increased LV mass is common among US firefighters and plays a major role in firefighter sudden cardiac death. We aim to identify significant predictors of LV mass among firefighters. Cross-sectional study of 400 career male firefighters selected by an enriched randomization strategy. Weighted analyses were performed based on the total number of risk factors per subject with inverse probability weighting. LV mass was assessed by echocardiography (ECHO) and cardiac magnetic resonance, and normalized (indexed) for height. CVD risk parameters included vital signs at rest, body mass index (BMI)–defined obesity, obstructive sleep apnea risk, low cardiorespiratory fitness, and physical activity. Linear regression models were performed. In multivariate analyses, BMI was the only consistent significant independent predictor of LV mass indexes (all, p <0.001). A 1-unit decrease in BMI was associated with 1-unit (g/m1.7) reduction of LV mass/height1.7 after adjustment for age, obstructive sleep apnea risk, and cardiorespiratory fitness. In conclusion, after height-indexing ECHO-measured and cardiac magnetic resonance–measured LV mass, BMI was found to be a major driver of LV mass among firefighters. Our findings taken together with previous research suggest that reducing obesity will improve CVD risk profiles and decrease on-duty CVD and sudden cardiac death events in the fire service. Our results may also support targeted noninvasive screening for LV hypertrophy with ECHO among obese firefighters.
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    Modified Mediterranean Diet Score and Cardiovascular Risk in a North American Working Population
    (Public Library of Science, 2014) Yang, Justin; Farioli, Andrea; Korre, Maria; Kales, Stefanos
    Introduction: Greater adherence to a Mediterranean diet is linked to lower risk for cardiovascular morbidity/mortality in studies of Mediterranean cohorts, older subjects, and/or those with existing health conditions. No studies have examined the effects of this dietary pattern in younger working populations in the United States. We investigated the effects of Mediterranean diet adherence on cardiovascular disease (CVD) biomarkers, metabolic syndrome and body composition in an occupationally active, non-Mediterranean cohort. Methods: A cross-sectional study in a cohort of 780 career male firefighters, ages 18 years or older, from the United States Midwest. No dietary intervention was performed. A modified Mediterranean diet score (mMDS) was developed for assessment of adherence to a Mediterranean dietary pattern from a previously administered life-style questionnaire that examined pre-existing dietary habits. Clinical data from fire department medical examinations were extracted and analyzed. Results: Obese subjects had significantly lower mMDS, and they reported greater fast/take-out food consumption (p<0.001) and intake of sweetened drinks during meals (p = 0.002). After multivariate adjustment, higher mMDS was inversely related to risk of weight gain over the past 5 years (odds ratio [OR]: 0.57, 95% confidence interval [CI]: 0.39–0.84, p for trend across score quartiles: 0.01); as well as the presence of metabolic syndrome components (OR: 0.65, 95% CI: 0.44–0.94, p for trend across score quartiles: 0.04). Higher HDL-cholesterol (p = 0.008) and lower LDL-cholesterol (p = 0.04) were observed in those with higher mMDS in linear regression after multivariate adjustment for age, BMI and physical activity. Conclusions: In a cohort of young and active US adults, greater adherence to a Mediterranean-style dietary pattern had significant inverse associations with metabolic syndrome, LDL-cholesterol and reported weight gain, and was significantly and independently associated with higher HDL-cholesterol. Our results support the potential effectiveness of this diet in young, non-Mediterranean working cohorts, and justify future intervention studies.
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    Non-Invasive Identification of Left Ventricular Hypertrophy (LVH)/ Cardiomegaly in US Firefighters
    (2016-05-03) Korre, Maria; Kales, Stefanos; Christiani, David; Christophi, Costas; Lombardi, David
    Background: Cardiovascular disease (CVD) causes 45% of firefighters’ on-duty deaths, but the risk of these events is limited to susceptible individuals. Left ventricular hypertrophy (LVH)/cardiomegaly increases arrhythmia, myocardial infarction, stroke and death risks, and is a condition which renders firefighters susceptible to CVD events. Autopsies demonstrate LVH/cardiomegaly in most firefighter CVD fatalities. If recognized beforehand, however, effective treatments are available. In this work we i) describe the state of the art knowledge on the definition of cardiac enlargement across imaging modalities, normalization techniques (indices) and reference ranges; ii) estimate the current prevalence of cardiac enlargement among the US firefighters; and iii) identify the significant predictors of LV mass (LVM). Methods: We conducted a literature review to compare measurements for heart size and mass by cardiac MRI (CMR), Echocardiograms (ECHO) and autopsies in healthy and diseased hearts in the general population (Chapter 1). We selected 400 participants by an enriched randomization sampling strategy from a population of active firefighters. All participants received a screening ECHO, followed by CMR. Prevalence estimates for LVH were derived among the active firefighters based on ECHO and CMR. Separate estimates were made by examining autopsies of other firefighters who suffered a noncardiac on-duty fatality (Chapter 2). Risk factors were evaluated as predictors for LVM normalized for height (Chapter 3). Results: The findings from Chapter 1 demonstrated a wide variance in LVH definitions and reference ranges; ECHO remains the most widely used diagnostic tool; and few direct comparisons exist between imaging and autopsies studies at this time. Chapter 2 showed a wide range of prevalence estimates of cardiac enlargement and body mass index (BMI) to be a major driver of heart weight. Chapter 3 identified BMI as the most significant and only consistent independent predictor of LVM indices. Conclusions: Standardization of cardiac enlargement definitions is needed. However, BMI drives LVM, heart weight and LV wall thickness. Therefore, reducing obesity will decrease the prevalence of LVH/cardiac enlargement in the fire service, which should in turn reduce CVD events.