Background-The epidemiology of heart failure (HF) in young adults is poorly understood.

Rationale: Although asthma is usually considered to originate in childhood, adult-onset disease is being increasingly reported.Objectives: To contrast the proportion and natural history of adultonset versus pediatric-onset asthma in a community-based cohort. We hypothesized that asthma in women is predominantly of adult onset rather than of pediatric onset.Methods: This study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort in the United States over a 25-year period. Adult-and pediatric-onset asthma phenotypes were studied, as defined by age at onset of 18 years or older. Subjects with asthma were categorized by sex, obesity, atopy, smoking, and race by mean age/examination year, using a three-way analysis of covariance model. Natural history of disease was examined using probabilities derived from a Markov chain model. Measurements and Main Results:Asthma of adult onset became the dominant (i.e., exceeded 50%) phenotype in women by age 40 years. The age by which adult-onset asthma became the dominant phenotype was further lowered for obese, nonatopic, eversmoking, or white women. The prevalence trend with increasing time for adult-onset disease was greater among subjects with nonatopic than atopic asthma among both sexes. Furthermore, adult-onset asthma had remarkable sex-related differences in risk factors. In both sexes, the quiescent state for adult-onset asthma was less frequent and also "less stable" over time than for pediatric-onset asthma.Conclusions: Using a large national cohort, this study challenges the dictum that most asthma in adults originates in childhood. Studies of the differences between pediatric-and adult-onset asthma may provide greater insight into the phenotypic heterogeneity of asthma.

Introduction Few large studies describe quality control procedures and reproducibility findings in cardiovascular ultra-sound, particularly in novel techniques such as Speckle Tracking (STE). We evaluate the echocardiography assessment performance in the CARDIA study Y25 examination (2010-2011) and report findings from a quality control and reproducibility program conducted to assess Field Center image acquisition and Reading Center (RC) accuracy. Methods The CARDIA Y25 examination had 3,475 echocardiograms performed in 4 US Field Centers and analyzed in a Reading Center, assessing standard echocardiography (LA dimension, aortic root, LV mass, LV end-diastolic volume [LVEDV], ejection fraction [LVEF]), and STE (2- and 4-chamber longitudinal, circumferential, and radial strains). Reproducibility was assessed using intra-class correlation coefficients (ICC), coefficients of variation (CV), and Bland-Altman plots. Results For standard echocardiography reproducibility, LV mass and LVEDV consistently had CV above 10% and aortic root below 6%. Intra-sonographer aortic root and LV mass had the most robust values of ICC in standard echocardiography. For STE, the number of properly tracking segments was above 80% in short-axis and 4-chamber and 58% in 2-chamber. Longitudinal strain parameters were the most robust and radial strain showed the highest variation. Comparing Field Centers with Echo RC STE readings, mean differences ranged from 0.4% to 4.1% and ICC from 0.37 to 0.66, with robust results for longitudinal strains. Conclusion Echocardiography image acquisition and reading processes in the CARDIA study were highly reproducible, including robust results for STE analysis. Consistent quality control may increase the reliability of echocardiography measurements in large cohort studies.

Rationale: Chronic lung diseases are associated with cardiovascular disease. How these associations evolve from young adulthood forward is unknown. Understanding the preclinical history of these associations could inform prevention strategies for common heartlung conditions.Objectives: To use the Coronary Artery Risk Development in Young Adults (CARDIA) study to explore the development of heart-lung interactions.Methods: We analyzed cardiac structural and functional measurements determined by echocardiography at Year 25 of CARDIA and measures of pulmonary function over 20 years in 3,000 participants. Conclusions: Patterns of loss of lung health are associated with specific cardiovascular phenotypes in middle age. Decline in FEV 1 / FVC ratio is associated with underfilling of the left heart and low cardiac output. Decline in FVC with preserved FEV 1 /FVC ratio is associated with left ventricular hypertrophy and diastolic dysfunction. Cardiopulmonary interactions apparent with common complex heart and lung diseases evolve concurrently from early adulthood forward.

Rationale: It is hypothesized that the metabolic syndrome explains the association between body mass index (BMI) and asthma in adults. Objectives: Our objective was to longitudinally compare the relative strengths of the associations of the metabolic syndrome and BMI with incident asthma in adults. Methods: We included 4,619 eligible participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort followed over 25 years. Incident asthma was defined by a new self-reported provider asthma diagnosis plus either the presence of asthma symptoms and/or use of asthma medications. Cox proportional hazard analyses were performed. Measurements and Main Results: Six hundred two subjects (417 women and 185 men) developed incident asthma over 25 years of follow-up. Metabolic syndrome predicted incident asthma among women but not men (unadjusted hazard ratios, 1.50 and 0.98; P ¼ 0.01 and 0.93, respectively). BMI had a similar predictive association among women but not men (unadjusted hazard ratios, 1.19 and 1.04 per 5 units of BMI; P , 0.001 and 0.60, respectively). The association of metabolic syndrome with incident asthma in women was no longer statistically significant after adjustment for BMI (P ¼ 0.44). In contrast, the association of BMI with incident asthma in women remained statistically significant after adjusting for the metabolic syndrome (P ¼ 0.01). In a stepwise model, BMI was a stronger predictor than the metabolic syndrome (P ¼ 0.001). Conclusions: BMI is a stronger predictor of incident asthma among women than the metabolic syndrome. Other obesity-associated factors that are not a part of the metabolic syndrome may play a role in the BMI-asthma association in women.Keywords: incident asthma; metabolic syndrome; body mass index Obesity and asthma are chronic diseases that have increased in prevalence across the world over the last 2 decades (1, 2). During the period 2009 to 2010, 1 in 12 American adults had asthma, and more than one-third of American adults were obese (3, 4). Obesity, as defined by elevated body mass index (BMI) of 30 kg/m 2 or more, is a risk factor for asthma, particularly among women. The basis for this association, however, remains unclear. The metabolic syndrome, as defined by the third Adult Treatment Panel (ATP-III) criteria (5), includes the presence of any three of the following five traits: abdominal adiposity (waist circumference . 102 cm in men and . 88 cm in women), hypertriglyceridemia (>150 mg/dl or drug treatment for high triglycerides), low high-density lipoprotein (HDL) cholesterol levels (,40 mg/dl in men and ,50 mg/dl in women or drug treatment for low HDL), elevated blood pressure (>130/85 mm Hg or drug treatment for elevated blood pressure), and impaired fasting blood glucose or diabetes mellitus (>100 mg/dl or antidiabetic drug treatment) (6). Some epidemiologic studies suggest that waist circumference-defined abdominal adiposity, one of the characteristics of the metabolic syndrome, is more strongly associated with prevalent asthma than is BMI-defined...