Brian Kral
Johns Hopkins University School of Medicine, Medicine, Faculty Member
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BACKGROUND The blood brain barrier (BBB) is a major obstacle to the delivery of chemotherapy to the CNS. Regadenoson is an FDA approved adenosine A2 agonist used for cardiac stress tests. In murine models, it transiently increases BBB... more
BACKGROUND The blood brain barrier (BBB) is a major obstacle to the delivery of chemotherapy to the CNS. Regadenoson is an FDA approved adenosine A2 agonist used for cardiac stress tests. In murine models, it transiently increases BBB permeability to a 70KD dextran. This multi-institutional, NIH funded, Adult Brain Tumor Consortium trial was designed to discover a dose of regadenoson that substantially increases vascular permeability in normal appearing white matter (NAWM) where drug delivery is particularly challenging. METHODS Adults ages 18-45 with supratentorial gliomas at low-risk for regadenoson complications were recruited (n = 7). One patient was treated at each of seven dose levels (from 0.05 to 1.4 mg) that are known to be safe in humans. The primary outcome measure is change in vascular permeability via dynamic contrast enhanced (DCE) perfusion MRI estimates of Ktrans. The primary outcome measure was a 10-fold higher Ktrans in NAWM than reported in literature (Ktrans >...
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Introduction: Induced pluripotent stem cells (iPSC) have a significant capacity for self-renewal and can differentiate into any somatic cell type, such as megakaryocytes (MK) and vascular endothelial cells (EC). We have previously shown... more
Introduction: Induced pluripotent stem cells (iPSC) have a significant capacity for self-renewal and can differentiate into any somatic cell type, such as megakaryocytes (MK) and vascular endothelial cells (EC). We have previously shown that iPSC-derived MKs (IPSC-MK) upregulate the gene expression levels of irreversible glycolytic enzymes committing glucose to glycolysis in comparison to their parental iPSC lines (Vaidya et al., 2016). This pattern differed from past comparisons between somatic source cells and iPSCs (Chung et al., 2007; Varum et al., 2011; Zhang et al., 2011). To further corroborate our data, we extended our analysis to iPSC-derived ECs (iPSC-EC). Methods: We studied expression of glycolytic enzyme genes in 30 human iPSC lines and paired iPSC-EC and iPSC-MK lines using RNA-seq. iPSC-EC to iPSC expression ratios for 11 glycolytic enzymes were estimated using a multilevel mixed-effect model regression, and a significance threshold of p < 0.05/11 = 0.0045 was used...
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Introduction: We previously reported impaired manipulative manual dexterity measured by grooved peg-board test (GPBT) in healthypeople with increased total brain ischemic white matter hyperintensities. We hypothesized that preclinical... more
Introduction: We previously reported impaired manipulative manual dexterity measured by grooved peg-board test (GPBT) in healthypeople with increased total brain ischemic white matter hyperintensities. We hypothesized that preclinical white matter tract damage (WMTD), measured as lower regional fractional anisotropy (rFA), is associated with functional decrements measured with GPBT, and with a biomarker of white matter disease, serum ceramides. Methods: Participants were recruited from the GeneSTAR study in families with a history of coronary artery disease. Diffusion tensor imaging was acquired on a Phillips 3T MRI and rFA was calculated using the 181 Eve segmented atlas. 48 susceptible regions for WMTD were analyzed.Liquid chromatography was used to measure ceramides (C). Spearman’s rank correlation (SRC) was used to test statistical associations and Bonferroni method was used to correct for multiple comparisons. Multivariate analysis (GEE) adjusting for age, sex, race and educati...
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Background: Positive emotional health has been shown to be protective against coronary artery disease, putatively through pro-health behaviors including exercise and fitness. It has been suggested that this positive emotion trait is... more
Background: Positive emotional health has been shown to be protective against coronary artery disease, putatively through pro-health behaviors including exercise and fitness. It has been suggested that this positive emotion trait is prevalent among obese persons (“jolly fat” hypothesis) implying that it may lead to fitness even with higher BMI. We thus examined the longitudinal associations among fatness, fitness and positive emotion using structural equation modeling (SEM). Methods: We examined GeneSTAR (Genetic Study of Atherosclerosis Risk) cohort data (N = 947, 57% women, 50% African American, baseline age 47 ± 7 years, follow-up measures 7 ± 2 years). We fit SEMs to determine the temporal associations between fatness (BMI), fitness (METs achieved on a treadmill test) and positive emotion (General Well Being Schedule, GWBS) adjusting for age, sex, race and follow-up time. Results: The cross-sectional correlations were significant in SEM (BMI-METs -0.42, GWBS-MET -0.14, BMI-GWBS ...
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Background.—The PlA2 polymorphism of GPIIIa has been associated with unstable coronary syndromes in some studies, but the association has remained debated. None of the previous studies have focused on families at high risk. Risk factors... more
Background.—The PlA2 polymorphism of GPIIIa has been associated with unstable coronary syndromes in some studies, but the association has remained debated. None of the previous studies have focused on families at high risk. Risk factors tend to cluster within kindreds with high prevalence of premature coronary heart disease (CHD). Therefore, a heightened prevalence of the PlA2 polymorphism among siblings of patients with CHD would support the hypothesis that PlA2 is linked, directly or indirectly, to CHD. Objectives.—To measure the prevalence of the PlA2 polymorphism among siblings of patients with CHD before the age of 60 years and to seek an association between the PlA2 polymorphism and established atherosclerotic and thrombogenic risk factors. Methods.—From January 1994 to April 1996, we genotyped 116 asymptomatic siblings (60 Caucasians, 56 Afro-Caribbeans) of patients with CHD manifestations before the age of 60 years for the PlA polymorphism (also called HPA-1). A control coho...
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De novo mutations (DNMs), or mutations that appear in an individual despite not being seen in their parents, are an important source of genetic variation whose impact is relevant to studies of human evolution, genetics, and disease.... more
De novo mutations (DNMs), or mutations that appear in an individual despite not being seen in their parents, are an important source of genetic variation whose impact is relevant to studies of human evolution, genetics, and disease. Utilizing high-coverage whole-genome sequencing data as part of the Trans-Omics for Precision Medicine (TOPMed) Program, we called 93,325 single-nucleotide DNMs across 1,465 trios from an array of diverse human populations, and used them to directly estimate and analyze DNM counts, rates, and spectra. We find a significant positive correlation between local recombination rate and local DNM rate, and that DNM rate explains a substantial portion (8.98 to 34.92%, depending on the model) of the genome-wide variation in population-level genetic variation from 41K unrelated TOPMed samples. Genome-wide heterozygosity does correlate with DNM rate, but only explains <1% of variation. While we are underpowered to see small differences, we do not find significan...
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Purpose To compare epicardial fat in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) with that in healthy subjects. Materials and Methods In this retrospective study, cardiac CT scans in 44 patients with... more
Purpose To compare epicardial fat in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) with that in healthy subjects. Materials and Methods In this retrospective study, cardiac CT scans in 44 patients with ARVD/C (mean age, 39 years ± 12; 23 men) were compared with those in 45 control group participants between January 2008 and July 2015. Volumes of intrathoracic adipose tissue, mediastinal adipose tissue (MAT), and total epicardial adipose tissue (EAT) were quantified. EAT was subdivided into three regions-right ventricular (RV) EAT, left ventricular (LV) EAT, and peri-atrial EAT (atrial EAT)-and normalized to MAT for all regions. Logistic regression and receiver operating characteristic analysis were performed to evaluate the association between epicardial fat with the diagnosis of ARVD/C. Results Total EAT volume was higher in patients with ARVD/C than in healthy control group participants (median, 98 mL vs 76 mL, respectively; P = .04). Regionally,...
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Exercise training (ET) has been variably associated with body composition changes among persons with type 2 diabetes (T2DM). The degree to which these changes are related to hyperglycemia remains unclear. Our objective was to investigate... more
Exercise training (ET) has been variably associated with body composition changes among persons with type 2 diabetes (T2DM). The degree to which these changes are related to hyperglycemia remains unclear. Our objective was to investigate the relationship of baseline fasting glucose (FG) to the magnitude of muscle gains and fat loss after ET in individuals with T2DM. Participants were enrolled in the SHAPE-2 trial, a six month supervised aerobic and resistance training intervention (three days/week), at Johns Hopkins. This was a post hoc single arm intervention study of participants who completed the exercise intervention (n=50). Participants were aged 40-65years and had T2DM that was not treated with insulin. Body composition was assessed by DEXA. After 6months of ET, total fat mass decreased (-2.1±3.1kg) and total lean body mass (LBM) increased (0.5±2.0kg) overall, but there was variability among individual participants. There was an increase in % total LBM (1.4±1.9%) and decrease ...
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Background: Ischemic white matter disease (IWMD) is associated with incident stroke. Similarly subclinical coronary artery disease is associated with incident coronary artery disease (CAD) events. Although, atherogenesis in both vascular... more
Background: Ischemic white matter disease (IWMD) is associated with incident stroke. Similarly subclinical coronary artery disease is associated with incident coronary artery disease (CAD) events. Although, atherogenesis in both vascular beds likely shares common mechanisms, the extent to which subclinical CAD is associated with preclinical IWMD in a young to middle-aged healthy asymptomatic high risk population with a family history of premature CAD remains unknown. Methods: We screened 405 apparently healthy participants in Genetic Study of Atherosclerotic Risk (GeneSTAR) (mean age 51.6 ± 10.6 years, 60% female, 36% African American) for CAD risk factors, and for the presence of calcified and noncalcified coronary plaque using dual-source 256 multi-detector cardiac CT angiography. The presence of IWMD was assessed by 3 Tesla brain MRI and the ischemic white-matter volume to brain volume (WVBV) ratio was calculated using direct measurements. A multivariate linear regression analysis predicting WVBV was p...
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Introduction: Some obese individuals are thought to be “metabolically healthy” (MHO) with lower risk for cardiovascular disease. This study was designed to identify healthy obesity and its associat...
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Research Interests: Medicine and Circulation
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We hypothesized that integrated motor-visual functions measured by manipulative manual dexterity are affected by white matter lesion (WML) burden as measured on cranial MRI across relevant brain regions in subjects at risk of preclinical... more
We hypothesized that integrated motor-visual functions measured by manipulative manual dexterity are affected by white matter lesion (WML) burden as measured on cranial MRI across relevant brain regions in subjects at risk of preclinical occult vascular disease. A real-time cross-sectional study of healthy subjects aged 29 to 74 years with a family history of early-onset coronary artery disease (n = 714; mean age, 51 ± 11 years; mean education, 14 ± 3 years; 42% male; 38% black) were identified from probands with coronary artery disease diagnosed before age 60 years. WMLs on 3-tesla brain MRI and Grooved Pegboard scores were measured. WMLs were observed at all ages. Mean pegboard scores were 108 ± 18, similar to normal populations. In unadjusted analysis, WMLs and pegboard scores were significantly correlated by region (total WMLs, r = 0.34, p = 0.0001; frontal [r = 0.34, p < 0.0001], insula [r = 0.31, p < 0.0001], parietal [r = 0.31, p < 0.0001], and temporal [r = 0.17, p ...
Research Interests: Psychology, Cognitive Science, Neurology, Magnetic Resonance Imaging, Medicine, and 15 moreMovement disorders, Humans, Female, Male, Clinical Sciences, Aged, Middle Aged, Adult, Reproducibility of Results, Coronary Artery Disease, Sensitivity and Specificity, Reference Values, Cerebrovascular Disorders, Neurosciences, and Psychomotor Performance
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Research Interests: Genetics, Genetic Epidemiology, Human Genetics, Genomics, Biology, and 15 moreEpigenetics, Human, Cytogenetics, Humans, African American, Female, Clinical Genetics, African Americans, Clinical Sciences, Human Genome, Adult, Coronary Artery Disease, Case Control Study, Generalized estimating equation, and Confidence Interval
OBJECTIVE Any combination of metabolic abnormalities may constitute the metabolic syndrome (MetS), conferring coronary artery disease (CAD) risk, but the independent effect of different combinations on CAD onset remains unknown. RESEARCH... more
OBJECTIVE Any combination of metabolic abnormalities may constitute the metabolic syndrome (MetS), conferring coronary artery disease (CAD) risk, but the independent effect of different combinations on CAD onset remains unknown. RESEARCH DESIGN AND METHODS Healthy adult siblings (n = 987) of premature CAD (<60 years) case subjects were followed for 9.8 ± 3.8 years. Baseline MetS variables (insulin sensitivity index, waist circumference, systolic blood pressure, HDL cholesterol, and triglycerides) were recombined into five principal components (PC1–5), and risk factor–adjusted proportional hazards for CAD onset of median-dichotomized PCs were estimated. RESULTS The significant hazard ratios were as follows: for PC1 (all abnormalities except blood pressure) 1.66 (P = 0.036), PC2 (high blood pressure levels, high HDL cholesterol) 1.71 (P = 0.016), and PC4 (low HDL cholesterol, high insulin sensitivity, low triglycerides) 2.0 (P = 0.001). Traditionally defined MetS had a hazard ratio...
Research Interests: Endocrinology, Nutrition, Principal Component Analysis, Prediction, Medicine, and 15 moreMetabolic syndrome, Humans, Blood Pressure, Female, Male, Triglycerides, Middle Aged, Genotype, Adult, Coronary Artery Disease, Genetic Variability, Proportional Hazards Models, Diabetes Care, Metabolic Syndrome X, and Medical and Health Sciences
OBJECTIVE The metabolic syndrome (MetS) is defined as concomitant disorders of lipid and glucose metabolism, central obesity, and high blood pressure, with an increased risk of type 2 diabetes and cardiovascular disease. This study tests... more
OBJECTIVE The metabolic syndrome (MetS) is defined as concomitant disorders of lipid and glucose metabolism, central obesity, and high blood pressure, with an increased risk of type 2 diabetes and cardiovascular disease. This study tests whether common genetic variants with pleiotropic effects account for some of the correlated architecture among five metabolic phenotypes that define MetS. RESEARCH DESIGN AND METHODS Seven studies of the STAMPEED consortium, comprising 22,161 participants of European ancestry, underwent genome-wide association analyses of metabolic traits using a panel of ∼2.5 million imputed single nucleotide polymorphisms (SNPs). Phenotypes were defined by the National Cholesterol Education Program (NCEP) criteria for MetS in pairwise combinations. Individuals exceeding the NCEP thresholds for both traits of a pair were considered affected. RESULTS Twenty-nine common variants were associated with MetS or a pair of traits. Variants in the genes LPL, CETP, APOA5 (an...
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Background— Exercise stress testing alone or with perfusion imaging is the standard screening method to determine the presence of obstructive coronary artery disease (CAD) in people with chest pain. In asymptomatic individuals with a... more
Background— Exercise stress testing alone or with perfusion imaging is the standard screening method to determine the presence of obstructive coronary artery disease (CAD) in people with chest pain. In asymptomatic individuals with a family history of premature CAD, it is unclear whether abnormalities on these functional exercise tests represent significant coronary disease. Methods and Results— An abnormal exercise test, thallium scan, or both occurred in 153 (21%) of 734 asymptomatic siblings of persons with documented CAD, of whom 105 underwent coronary angiography with quantitative analysis of stenosis severity. Overall, 95% had coronary atherosclerosis, but only 39% had 1 or more stenoses with ≥50% narrowing. Of 30 siblings in whom the exercise test and perfusion scan were both abnormal, 70% had ≥50% stenoses. The mean stenosis in arteries that fed perfusion defects was only 43±31%, and 68% of such stenoses were <50%. However, in 71% of all defects, the location matched arte...
Research Interests: Medicine, Family history, Humans, Female, Male, and 15 moreClinical Sciences, Middle Aged, Coronary Angiography, Adult, Coronary heart disease, Public health systems and services research, Circulation, Quantitative Analysis, Coronary Artery Disease, Exercise Test, Chest Pain, Predictive value of tests, Myocardial Ischemia, High risk, and Cardiovascular medicine and haematology
Background: African Americans (AAs) have a higher prevalence of extreme ischemic white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) than do European Americans (EAs) based on the Cardiovascular Health Study (CHS)... more
Background: African Americans (AAs) have a higher prevalence of extreme ischemic white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) than do European Americans (EAs) based on the Cardiovascular Health Study (CHS) score. Ischemic white matter disease, limited to the deep white matter, may be biologically distinct from disease in other regions and may reflect a previously observed trend toward an increased risk of subcortical lacunar infarcts in AAs. We hypothesized that extreme deep WMH volume (DWMV) or periventricular volume (PV) may also have a higher prevalence in AAs. Thus, we studied extreme CHS scores and extreme DWMV and PV in a healthy population enriched for cardiovascular disease risk factors. Methods: We imaged the brains of 593 subjects who were first-degree relatives of probands with early onset coronary disease prior to 60 years of age. WMHs were manually delineated on 3-tesla cranial MRI by a trained radiology reader; the location and volume of les...
Research Interests: Magnetic Resonance Imaging, Medicine, Humans, Hypertension, Female, and 15 moreMale, Cerebrovascular diseases, Risk factors, African Americans, Clinical Sciences, Aged, Prevalence, Middle Aged, White matter, Adult, Age Factors, European Continental Ancestry Group, Risk Factors, Cerebrovascular Disorders, and Neurosciences
AimsWe investigated whether KIF6 Trp719Arg genotypes affect cardiovascular outcomes and efficacy of statin therapy in patients with type 2 diabetes mellitus undergoing hemodialysis.
Research Interests: Atherosclerosis, Cardiovascular Risk, Germany, Humans, Internal Medicine, and 15 moreFemale, Hemodialysis, Male, Clinical Sciences, Aged, Kinesin, Analysis of Variance, Internationality, Arginine, Cardiovascular Diseases, Coronary Artery Disease, Case Control Study, Logistic Models, Case Control Studies, and Cardiovascular medicine and haematology
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Although small, dense low-density lipoprotein (LDL) has been implicated in atherogenesis and coronary heart disease (CHD) events, little is known about possible racial differences in LDL particle size. This study was designed to examine... more
Although small, dense low-density lipoprotein (LDL) has been implicated in atherogenesis and coronary heart disease (CHD) events, little is known about possible racial differences in LDL particle size. This study was designed to examine racial differences in the prevalence of small, dense LDL among 159 African-American and 477 White siblings of persons with premature (&amp;amp;lt;60 years of age) CHD. This study examined fasting levels of total cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, apolipoprotein B (ApoB), apolipoprotein A-1, and triglycerides, as well as factors known to be associated with small, dense LDL, including age, sex, obesity, hypertension, and diabetes. Relative LDL particle size was defined by the LDL cholesterol to ApoB ratio. Direct measurement of LDL particle size was obtained by proton NMR spectroscopy in a subset of 64 siblings. Despite similar levels of total and LDL cholesterol, White siblings were more likely to have low LDL cholesterol to ApoB ratios, indicative of atherogenic small, dense LDL, compared with African-American siblings. Multiple logistic regression analysis predicting the presence of LDL cholesterol/ApoB &amp;amp;lt; or = 1.0 demonstrated that race (P = .009), triglyceride level (P = .0001), and diabetes (P = .02) were independent predictors, controlling for age and all other variables. Direct measurement of LDL particle size by NMR spectroscopy supported these findings. These findings provide the first known evidence that White individuals from a population at high risk for premature CHD have a greater probability of having a preponderance of small, dense LDL particles than do African Americans, independent of triglyceride levels, and despite comparable levels of total and LDL cholesterol.
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To determine the association of lean vs fat mass with fitness in healthy, overweight and obese African Americans from families with early-onset coronary disease. Cross-sectional study. Baltimore, Maryland. 191 healthy, overweight,... more
To determine the association of lean vs fat mass with fitness in healthy, overweight and obese African Americans from families with early-onset coronary disease. Cross-sectional study. Baltimore, Maryland. 191 healthy, overweight, sedentary African Americans (69% women; aged 44.8 ± 11 years; body mass index 34 ± 5 kg/m2). Anthropometrics, smoking, blood pressure, lipids, c-reactive protein, and glucose were assessed with standard methods; body composition was determined by dual energy X-ray absorptiometry; cardiorespiratory fitness was expressed as VO(2peak) attained during a maximal treadmill test. In both men and women, greater lean mass was independently associated with higher VO(2peak) (P < .05) and explained > 21% of the variance in VO(2peak), adjusted for body mass index, fat mass, important covariables, and nonindependence of families. In this cross-sectional study, lean mass was the key determinant of cardiorespiratory fitness, independent of sex, age, and magnitude of...
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For dual-source cardiac computed tomography (CT) scans without heart rate (HR) control, the influence of body habitus on quality is uncertain. We evaluated study quality across a range of HRs and body size. One hundred sixty subjects were... more
For dual-source cardiac computed tomography (CT) scans without heart rate (HR) control, the influence of body habitus on quality is uncertain. We evaluated study quality across a range of HRs and body size. One hundred sixty subjects were randomly selected for 4 HR groups (<70, 70-79, 80-89, ≥90 beats per minute) from 703 subjects who underwent cardiac CT without premedication. Coronary visualization quality was scored on a 3-point scale (1, nondiagnostic; 2, diagnostic; 3, excellent). Ninety-nine percent of coronaries were diagnostic quality. Six vessels were nondiagnostic, mostly due to motion. Nondiagnostic or diagnostic scores (<3) were greatest in the group with HR of more than or equal to 90 beats per minute. All normal weight subjects had excellent quality, but 6% of vessels in overweight and 17% in obese subjects had diagnostic scores less than 3. The mean effective dose was 11.4 mSv and correlated with body size. Diagnostic quality cardiac CT examinations can be obtai...
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Greater ex vivo platelet aggregation to agonists may identify individuals at risk of acute coronary syndromes (ACS). However, increased aggregation to a specific agonist may be masked by inherent variability in other activation pathways.... more
Greater ex vivo platelet aggregation to agonists may identify individuals at risk of acute coronary syndromes (ACS). However, increased aggregation to a specific agonist may be masked by inherent variability in other activation pathways. In this study, we inhibited the cyclooxygenase-1 (COX1) pathway with 2-week aspirin therapy and measured residual aggregation to collagen and ADP to determine whether increased aggregation in a non-COX1 pathway is associated with incident ACS. We assessed ex vivo whole blood platelet aggregation in 1,699 healthy individuals with a family history of early-onset coronary artery disease followed for 6±1.2 years. Incident ACS events were observed in 22 subjects. Baseline aggregation was not associated with ACS. After COX1 pathway inhibition, collagen-induced aggregation was significantly greater in participants with ACS compared with those without (29.0 vs. 23.6 ohms, p < 0.001). In Cox proportional hazards models, this association remained significa...
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... Brian G. Kral, MD, MPH, Lookman Lawal, MD, and Lewis C. Becker, MD ... of young, healthy Chinese people, the presence of the 893CC genotype was associated with an attenuated antiplatelet response during treatment with 100 mg of... more
... Brian G. Kral, MD, MPH, Lookman Lawal, MD, and Lewis C. Becker, MD ... of young, healthy Chinese people, the presence of the 893CC genotype was associated with an attenuated antiplatelet response during treatment with 100 mg of aspirin, as defined by arachi-donic acid ...
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African Americans (AA) have been shown to have lower exercise capacities and a higher prevalence of related risk for cardiovascular disease (CVD) compared to European Americans (EA). Broad biopsychosocial models that may inform the design... more
African Americans (AA) have been shown to have lower exercise capacities and a higher prevalence of related risk for cardiovascular disease (CVD) compared to European Americans (EA). Broad biopsychosocial models that may inform the design of ethnic-specific exercise programs have not been well examined. We thus examined exercise capacity and its biopsychosocial correlates in a healthy population of AA and EA at increased risk of CVD. Subjects underwent maximal graded treadmill testing with gated single-photon emission computed tomography (SPECT); exercise capacity was expressed in MET-minutes. Medical history, psychosocial variables, general well-being, physical activity, and anthropometrics were assessed. Peak filling rate, a measure of left ventricular function, and ejection fraction were obtained from SPECT imaging, and the presence of silent ischemia was determined from the treadmill and SPECT imaging. The sample (N = 1054) was 47% AA and 60% female. Mean age was 52.1 ± 9 yr for AA and 49.9 ± 10 yr for EA. Body mass index (BMI) was 32.5 ± 6.7 kg·m(-2) for AA and 29 ± 5.3 kg·m(-2) for EA. AA achieved a mean maximal exercise level of 31 MET·min less than EA did. In separate regression models by race, BMI (r(2) = 0 .30), age (r(2) = 0 .07), and sex (r(2) = 0 .03) explained 40% of the variance in MET-minutes in AA and 36% in EA, with a similar hierarchy of associated variables. The remaining variables had minimal effect on exercise capacity in either group. BMI, older age, and female sex together contribute most to exercise capacity in both ethnicities. Hypothetically important biopsychosocial variables that may help shape ethnic-specific exercise programs add little to the prediction of exercise capacity. Thus, programs designed to reduce disparities in exercise capacity still need to first and foremost be geared to the age and sex demographics and address obesity.