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Piya MK, Hocking S. Challenges in achieving racial and ethnic health equity in type 2 diabetes: access to newer medications. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100784. [PMID: 38817955 PMCID: PMC11137501 DOI: 10.1016/j.lana.2024.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Milan K. Piya
- Western Sydney University, Macarthur Clinical School, Campbelltown, NSW, 2560, Australia
- Camden and Campbelltown Hospitals, Campbelltown, NSW, 2560, Australia
| | - Samantha Hocking
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
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Mohamed MO, Ghosh AK, Banerjee A, Mamas M. Socioeconomic and Ethnic Disparities in the Process of Care and Outcomes Among Cancer Patients With Acute Coronary Syndrome. Can J Cardiol 2024:S0828-282X(24)00273-3. [PMID: 38537671 DOI: 10.1016/j.cjca.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 05/01/2024] Open
Abstract
Cancer and acute coronary syndrome (ACS) are the leading causes of morbidity and mortality globally, with many shared risk factors. There are several challenges to the management of patients with cancer presenting with ACS, owing to their higher baseline risk profile, the complexities of their cancer-related therapies and prognosis, and their higher risk of adverse outcomes after ACS. Although previous studies have demonstrated disparities in the care of both cancer and ACS among patients from ethnic minorities and socioeconomic deprivation, there is limited evidence around the magnitude of such disparities specifically in cancer patients presenting with ACS. This review summarises the current literature on differences in prevalence and management of ACS among patients with cancer from ethnic minorities and socioeconomically deprived backgrounds, as well as the gaps in evidence around the care of this high-risk population and potential solutions.
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Affiliation(s)
- Mohamed O Mohamed
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Cardio-Oncology Service, Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom.
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Sebastian SA, Padda I, Johal G. Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review. Curr Probl Cardiol 2024; 49:102344. [PMID: 38103820 DOI: 10.1016/j.cpcardiol.2023.102344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
The correlation between obesity, type 2 diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease (CKD) is an escalating and widely acknowledged epidemic in industrialized nations. Recently, this complex web of interrelated health conditions has been collectively defined as the Cardiovascular-Kidney-Metabolic (CKM) syndrome by the American Heart Association (AHA). The molecular mechanisms underlying CKM disease contain a spectrum of interconnected factors, including hyperglycemia, insulin resistance, heightened activity of the renin-angiotensin-aldosterone system (RAAS), the generation of advanced glycation end-products, oxidative stress, lipotoxicity, endoplasmic reticulum stress, abnormalities in calcium handling, malfunctioning of mitochondria and impaired energy production, as well as persistent chronic inflammation. Addressing their prevention, management, and treatment is of paramount importance to promote better patient health outcomes. The objective of this review is to provide a comprehensive and critical examination of the current state-of-the-art regarding the recently defined CKM syndrome. This includes an exploration of epidemiological evidence establishing connections between cardio-renal-metabolic diseases, an examination of the underlying pathophysiological mechanisms, and a comprehensive overview of existing treatment modalities.
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Affiliation(s)
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Gurpreet Johal
- Department of Cardiology, Valley Medical Center, University of Washington, Seattle, USA
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Zhou S, Zhang Y, Dong X, Zhang X, Ma J, Li N, Shi H, Yin Z, Xue Y, Hu Y, He Y, Wang B, Tian X, Smith SC, Xu M, Jin Y, Huo Y, Zheng ZJ. Sex Disparities in Management and Outcomes Among Patients With Acute Coronary Syndrome. JAMA Netw Open 2023; 6:e2338707. [PMID: 37862014 PMCID: PMC10589815 DOI: 10.1001/jamanetworkopen.2023.38707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/28/2023] [Indexed: 10/21/2023] Open
Abstract
Importance Sex disparities in the management and outcomes of acute coronary syndrome (ACS) have received increasing attention. Objective To evaluate the association of a quality improvement program with sex disparities among patients with ACS. Design, Setting, and Participants The National Chest Pain Centers Program (NCPCP) is an ongoing nationwide program for the improvement of quality of care in patients with ACS in China, with CPC accreditation as a core intervention. In this longitudinal analysis of annual (January 1, 2016, to December 31, 2020) cross-sectional data of 1 095 899 patients with ACS, the association of the NCPCP with sex-related disparities in the care of these patients was evaluated using generalized linear mixed models and interaction analysis. The robustness of the results was assessed by sensitivity analyses with inverse probability of treatment weighting. Data were analyzed from September 1, 2021, to June 30, 2022. Exposure Hospital participation in the NCPCP. Main Outcomes and Measures Differences in treatment and outcomes between men and women with ACS. Prehospital indicators included time from onset to first medical contact (onset-FMC), time from onset to calling an emergency medical service (onset-EMS), and length of hospital stay without receiving a percutaneous coronary intervention (non-PCI). In-hospital quality indicators included non-PCI, use of statin at arrival, discharge with statin, discharge with dual antiplatelet therapy, direct PCI for ST-segment elevation myocardial infarction (STEMI), PCI for higher-risk non-ST-segment elevation ACS, time from door to catheterization activation, and time from door to balloon. Patient outcome indicators included in-hospital mortality and in-hospital new-onset heart failure. Results Data for 1 095 899 patients with ACS (346 638 women [31.6%] and 749 261 men [68.4%]; mean [SD] age, 63.9 [12.4] years) from 989 hospitals were collected. Women had longer times for onset-FMC and onset-EMS; lower rates of PCI, statin use at arrival, and discharge with medication; longer in-hospital delays; and higher rates of in-hospital heart failure and mortality. The NCPCP was associated with less onset-FMC time, more direct PCI rate for STEMI, lower rate of in-hospital heart failure, more drug use, and fewer in-hospital delays for both men and women with ACS. Sex-related differences in the onset-FMC time (β = -0.03 [95% CI, -0.04 to -0.01), rate of direct PCI for STEMI (odds ratio, 1.11 [95% CI, 1.06-1.17]), time from hospital door to balloon (β = -1.38 [95% CI, -2.74 to -0.001]), and rate of in-hospital heart failure (odds ratio, 0.90 [95% CI, 0.86-0.94]) were significantly less after accreditation. Conclusions and Relevance In this longitudinal cross-sectional study of patients with ACS from hospitals participating in the NCPCP in China, sex-related disparities in management and outcomes were smaller in some aspects by regionalization between prehospital emergency and in-hospital treatment systems and standardized treatment procedures. The NCPCP should emphasize sex disparities to cardiologists; highlight compliance with clinical guidelines, particularly for female patients; and include the reduction of sex disparities as a performance appraisal indicator.
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Affiliation(s)
- Shuduo Zhou
- Department of Global Health, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yan Zhang
- Division of Cardiology, Peking University First Hospital, Beijing, China
| | - Xuejie Dong
- Department of Global Health, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xu Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Junxiong Ma
- Department of Global Health, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Na Li
- Department of Global Health, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Hong Shi
- Chinese Medical Association, Beijing, China
| | - Zuomin Yin
- Department of Emergency, The Affiliated Qingdao Central Hospital of Qingdao University, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong, China
| | - Yuzeng Xue
- Division of Cardiology, Liaocheng People’s Hospital, Liaocheng, China
| | - Yali Hu
- Division of Cardiology, Cangzhou People’s Hospital, Cangzhou, China
| | - Yi He
- Division of Cardiology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Bin Wang
- Division of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiang Tian
- Division of Cardiology, Baoding No.1 Central Hospital, Baoding, China
| | - Sidney C. Smith
- Division of Cardiovascular Medicine, School of Medicine, The University of North Carolina at Chapel Hill
| | - Ming Xu
- Department of Global Health, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yong Huo
- Division of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
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Bouazza A, Tahar A, AitAbderrhmane S, Saidani M, Koceir EA. Modulation of cardiometabolic risk and CardioRenal syndrome by oral vitamin D 3 supplementation in Black and White Southern Sahara residents with chronic kidney disease Stage 3: focus on racial and ethnic disparities. Ren Fail 2022; 44:1243-1262. [PMID: 35930297 PMCID: PMC9359195 DOI: 10.1080/0886022x.2022.2106244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Several studies have shown that cholecalciferol supplementation (25OHD-S) in chronic kidney disease (CKD) improves kidney injury by reducing fibrosis-related vascular calcification and declining apoptosis-linked nephron damage. METHODS The oral 25OHD-S was evaluated in 60,000 IU/month/36 weeks versus in 2000 IU/d/24 weeks in CKD Stage 3 with serum 25OHD level < 20 ng/mL. The study was undertaken on 156 black subjects and 150 white subjects Southern Sahara (SS). All biomarkers of cardiometabolic (CMet) and cardiorenal (CRenal) syndrome, Renin-angiotensin-aldosterone system (RAAS) profile, secondary hyperparathyroidism (SHPT), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin T (cTnT) and atherogenicity risk were assessed by biochemical methods. Estimate glomerular filtration rate (eGFR) by chronic CKD-EPI equation formula. Total serum vitamin D by liquid chromatography-tandem mass spectrometry (MS). RESULTS Vitamin D deficiency alters in the same manner CMet, CRenal, and others biomarkers in both groups SS; however, these disorders are more acute in blacks compared to whites SS. Oral 25OHD-S a highlighted improvement of eGFR drop, SHPT decrease, decline proteinuria, and cardiac failure risk (NT-proBNP and cTnT) attenuation. Concomitantly, 25OHD-S normalizes Renin, Aldosterone, and Angiotensin System (RAAS) activity. Nevertheless, homocysteine and Lp (a) do not modulate by 25OHD-S. CONCLUSIONS The oral vitamin D3 supplementation, according the dose, and the treatment duration does not like in black-skinned people versus to white-skinned inhabitants, while the 02 groups are native to the same Saharan environment. It emerge that a high intermittent dose through an extensive supplementation (60,000 IU/36 weeks) was more effective in black subjects. At opposite, a lower dose during a short period supplementation is sufficient (2000 IU/24 weeks) in white subjects.
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Affiliation(s)
- Asma Bouazza
- Nutrition and Dietetics in Human Pathologies Post Graduate School, Bioenergetics, Intermediary Metabolism team, Biology and Organisms Physiology laboratory, USTHB, Algiers, Algeria
| | - Amina Tahar
- Nutrition and Dietetics in Human Pathologies Post Graduate School, Bioenergetics, Intermediary Metabolism team, Biology and Organisms Physiology laboratory, USTHB, Algiers, Algeria
| | | | - Messaoud Saidani
- Clinical Nephrology Exploration Unit, Dialysis and Kidney Transplantation Unit, University Hospital Center of Beni Messous, Algiers, Algeria
| | - Elhadj-Ahmed Koceir
- Nutrition and Dietetics in Human Pathologies Post Graduate School, Bioenergetics, Intermediary Metabolism team, Biology and Organisms Physiology laboratory, USTHB, Algiers, Algeria
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White WB, Harris KK, Mohamed A, Henderson FC. Thinking Ahead to the Next Generation of Cardiometabolic Investigators: What It Takes to Successfully Engage Underrepresented Minorities in Biomedical and Public Health Careers. Curr Diab Rep 2022; 22:311-316. [PMID: 35579784 PMCID: PMC9110944 DOI: 10.1007/s11892-022-01472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the existing information regarding cardiometabolic syndrome (CMS) manifestations among underrepresented minority populations, underrepresented minorities' representation in the cardiometabolic workforce, and the models that successfully recruit and retain underrepresented minorities in the field. RECENT FINDINGS The scientific literature is replete with information on methods to recruit and train URM in research careers. However, there are few programs that are specifically designed to train URM to become diabetes researchers, or more specifically cardiometabolic researchers. The CMS scientific community leaders do not have to design a new learning program to engage URM in research. They only have to follow the prototypes by other organizations and make applicable to cardiometabolic research.
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Affiliation(s)
- Wendy B White
- JHSUTEC Tougaloo College, 500 West County Line Road, Tougaloo, MS, 39174, USA.
| | - Kisa K Harris
- JHSUTEC Tougaloo College, 500 West County Line Road, Tougaloo, MS, 39174, USA
| | - Amel Mohamed
- JHSUTEC Tougaloo College, 500 West County Line Road, Tougaloo, MS, 39174, USA
| | - Frances C Henderson
- JHSUTEC Tougaloo College, 500 West County Line Road, Tougaloo, MS, 39174, USA
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Frequency of Detection of the Main Risk Factors for Cardiovascular Events Among Servicemen. Fam Med 2021. [DOI: 10.30841/2307-5112.2-3.2021.240766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiovascular diseases are the leading diseases in Ukraine and are the cause of more than half of deaths. They are inextricably linked to lifestyle, diet, bad habits, physical activity, stressors and are the cause of other risk factors. The most common of these are unmodified factors, such as: gender, age, heredity; and modified: dyslipidemia, arterial hypertension, overweight and obesity, diabetes mellitus, smoking, psychosocial factors.
According to the results of the published STEPS study in 2019, conducted together with the WHO, which analyzed risk factors among the civilian population of Ukraine aged 18 to 69 years. It was noted that 32,8% of the population had risk factors for CVD. High blood pressure or hypertension was observed in 34,8% of the population. The prevalence of hyperglycemia was 7,1%. Only 39,6% of the population of Ukraine had a normal weight for BMI, 59,1% were overweight, including 24,8% of the population were obese. 33,9% were active smokers, and alcohol consumption was observed in 19,7% of the population. Given the data from the STEPS study, we were interested in the frequency of detection of the main risk factors for cardiovascular events among servicemen.
The objective: of the study is to determine the frequency of detection of the main risk factors for cardiovascular events among active servicemen and retirees of the Ministry of Internal Affairs at the stage of inpatient treatment in the conditions of NVMKC «GVKG».
Materials and methods. Random sampling was used to analyze 104 case histories of patients in the cardiology department of NVMKC «GVKG» for the period from January 2018 to December 2019. Risk factors and the frequency with which they occur in different categories of patients were studied. The examination group consisted of male patients (100% of cases) aged 33 to 93 years, the average was 66,55±1,47 years. To study the age characteristics of the prevalence of CVD risk factors, patients were divided into two groups: Group I active servicemen, whose average age was 46,41±1,78 years; Group II retirees MOU, whose average age was 71,95±1,26 years.
Statistical processing of the results was performed by methods of variation, parametric and non parametric statistics of medical and biological profile using a package of original applied statistical programs «Microsoft Ecxel», «Statistica 7.0».
Results. According to the results of the study, the indicators of blood pressure in group I were analyzed: the indicators of mean systolic and diastolic pressure were 129,09±3,86 / 80,45±2,71 mm Hg (n=22). In group II, the average systolic and diastolic pressure were: 138,84±2,41 / 82,99±1,22 mm Hg (n=82). To assess blood pressure, we chose the classification proposed by the WHO in the study (STEPS-2019) for the possibility of compara tive analysis.
The percentage of patients in group I with normal blood pressure was 77,27%; high blood pressure was observed in 22,73% of patients, according to the results of their own study, high blood pressure was not detected. In patients of group II normal blood pressure was registered in 63,41%, elevated in 26,83% of patients and high blood pressure was observed in 9,76% of patients.
Examining the indicators of laboratory studies, we found that an increase in cholesterol was observed in 45,5% of cases in group I, and in 22,7% of cases the level of cholesterol was not determined. In group II, an increase in cholesterol levels was found in 35,4% of cases, in 13,4% of cases the cholesterol level was not determined.
According to the results of the study, an increase in blood glucose levels was observed in 10,6% of cases and 55,8% of cases in group II. Normal blood glucose levels were in 33,7% of patients. The percentage of patients with concomitant type II diabetes was 1,9% of cases of group I, and 14.4% of cases of group II. 72,2% of Group I servicemen and 64.6% of Group II servicemen had an elevated BMI. 50% had a bad habit – smoking in the first group and 18,3% in the second group.
Conclusions. We found that the indicators of high blood pressure in groups I and II were 22,73% and 26,83%, which is 12,07% and 6,77% less than among the civilian population of Ukraine where the rate of high blood pressure was 34,8%. The level of total cholesterol is 4,8% higher in patients of group I (45,5%) than among the civilian population of Ukraine (40,7%). In group II by 5,3% less (35,4%), respectively, from the study. The rate of elevated fasting blood glucose in group I (10,6%) is 3,5% higher, and in group II (55,8%), 48,7% higher than the results obtained among the civilian population of Ukraine, where the level of glycemia was 7,1%. The incidence of type II diabetes mellitus in group I (1,9%), which is 1,9% less than the results obtained among the population of Ukraine, where the result was 3,8%, and in group II (14,4%) by 10,6% more, respectively.
The increase in BMI in patients of groups I and II was 40,9% and 46,3%, which is 18,2% and 12,8% lower than the data obtained among the civilian population of Ukraine, where the percentage of overweight was 59,1%. The prevalence of smoking among servicemen is 6,68% lower than among the civilian population of Ukraine (33,9%) and amounted to 27,04%.
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Racial Disparities in Clinical Characteristics and Outcomes of Women Undergoing Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1039-1042. [PMID: 31678115 DOI: 10.1016/j.carrev.2019.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Women are underrepresented in cardiovascular clinical studies. Black women have a higher ischemic heart disease mortality risk than their white counterparts. However, there exist limited outcome data comparing black women and white women after percutaneous coronary intervention (PCI). The aim of this retrospective analysis was to evaluate for racial disparities in 1-year major adverse cardiovascular events (MACE) in women undergoing PCI. METHODS/MATERIALS Within our PCI database, we identified 4776 female patients who underwent PCI between 2003 and 2016. Of those, 1916 were black and 2860 were white. Endpoints included MACE, death, myocardial infarction, target vessel revascularization (TVR) and stent thrombosis (ST) at 30 days and 1 year. A proportional Cox hazard model analysis was performed to assess outcomes after adjustment for confounding factors. RESULTS Black women presented at a younger age and had a significantly higher prevalence of risk factors. Periprocedural and in-hospital outcomes were similar in the 2 groups. At 30 days and 1 year, the rates of myocardial infarction, TVR and ST were significantly higher in black women. After adjustment for baseline differences, only ST appears to be more likely to occur in black women than in white women. CONCLUSIONS In this large cohort of women with coronary artery disease undergoing PCI, we observed racial disparities primarily in baseline characteristics indicative of need for interventions to achieve early diagnosis and better prevention in black women. Future directions should include efforts to identify and better characterize the factors underlying and contributing to cardiovascular outcomes in women after PCI. SUMMARY In this real-world analysis from a large cohort of women with coronary artery disease undergoing percutaneous coronary intervention at a US tertiary-care center, racial disparities were observed, especially in baseline characteristics, indicating late presentation.
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Outcomes by Gender and Ethnicity After Percutaneous Coronary Intervention. Am J Cardiol 2019; 123:1941-1948. [PMID: 31005238 DOI: 10.1016/j.amjcard.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/03/2019] [Accepted: 03/14/2019] [Indexed: 01/05/2023]
Abstract
Limited data on gender differences by ethnicity after percutaneous coronary intervention (PCI) exist. In this prospective cohort study, we examined gender differences in 1-year outcomes among patients from 4 ethnic groups who underwent PCI from 2010 to 2016 at a tertiary center. The primary outcome was 1-year major adverse cardiovascular events (MACE) defined as composite of all-cause death, nonfatal myocardial infarction (MI), or target lesion revascularization. Secondary outcomes included composite of death or MI and individual components of MACE. Baseline characteristics and outcomes were compared between gender in each ethnic group. The study included 16,361 patients: 7,881 whites (26.1% women), 1,943 blacks (47.3% women), 2,621 Asians (22.6% women), and 3,916 Hispanics (39.3% women). Women were older with more co-morbidities than men. Unadjusted, women had higher incidence of 1-year MACE than men among whites and Asians but not blacks or Hispanics, which was driven by a greater incidence of death in white women and greater incidence of MI in Asian women compared with male counterparts. After adjustment, findings showed similar risk of 1-year MACE in women versus men in whites, Asians, and Hispanics (Whites: hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78 to 1.16; Asians: HR 1.14, 95% CI 0.77 to 1.67; Hispanics: HR 0.97, 95% CI 0.74 to 1.27). Black women had lower risk of 1-year MACE compared with black men (HR 0.67, 95% CI 0.46 to 0.97), driven by lower risk of death or MI. In conclusion, this study suggests that risk factors account for adverse events in women after PCI.
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Schoenthaler A, Fei K, Ramos MA, Richardson LD, Ogedegbe G, Horowitz CR. Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans. J Clin Hypertens (Greenwich) 2019; 21:794-803. [PMID: 31125186 DOI: 10.1111/jch.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 12/25/2022]
Abstract
This paper describes the multilevel factors that contribute to hypertension disparities in 2052 hypertensive African Americans (mean age 52.9 ± 9.9 years; 66.3% female) who participated in a clinical trial. At the family level, participants reported average levels of life chaos and high social support. However, at the individual level, participants exhibited several adverse clinical and behavioral factors including poor blood pressure control (45% of population), obesity (61%), medication non-adherence (48%), smoking (32%), physical inactivity (45%), and poor diet (71%). While participants rated their provider as trustworthy, they reported high levels of discrimination in the health care system. Finally, community-level data indicate that participants reside in areas characterized by poor socio-economic and neighborhood conditions (eg, segregation). In the context of our trial, hypertensive African Americans exhibited several adverse risks and protective factors at multiple levels of influence. Future research should evaluate the impact of these factors on cardiovascular outcomes using a longitudinal design.
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Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Kezhen Fei
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle A Ramos
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne D Richardson
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Carol R Horowitz
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
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Caballero AE. The "A to Z" of Managing Type 2 Diabetes in Culturally Diverse Populations. Front Endocrinol (Lausanne) 2018; 9:479. [PMID: 30233490 PMCID: PMC6127640 DOI: 10.3389/fendo.2018.00479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes affects racial/ethnic minorities at an alarming rate in the US and in many countries around the world. The quality of health care provided to these groups is often suboptimal, resulting in worse patient-related outcomes when compared to those in mainstream populations. Understanding the complex biological elements that influence the development and course of the disease in high-risk populations is extremely important but often insufficient to implement effective prevention and treatment plans. Multiple factors must be addressed in routine diabetes clinical care. This paper discusses various key factors, organized in alphabetical order. These are acculturation, biology, clinician's cultural awareness, depression and diabetes-specific emotional distress, educational level, fears, group integration, health literacy, intimacy and sexual dysfunction, judging, knowledge of the disease, language, medication adherence, nutritional preferences, other forms of medicine (alternative), perception of body image, quality of life, religion and faith, socio-economic status, technology, unconscious bias, vulnerable groups, asking why?, exercise, "you are in charge" and zip it! Considering these factors in the development of type 2 diabetes prevention and treatment programs will help improve diabetes-related outcomes in culturally diverse populations and reduce health care disparities.
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Affiliation(s)
- A. Enrique Caballero
- Office for External Education, Harvard Medical School, Boston, MA, United States
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Whaley-Connell A, Sowers JR. Insulin Resistance in Kidney Disease: Is There a Distinct Role Separate from That of Diabetes or Obesity? Cardiorenal Med 2017; 8:41-49. [PMID: 29344025 DOI: 10.1159/000479801] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Insulin resistance is a central component of the metabolic dysregulation observed in obesity, which puts one at risk for the development of type 2 diabetes and complications related to diabetes such as chronic kidney disease. Insulin resistance and compensatory hyperinsulinemia place one at risk for other risk factors such as dyslipidemia, hypertension, and proteinuria, e.g., development of kidney disease. Our traditional view of insulin actions focuses on insulin-sensitive tissues such as skeletal muscle, liver, adipose tissue, and the pancreas. However, insulin also has distinct actions in kidney tissue that regulate growth, hypertrophy, as well as microcirculatory and fibrotic pathways which, in turn, impact glomerular filtration, including that governed by tubuloglomerular feedback. However, it is often difficult to discern the distinct effects of excess circulating insulin and impaired insulin actions, as exist in the insulin resistance individual, from the associated effects of obesity or elevated systolic blood pressure on the development and progression of kidney disease over time. Therefore, we review the experimental and clinical evidence for the distinct impact of insulin resistance on kidney function and disease.
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Affiliation(s)
- Adam Whaley-Connell
- Research Service, Harry S. Truman Memorial Veterans' Hospital, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Diabetes and Cardiovascular Center, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Division of Nephrology and Hypertension, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Division of Endocrinology and Metabolism, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Department of Medicine, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA
| | - James R Sowers
- Research Service, Harry S. Truman Memorial Veterans' Hospital, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Diabetes and Cardiovascular Center, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Division of Endocrinology and Metabolism, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Department of Medicine, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Department of Medical Pharmacology and Physiology, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA
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13
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Cancer-related risk factors and incidence of major cancers by race, gender and region; analysis of the NIH-AARP diet and health study. BMC Cancer 2017; 17:597. [PMID: 28854891 PMCID: PMC5577755 DOI: 10.1186/s12885-017-3557-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/16/2017] [Indexed: 12/26/2022] Open
Abstract
Background Racial disparities in the incidence of major cancers may be attributed to differences in the prevalence of established, modifiable risk factors such as obesity, smoking, physical activity and diet. Methods Data from a prospective cohort of 566,398 adults aged 50–71 years, 19,677 African-American and 450,623 Whites, was analyzed. Baseline data on cancer-related risk factors such as smoking, alcohol, physical activity and dietary patterns were used to create an individual adherence score. Differences in adherence by race, gender and geographic region were assessed using descriptive statistics, and Cox proportional hazards models were used to determine the association between adherence and cancer incidence. Results Only 1.5% of study participants were adherent to all five cancer-related risk factor guidelines, with marked race-, gender- and regional differences in adherence overall. Compared with participants who were fully adherent to all five cancer risk factor criteria, those adherent to one or less had a 76% increased risk of any cancer incidence (HR: 1.76, 95% CI: 1.70 – 1.82), 38% increased risk of breast cancer (HR: 1.38, 95% CI: 1.25 – 1.52), and doubled the risk of colorectal cancer (HR: 2.06, 95% CI: 1.84 – 2.29). However, risk of prostate cancer was lower among participants adherent to one or less compared with those who were fully adherent (HR: 0.79, 95% CI: 0.75 – 0.85). The proportion of cancer incident cases attributable to low adherence was higher among African-Americans compared with Whites for all cancers (21% vs. 19%), and highest for colorectal cancer (25%) regardless of race. Conclusion Racial differences in the proportion of cancer incidence attributable to low adherence suggests unique opportunities for targeted cancer prevention strategies that may help eliminate racial disparities in cancer burden among older US adults. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3557-1) contains supplementary material, which is available to authorized users.
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14
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Whaley-Connell A, Sowers JR. Obesity and kidney disease: from population to basic science and the search for new therapeutic targets. Kidney Int 2017; 92:313-323. [DOI: 10.1016/j.kint.2016.12.034] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/22/2016] [Accepted: 12/14/2016] [Indexed: 12/17/2022]
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15
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Caballero AE. GLP-1 ANALOGUES FOR THE TREATMENT OF TYPE 2 DIABETES IN LATINOS/HISPANICS. Endocr Pract 2016; 22:1459-1461. [PMID: 27929679 DOI: 10.4158/ep161593.co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Akinyemiju T, Moore JX, Pisu M, Lakoski SG, Shikany J, Goodman M, Judd SE. A prospective study of dietary patterns and cancer mortality among Blacks and Whites in the REGARDS cohort. Int J Cancer 2016; 139:2221-31. [PMID: 27459634 DOI: 10.1002/ijc.30287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/12/2016] [Accepted: 07/18/2016] [Indexed: 12/20/2022]
Abstract
Marked racial differences exist in dietary patterns and obesity, as well as cancer mortality. This study aims to assess whether dietary patterns are associated with cancer mortality overall and by race. We identified 22,041 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Dietary patterns were categorized into: Convenience (Chinese and Mexican foods, pasta, pizza), Plant-based (fruits, vegetables), Southern (added fats, fried foods, sugar-sweetened beverages), Sweets/Fats (sugary foods) and Alcohol/Salads (alcohol, green-leafy vegetables, salad dressing). Using Cox regression, we examined the association between quartiles of dietary patterns and cancer mortality, adjusted for potential confounders, overall among all participants and stratified by race. A total of 873 cancer deaths were observed over the 10-year observation period: 582 (66.7%) in Whites and 291 (33.3%) in Blacks. Greater adherence to the Southern dietary pattern was associated with an increased risk of cancer mortality (4th vs. 1st quartile HR: 1.67; 95% CI: 1.32-2.10) overall, especially among Whites (4th vs. 1st quartile HR: 1.59; 95% CI: 1.22-2.08). The convenience (HR: 0.73; 95% CI: 0.56-0.94) and Plant-based (HR: 0.72; 95% CI: 0.55-0.93) dietary patterns were associated with up to a 28% reduced risk of cancer mortality, but only among Whites. Greater adherence to the Southern dietary pattern increased the risk of cancer mortality, while greater adherence to the convenience and Plant-based diets reduced the risk of cancer mortality among Whites. Racial differences were observed in the association between dietary patterns and cancer mortality, but warrant further study.
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Affiliation(s)
- Tomi Akinyemiju
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.
| | - Justin Xavier Moore
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Maria Pisu
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.,Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Susan G Lakoski
- Department of Clinical Cancer Prevention and Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
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17
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Ferdinand KC. Cardiovascular risk reduction in African Americans: Current concepts and controversies. Glob Cardiol Sci Pract 2016; 2016:e201602. [PMID: 29043252 PMCID: PMC5642780 DOI: 10.21542/gcsp.2016.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Keith C Ferdinand
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, 1430 Tulane Avenue, SL-8548, New Orleans, LA 70112, USA
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18
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Graham G. Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes. Clin Cardiol 2016; 39:299-306. [PMID: 27028198 DOI: 10.1002/clc.22524] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/13/2016] [Indexed: 01/01/2023] Open
Abstract
In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non-Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non-Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non-Hispanic white ACS/MI patients were the 3 most-studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.
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Affiliation(s)
- Garth Graham
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.,Aetna Foundation, Aetna Inc., Hartford, Connecticut
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19
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Graham G, Xiao YYK, Rappoport D, Siddiqi S. Population-level differences in revascularization treatment and outcomes among various United States subpopulations. World J Cardiol 2016; 8:24-40. [PMID: 26839655 PMCID: PMC4728105 DOI: 10.4330/wjc.v8.i1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/29/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023] Open
Abstract
Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.
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20
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Wheat CL, Strate LL. Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States From 2000 to 2010. Clin Gastroenterol Hepatol 2016; 14:96-103.e1. [PMID: 25862988 PMCID: PMC4624035 DOI: 10.1016/j.cgh.2015.03.030] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/13/2015] [Accepted: 03/15/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Most studies of trends in diverticular disease have focused on diverticulitis or on a composite outcome of diverticulitis and bleeding. We aimed to quantify and compare the prevalence of hospitalization for diverticular bleeding and diverticulitis overall and by sex and race. METHODS We analyzed data from the Nationwide Inpatient Sample from 2000 through 2010. We identified adult patients with a discharge diagnosis of diverticular bleeding or diverticulitis. By using yearly US intercensal data, we calculated age-, sex-, and race-specific rates, as well as age-adjusted prevalence rates. RESULTS The prevalence of hospitalizations per 100,000 persons for diverticular bleeding decreased over the 10-year period from 32.5 to 27.1 (-5.4; 95% confidence interval, -5.1 to -5.7). The prevalence of hospitalizations for diverticulitis peaked in 2008 (74.1/100,000 in 2000, 96.0/100,000 in 2008, and 91.9/100,000 in 2010). The prevalence of diverticulitis was higher in women than in men, whereas women and men had similar rates of diverticular bleeding. The prevalence of diverticular bleeding was highest in blacks (34.4/100,000 in 2010); whereas the prevalence of diverticulitis was highest in whites (75.5/100,000 in 2010). CONCLUSIONS Over the past 10 years, the prevalence of hospitalizations for diverticulitis increased and then plateaued, whereas that of diverticular bleeding decreased. The prevalence according to sex and race differed for diverticulitis and diverticular bleeding. These findings indicate different mechanisms of pathogenesis for these disorders.
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Affiliation(s)
- Chelle L Wheat
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle WA,School of Public Health, Department of Health Services, University of Washington, Seattle, WA
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington.
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21
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Rao A, Pandya V, Whaley-Connell A. Obesity and insulin resistance in resistant hypertension: implications for the kidney. Adv Chronic Kidney Dis 2015; 22:211-7. [PMID: 25908470 DOI: 10.1053/j.ackd.2014.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/08/2014] [Accepted: 12/19/2014] [Indexed: 12/12/2022]
Abstract
There is recognition that the obesity epidemic contributes substantially to the increasing incidence of CKD and resistant hypertension (HTN). The mechanisms by which obesity promotes resistance are an area of active interest and intense investigation. It is thought that increases in visceral adiposity lead to a proinflammatory, pro-oxidative milieu that promote resistance to the metabolic actions of insulin. This resistance to insulin at the level of skeletal muscle tissue impairs glucose disposal/utilization through actions on the endothelium that include vascular rarefaction, reductions in vascular relaxation, and vascular remodeling. Insulin resistance derived from increased adipose tissue and obesity has system-wide implications for other tissue beds such as the kidney that affects blood pressure regulation. The additional autocrine and paracrine activities of adipose tissue contribute to inappropriate activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system that promote kidney microvascular remodeling, stiffness, and sodium (Na(+)) retention that in turn promote HTN and in the CKD patient, resistance. In this review, we will summarize the important mechanisms that link obesity to CKD as they relate to resistant HTN.
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22
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Zhu Z, Yan Z, Zhang L, Du R, Zhu J, Zuo J, Chu S, Shen W, Zhang R. Increased arterial stiffness after coronary artery revascularization correlates with serious coronary artery lesions and poor clinical outcomes in patients with chronic kidney disease. Cardiorenal Med 2015; 4:280-9. [PMID: 25737692 DOI: 10.1159/000369107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/05/2014] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES This study aimed to clarify the relationship between arterial stiffness and coronary artery lesions as well as their influence on long-term outcomes after coronary artery revascularization in patients with chronic kidney disease (CKD). METHODS A total of 205 patients who had a coronary angiography and received coronary artery revascularization on demand were enrolled and followed up for 5 years. Demographic and clinical indicators, arterial stiffness indexes, angiographic characteristics and the Gensini score (GS) were recorded at baseline. Major adverse cardiac events (MACE), including cardiac death and repeat coronary artery revascularization, that occurred during the 5 years of follow-up were also recorded. RESULTS All indexes reflecting the degree of arterial stiffness, including PWV, C1, C2, CSBP, CDBP, AP and Aix, were significantly higher in CKD than in non-CKD patients (all p < 0.05). Patients with CKD also had a higher rate of coronary artery disease and a higher GS (p < 0.05 and p < 0.01, respectively). Logistic regression analysis revealed CKD to be an independent risk factor for increased arterial stiffness (OR = 2.508, 95% CI 1.308-4.808, p = 0.006). During follow-up, CKD patients with PWV >13 m/s or Aix@75 >30 had a significantly higher MACE occurrence rate after coronary artery revascularization (both p < 0.05). CONCLUSION These results highlight that CKD and arterial stiffness correlate with the severity of coronary artery lesions. CKD patients with impaired arterial stiffness have poor clinical outcomes, suggesting a further clinical use of the arterial stiffness index as a surrogate of worse cardiovascular prognosis in CKD than in non-CKD patients.
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Affiliation(s)
- Zhengbin Zhu
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijun Yan
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Zhang
- Department of Civil Aviation Administration of China (CAAC), East China Regional Administration Aviation Personnel Examination Center, Shanghai Hospital of Civil Aviation, Shanghai, China
| | - Run Du
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhou Zhu
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junli Zuo
- Department of Hypertension, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoli Chu
- Department of Hypertension, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weifeng Shen
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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23
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Padilla M, Peters AL. Diabetes and Cardiovascular Disease Risk Factors as Influenced by Race and Ethnic Background. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-014-0431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Frisbee JC, Goodwill AG, Frisbee SJ, Butcher JT, Brock RW, Olfert IM, DeVallance ER, Chantler PD. Distinct temporal phases of microvascular rarefaction in skeletal muscle of obese Zucker rats. Am J Physiol Heart Circ Physiol 2014; 307:H1714-28. [PMID: 25305181 DOI: 10.1152/ajpheart.00605.2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Evolution of metabolic syndrome is associated with a progressive reduction in skeletal muscle microvessel density, known as rarefaction. Although contributing to impairments to mass transport and exchange, the temporal development of rarefaction and the contributing mechanisms that lead to microvessel loss are both unclear and critical areas for investigation. Although previous work suggests that rarefaction severity in obese Zucker rats (OZR) is predicted by the chronic loss of vascular nitric oxide (NO) bioavailability, we have determined that this hides a biphasic development of rarefaction, with both early and late components. Although the total extent of rarefaction was well predicted by the loss in NO bioavailability, the early pulse of rarefaction developed before a loss of NO bioavailability and was associated with altered venular function (increased leukocyte adhesion/rolling), and early elevation in oxidant stress, TNF-α levels, and the vascular production of thromboxane A2 (TxA2). Chronic inhibition of TNF-α blunted the severity of rarefaction and also reduced vascular oxidant stress and TxA2 production. Chronic blockade of the actions of TxA2 also blunted rarefaction, but did not impact oxidant stress or inflammation, suggesting that TxA2 is a downstream outcome of elevated reactive oxygen species and inflammation. If chronic blockade of TxA2 is terminated, microvascular rarefaction in OZR skeletal muscle resumes, but at a reduced rate despite low NO bioavailability. These results suggest that therapeutic interventions against inflammation and TxA2 under conditions where metabolic syndrome severity is moderate or mild may prevent the development of a condition of accelerated microvessel loss with metabolic syndrome.
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Affiliation(s)
- Jefferson C Frisbee
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Adam G Goodwill
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Stephanie J Frisbee
- Department of Health Policy, Management and Leadership, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Joshua T Butcher
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Robert W Brock
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - I Mark Olfert
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, West Virginia; and Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Evan R DeVallance
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, West Virginia; and Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Paul D Chantler
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, West Virginia; and Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
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