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Abe TA, Olanipekun T, Yan F, Effoe V, Udongwo N, Oshunbade A, Thomas V, Onuorah I, Terry JG, Yimer WK, Ghali JK, Correa A, Onwuanyi A, Michos ED, Benjamin EJ, Echols M. Carotid Intima-Media Thickness and Improved Stroke Risk Assessment in Hypertensive Black Adults. Am J Hypertens 2024; 37:290-297. [PMID: 38236147 PMCID: PMC10941087 DOI: 10.1093/ajh/hpae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND We aim to determine the added value of carotid intima-media thickness (cIMT) in stroke risk assessment for hypertensive Black adults. METHODS We examined 1,647 participants with hypertension without a history of cardiovascular (CV) disease, from the Jackson Heart Study. Cox regression analysis estimated hazard ratios (HRs) for incident stroke per standard deviation increase in cIMT and quartiles while adjusting for baseline variables. We then evaluated the predictive capacity of cIMT when added to the pool cohort equations (PCEs). RESULTS The mean age at baseline was 57 ± 10 years. Each standard deviation increase in cIMT (0.17 mm) was associated with approximately 30% higher risk of stroke (HR 1.27, 95% confidence interval: 1.08-1.49). Notably, cIMT proved valuable in identifying residual stroke risk among participants with well-controlled blood pressure, showing up to a 56% increase in the odds of stroke for each 0.17 mm increase in cIMT among those with systolic blood pressure <120 mm Hg. Additionally, the addition of cIMT to the PCE resulted in the reclassification of 58% of low to borderline risk participants with stroke to a higher-risk category and 28% without stroke to a lower-risk category, leading to a significant net reclassification improvement of 0.22 (0.10-0.30). CONCLUSIONS In this community-based cohort of middle-aged Black adults with hypertension and no history of CV disease at baseline, cIMT is significantly associated with incident stroke and enhances stroke risk stratification.
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Affiliation(s)
- Temidayo A Abe
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Titilope Olanipekun
- Division of Internal Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Fengxia Yan
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Valery Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ndausung Udongwo
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Victoria Thomas
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ifeoma Onuorah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James G Terry
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wondwosen K Yimer
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jalal K Ghali
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anekwe Onwuanyi
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Melvin Echols
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
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McGraw KE, Konkle SL, Riggs DW, Rai SN, DeJarnett N, Xie Z, Keith RJ, Oshunbade A, Hall ME, Shimbo D, Bhatnagar A. Exposure to Volatile Organic Compounds Is Associated with Hypertension in Black Adults: The Jackson Heart Study. Environ Res 2023; 223:115384. [PMID: 36796615 PMCID: PMC10134439 DOI: 10.1016/j.envres.2023.115384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/15/2022] [Accepted: 01/27/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The prevalence of hypertension is higher among Black adults than among White and Hispanic adults. Nevertheless, reasons underlying the higher rates of hypertension in the Black population remain unclear but may relate to exposure to environmental chemicals such as volatile organic compounds (VOCs). METHODS We evaluated the associations of blood pressure (BP) and hypertension with VOC exposure in non-smokers and smokers in a subgroup of the Jackson Heart Study (JHS), consisting of 778 never smokers and 416 age- and sex-matched current smokers. We measured urinary metabolites of 17 VOCs by mass spectrometry. RESULTS After adjusting for covariates, we found that amoong non-smokers, metabolites of acrolein and crotonaldehyde were associated with a 1.6 mm Hg (95%CI: 0.4, 2.7; p = 0.007) and a 0.8 mm Hg (95%CI: 0.01, 1.6; p = 0.049) higher systolic BP, and the styrene metabolite was associated with a 0.4 mm Hg (95%CI: 0.09, 0.8, p = 0.02) higher diastolic BP. Current smokers had 2.8 mm Hg (95% CI 0.5, 5.1) higher systolic BP. They were at higher risk of hypertension (relative risk = 1.2; 95% CI, 1.1, 1.4), and had higher urinary levels of several VOC metabolites. Individuals who smoke had higher levels of the urinary metabolites of acrolein, 1,3-butadiene, and crotonaldehyde and were associated with higher systolic BP. The associations were stronger among participants who were <60 years of age and male. Using Bayesian kernel machine regression to assess the effects of multiple VOC exposures, we found that the relationship between VOCs and hypertension among non-smokers was driven primarily by acrolein and styrene in non-smokers, and crotonaldehyde in smokers. CONCLUSIONS Hypertension in Black individuals may be attributed, in part, to VOC exposure from the environment or tobacco smoke.
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Affiliation(s)
- Katlyn E McGraw
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville Superfund Research Center, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville School of Public Health and Information Sciences, 485 E Gray Street, Louisville, KY, 40202, USA
| | - Stacey L Konkle
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville Superfund Research Center, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville School of Public Health and Information Sciences, 485 E Gray Street, Louisville, KY, 40202, USA
| | - Daniel W Riggs
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville Superfund Research Center, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville School of Public Health and Information Sciences, 485 E Gray Street, Louisville, KY, 40202, USA
| | - Shesh N Rai
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville Superfund Research Center, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville School of Public Health and Information Sciences, 485 E Gray Street, Louisville, KY, 40202, USA
| | - Natasha DeJarnett
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA
| | - Zhengzhi Xie
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA
| | - Rachel J Keith
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville Superfund Research Center, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA
| | - Adebamike Oshunbade
- University of Mississippi Medical Center Department of Medicine - Cardiology, 2500 North State St, Jackson, MS, 39216, USA
| | - Michael E Hall
- University of Mississippi Medical Center Department of Medicine - Cardiology, 2500 North State St, Jackson, MS, 39216, USA
| | - Diachi Shimbo
- Columbia University Department of Medicine, 161 Fort Washington Ave, New York, NY, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA; University of Louisville Superfund Research Center, 302 E Muhammad Ali Blvd, Louisville, KY, 40202, USA.
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Garg PM, Paschal JL, Ansari MAY, Billington L, Ware J, Adams K, Hamda YA, Oshunbade A, Rosenfeld CR, Mir IN. Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants - A Matched Case-Control Study. Fetal Pediatr Pathol 2023; 42:187-197. [PMID: 35979839 PMCID: PMC9938086 DOI: 10.1080/15513815.2022.2110340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the association of placental pathology with the severity of necrotizing enterocolitis (NEC) in preterm infants. METHODS This single-center matched case-control study included infants with NEC (n = 107) and gestational age and birth weight-matched controls (n = 130), born between 2013 and 2020. Placentas were evaluated according to the Amsterdam Placental Workshop Group Consensus Statement. RESULTS Acute histologic chorioamnionitis with the fetal response was significantly more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). On regression model, infants with multiple placental pathologies (OR 2.16; 95% CI 1.01 - 4.73; p = 0.04) and maternal vascular malperfusion (OR 2.2; 95% CI 1.12 - 4.51; p = 0.02) had higher odds of either medical or surgical NEC than controls. CONCLUSION Infants with multiple placental lesions, including placental inflammatory and vascular lesions, were at higher risk of medical or surgical NEC in the postnatal period.
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Affiliation(s)
- Parvesh Mohan Garg
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jaslyn L Paschal
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Md Abu Yusuf Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lauren Billington
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennifer Ware
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kristin Adams
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Youssef Al Hamda
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Charles R Rosenfeld
- Department of Pediatrics/Neonatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Imran N Mir
- Department of Pediatrics/Neonatology, UT Southwestern Medical Center, Dallas, Texas, USA
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Abe T, Olanipekun T, Effoe V, Yan F, Yimer W, Oshunbade A, Udongwo N, Egbuche O, Ghali JK, Correa A, Onwuanyi A, Echols MR. CAROTID INTIMA MEDIA THICKNESS AND INCIDENT STROKE IN AFRICAN AMERICANS WITH HYPERTENSION: THE JACKSON HEART STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Hamid A, Yimer W, Oshunbade A, Khan MS, Kamimura D, Kipchumba RK, Pandey A, Clark D, Mentz R, Fox ER, Berry J, Stacey B, Shah A, Correa A, Virani SS, Butler J, Hall ME. Trajectory of high sensitivity c-reactive protein and incident heart failure in black adults: the jackson heart study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kamimura D, Yimer WK, Shah AM, Mentz RJ, Oshunbade A, Hamid A, Suzuki T, Clark D, Waller J, Fox ER, Correa A, Butler J, Hall ME. Vitamin D Levels in Black Americans and the Association With Left Ventricular Remodeling and Incident Heart Failure With Preserved Ejectin Fraction: The Jackson Heart Study. J Card Fail 2023; 29:150-157. [PMID: 35905866 DOI: 10.1016/j.cardfail.2022.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 07/06/2022] [Accepted: 07/16/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND In observational studies, a lower serum vitamin D3 concentration has been associated with an increased risk of cardiovascular disease. However, the associations between serum vitamin D3 levels and left ventricular (LV) structure and heart failure with preserved ejection fraction (HFpEF) have not been well-characterized among Black Americans. The prevalence of vitamin D3 deficiency is higher among Black Americans than in other race/ethnicity groups. We hypothesized that serum vitamin D3 levels are associated with LV concentric remodeling and incident HFpEF in Black Americans. METHODS AND RESULTS Among 5306 Black Americans in the Jackson Heart Study cohort, we investigated the relationships between serum vitamin D3 levels and LV structure and function, evaluated with echocardiography, and incident HF hospitalization, categorized as either HF with reduced EF (HFrEF; an EF of <50%) or HFpEF (an EF of ≥50%). After adjustment for possible confounding factors, lower vitamin D3 levels were associated with greater relative wall thickness (β for 1 standard deviation [SD] increase -0.003, 95% confidence interval -0.005 to -0.000). Over a median follow-up period of 11 years (range 10.2-11.0 years), 340 participants developed incident HF (7.88 cases per 1000 person-years), including 146 (43%) HFrEF and 194 (57%) HFpEF cases. After adjustment, higher serum vitamin D3 levels were associated with decreased hazard for HF overall (hazard ratio for 1 SD increase 0.88, 95% confidence interval 0.78-0.99) driven by a significant association with HFpEF (hazard ratio for 1 SD increase 0.84, 95% confidence interval 0.71-0.99). CONCLUSIONS In this community-based Black American cohort, lower serum vitamin D3 levels were associated with LV concentric remodeling and an increased hazard for HF, mainly HFpEF. Further investigation is required to examine whether supplementation with vitamin D3 can prevent LV concentric remodeling and incident HFpEF in Black Americans.
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Affiliation(s)
- Daisuke Kamimura
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Wondwosen K Yimer
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert J Mentz
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Arsalan Hamid
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Takeki Suzuki
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Donald Clark
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jamarius Waller
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Siddiqi TJ, Ahmed A, Greene SJ, Shahid I, Usman MS, Oshunbade A, Alkhouli M, Hall ME, Murad MH, Khera R, Jain V, Van Spall HGC, Khan MS. Performance of current risk stratification models for predicting mortality in patients with heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol 2022; 29:2027-2048. [PMID: 35919956 DOI: 10.1093/eurjpc/zwac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 11/12/2022]
Abstract
AIMS There are several risk scores designed to predict mortality in patients with heart failure (HF). This study aimed to assess performance of risk scores validated for mortality prediction in patients with acute HF (AHF) and chronic HF. METHODS AND RESULTS MEDLINE and Scopus were searched from January 2015 to January 2021 for studies which internally or externally validated risk models for predicting all-cause mortality in patients with AHF and chronic HF. Discrimination data were analysed using C-statistics, and pooled using generic inverse-variance random-effects model. Nineteen studies (n = 494 156 patients; AHF: 24 762; chronic HF mid-term mortality: 62 000; chronic HF long-term mortality: 452 097) and 11 risk scores were included. Overall, discrimination of risk scores was good across the three subgroups: AHF mortality [C-statistic: 0.76 (0.68-0.83)], chronic HF mid-term mortality [1 year; C-statistic: 0.74 (0.68-0.79)], and chronic HF long-term mortality [≥2 years; C-statistic: 0.71 (0.69-0.73)]. MEESSI-AHF [C-statistic: 0.81 (0.80-0.83)] and MARKER-HF [C-statistic: 0.85 (0.80-0.89)] had an excellent discrimination for AHF and chronic HF mid-term mortality, respectively, whereas MECKI had good discrimination [C-statistic: 0.78 (0.73-0.83)] for chronic HF long-term mortality relative to other models. Overall, risk scores predicting short-term mortality in patients with AHF did not have evidence of poor calibration (Hosmer-Lemeshow P > 0.05). However, risk models predicting mid-term and long-term mortality in patients with chronic HF varied in calibration performance. CONCLUSIONS The majority of recently validated risk scores showed good discrimination for mortality in patients with HF. MEESSI-AHF demonstrated excellent discrimination in patients with AHF, and MARKER-HF and MECKI displayed an excellent discrimination in patients with chronic HF. However, modest reporting of calibration and lack of head-to-head comparisons in same populations warrant future studies.
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Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aymen Ahmed
- Department of Medicine, DOW University of Health Sciences, Karachi, Pakistan
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | | | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Research Institute of St Joe's Hamilton and Population Health Research Institute, Hamilton, Canada
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Oshunbade A, Le TT, Lirette S, Hamid A, Mathews L, Kamimura D, Mentz R, Fox E, McMullan M, Butler J, Butler K, Mosley T, Hall M. THE RELATIONSHIP BETWEEN BIOMARKERS OF INFLAMMATION AND LEFT VENTRICULAR STRUCTURE AND FUNCTION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Onyeakusi NE, Mukhtar F, Gbadamosi SO, Oshunbade A, Adejumo AC, Olufajo O, Owoh J. Cancer-Related Pain Is an Independent Predictor of In-Hospital Opioid Overdose: A Propensity-Matched Analysis. Pain Med 2019; 20:2552-2561. [PMID: 31197321 DOI: 10.1093/pm/pnz130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND About 50% of patients with cancer who have undergone surgery suffer from cancer-related pain (CP). The use of opioids for postoperative pain management presents the potential for overdose, especially among these patients. OBJECTIVE The primary objective of this study was to determine the association between CP and postoperative opioid overdose among inpatients who had undergone major elective procedures. The secondary objective was to assess the relationship between CP and inpatient mortality, total hospital charge, and length of stay in this population. METHODS Data of adults 18 years and older from the National Inpatient Sample (NIS) were analyzed. Variables were identified using ICD-9 codes. Propensity-matched regression models were employed in evaluating the association between CP and outcomes of interest. RESULTS Among 4,085,355 selected patients, 0.8% (N = 2,665) had CP, whereas 99.92% (N = 4,082,690) had no diagnosis of CP. We matched patients with CP (N = 2,665) and no CP (N = 13,325) in a 1:5 ratio. We found higher odds of opioid overdose (adjusted odds ratio [aOR] = 4.82, 95% confidence interval [CI] = 2.68-8.67, P < 0.0001) and inpatient mortality (aOR = 1.39, 95% CI = 1.11-1.74, P = 0.0043) in patients with CP vs no CP. Also, patients with CP were more likely to stay longer in the hospital (12.76 days vs 7.88 days) with higher total hospital charges ($140,220 vs $88,316). CONCLUSIONS CP is an independent risk factor for opioid overdose, increased length of stay, and increased total hospital charges.
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Affiliation(s)
- Nnaemeka E Onyeakusi
- Department of Anesthesiology, Case Western Reserve University/MetroHealth Med Ctr, Cleveland, Ohio.,Department of Pediatrics, BronxCare Health System, Bronx, New York
| | - Fahad Mukhtar
- Department of Psychiatry, St. Elizabeth's Hospital, Washington, DC.,Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | | | | | - Olubode Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Jude Owoh
- Quinnipiac University, Hamden, Salem, Connecticut, USA
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