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Golden BP, Tackett S, Kobayashi K, Nelson TS, Agrawal AM, Zhang J, Jackson NA, Mills G, Lorigiano TJ, Hirpa M, Lin JS, Johnson T, Sajja A, Disney S, Huang S, Nayak J, Lautzenheiser M, Berry SA. Wall-mounted folding chairs to promote resident physician sitting at the hospital bedside. J Hosp Med 2024. [PMID: 38243720 DOI: 10.1002/jhm.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Sitting at the bedside may improve patient-clinician communication; however, many clinicians do not regularly sit during inpatient encounters. OBJECTIVE To determine the impact of adding wall-mounted folding chairs inside patient rooms, beyond any impact from a resident education campaign, on the patient-reported frequency of sitting at the bedside by internal medicine resident physicians. DESIGN, SETTING, AND PARTICIPANTS Prospective, controlled pre-post trial between 2019 and 2022 (data collection paused 2020-2021 due to COVID-19) at an academic hospital in Baltimore, Maryland. Folding chairs were installed in two of four internal medicine units and educational activities were delivered equally across all units. MAIN OUTCOME AND MEASURES Patient-reported frequency of sitting at bedside, assessed as means on Likert-type items with 1 being "never" and 5 being "every single time." We also examined the frequency of other patient-reported communication behaviors. RESULTS Two hundred fifty six and 206 patients enrolled in the pre and post-intervention periods, respectively. The mean frequency of patient-reported sitting by resident physicians increased from 1.8 (SD 1.2) to 2.3 (1.2) on education-only units (absolute difference 0.48 [95% CI: 0.21-0.75]) and from 2.0 (1.3) to 3.2 (1.4) on units receiving chairs (1.16, [0.87-1.45]). Comparing differences between groups using ordered logistic regression adjusting for clustering within residents, units with added chairs had greater increases in sitting (odds ratio 2.05 [1.10-3.82]), spending enough time at the bedside (2.43 [1.32-4.49]), and checking for understanding (3.04 [1.44-6.39]). Improvements in sitting and other behaviors were sustained on both types of units. CONCLUSIONS Adding wall-mounted folding chairs may help promote effective patient-clinician communication.
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Affiliation(s)
- Blair P Golden
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sean Tackett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimiyoshi Kobayashi
- Department of Medicine and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
| | | | - Alison M Agrawal
- Central Billing Office, University of Maryland Medical System, Baltimore, Maryland, USA
| | - Jerry Zhang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Geron Mills
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ting-Jia Lorigiano
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meron Hirpa
- City of Cincinnati Health Department, Cincinnati, Ohio, USA
| | - Jessica S Lin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Trent Johnson
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Aparna Sajja
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah Disney
- Johns Hopkins Surgery Centers Series, Baltimore, Maryland, USA
| | - Shanshan Huang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Juhi Nayak
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Lautzenheiser
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen A Berry
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Samuel C, Park J, Sajja A, Michos ED, Blumenthal RS, Jones SR, Martin SS. Accuracy of 23 Equations for Estimating LDL Cholesterol in a Clinical Laboratory Database of 5,051,467 Patients. Glob Heart 2023; 18:36. [PMID: 37361322 PMCID: PMC10289049 DOI: 10.5334/gh.1214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Background Alternatives to the Friedewald low-density lipoprotein cholesterol (LDL-C) equation have been proposed. Objective To compare the accuracy of available LDL-C equations with ultracentrifugation measurement. Methods We used the second harvest of the Very Large Database of Lipids (VLDbL), which is a population-representative convenience sample of adult and pediatric patients (N = 5,051,467) with clinical lipid measurements obtained via the vertical auto profile (VAP) ultracentrifugation method between October 1, 2015 and June 30, 2019. We performed a systematic literature review to identify available LDL-C equations and compared their accuracy according to guideline-based classification. We also compared the equations by their median error versus ultracentrifugation. We evaluated LDL-C equations overall and stratified by age, sex, fasting status, and triglyceride levels, as well as in patients with atherosclerotic cardiovascular disease, hypertension, diabetes, kidney disease, inflammation, and thyroid dysfunction. Results Analyzing 23 identified LDL-C equations in 5,051,467 patients (mean±SD age, 56±16 years; 53.3% women), the Martin/Hopkins equation most accurately classified LDL-C to the correct category (89.6%), followed by the Sampson (86.3%), Chen (84.4%), Puavilai (84.1%), Delong (83.3%), and Friedewald (83.2%) equations. The other 17 equations were less accurate than Friedewald, with accuracy as low as 35.1%. The median error of equations ranged from -10.8 to 18.7 mg/dL, and was best optimized using the Martin/Hopkins equation (0.3, IQR-1.6 to 2.4 mg/dL). The Martin/Hopkins equation had the highest accuracy after stratifying by age, sex, fasting status, triglyceride levels, and clinical subgroups. In addition, one in five patients who had Friedewald LDL-C <70 mg/dL, and almost half of the patients with Friedewald LDL-C <70 mg/dL and triglyceride levels 150-399 mg/dL, had LDL-C correctly reclassified to >70 mg/dL by the Martin/Hopkins equation. Conclusions Most proposed alternatives to the Friedewald equation worsen LDL-C accuracy, and their use could introduce unintended disparities in clinical care. The Martin/Hopkins equation demonstrated the highest LDL-C accuracy overall and across subgroups.
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Affiliation(s)
- Christeen Samuel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jihwan Park
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aparna Sajja
- Medstar Georgetown University Hospital-Washington Hospital Center, Division of Cardiology, Washington, DC, USA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven R. Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sajja A, Lloyd M. "Can we ablate your atrial fibrillation? Let's check your bloodwork." Genetic profiling and its role in ablation for atrial fibrillation. Heart Rhythm 2022; 19:2051-2053. [PMID: 36087687 DOI: 10.1016/j.hrthm.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Aparna Sajja
- Section of Cardiac Electrophysiology, Emory University Hospital, Atlanta, Georgia
| | - Michael Lloyd
- Section of Cardiac Electrophysiology, Emory University Hospital, Atlanta, Georgia.
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Griffith N, Bigham G, Sajja A, Gluckman TJ. Leveraging Healthcare System Data to Identify High-Risk Dyslipidemia Patients. Curr Cardiol Rep 2022; 24:1387-1396. [PMID: 35994196 DOI: 10.1007/s11886-022-01767-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW While randomized controlled trials have historically served as the gold standard for shaping guideline recommendations, real-world data are increasingly being used to inform clinical decision-making. We describe ways in which healthcare systems are generating real-world data related to dyslipidemia and how these data are being leveraged to improve patient care. RECENT FINDINGS The electronic medical record has emerged as a major source of clinical data, which alongside claims and pharmacy dispending data is enabling healthcare systems the ability to identify care gaps (underdiagnosis and undertreatment) in patients with dyslipidemia. Availability of this data also allows healthcare systems the ability to test and deliver interventions at the point-of-care. Real-world data possess great potential as a complement to randomized controlled trials. Healthcare systems are uniquely positioned to not only define care gaps and areas of opportunity, but to also to leverage tools (e.g., clinical decision support, case identification) aimed at closing them.
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Affiliation(s)
- Nayrana Griffith
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA.
| | - Grace Bigham
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Aparna Sajja
- Division of Cardiology, Medstar Georgetown University Hospital-Washington Hospital Center, Washington, DC, USA
| | - Ty J Gluckman
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, OR, USA
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Ohlfest M, Sajja A. ADULT-ONSET STILL'S DISEASE AND CARDIOMYOPATHY FOLLOWING COVID-19 INFECTION. J Am Coll Cardiol 2022. [PMCID: PMC8972360 DOI: 10.1016/s0735-1097(22)03290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sajja A, Li HF, Spinelli KJ, Blumenthal RS, Virani SS, Martin SS, Gluckman TJ. Discordance Between Standard Equations for Determination of LDL Cholesterol in Patients With Atherosclerosis. J Am Coll Cardiol 2022; 79:530-541. [PMID: 35144744 DOI: 10.1016/j.jacc.2021.11.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Accurate estimation of low-density lipoprotein cholesterol (LDL-C) is important for guiding cholesterol-lowering therapy. Different methods currently exist to estimate LDL-C. OBJECTIVES This study sought to assess discordance of estimated LDL-C using the Friedewald, Sampson, and Martin/Hopkins equations. METHODS Electronic health record data from patients with atherosclerotic cardiovascular disease and triglyceride (TG) levels of <400 mg/dL between October 1, 2015, and June 30, 2019, were retrospectively analyzed. LDL-C was estimated using the Friedewald, Sampson, and Martin/Hopkins equations. Patients were categorized as concordant if LDL-C was <70 mg/dL with each pairwise comparison of equations and as discordant if LDL-C was <70 mg/dL for the index equation and ≥70 mg/dL for the comparator. RESULTS The study included 146,106 patients with atherosclerotic cardiovascular disease (mean age: 68 years; 56% male; 91% White). The Martin/Hopkins equation consistently estimated higher LDL-C values than the Friedewald and Sampson equations. Discordance rates were 15% for the Friedewald vs Martin/Hopkins comparison, 9% for the Friedewald vs Sampson comparison, and 7% for the Sampson vs Martin/Hopkins comparison. Discordance increased at lower LDL-C cutpoints and in those with elevated TG levels. Among patients with TG levels of ≥150 mg/dL, a >10 mg/dL difference in LDL-C was present in 67%, 27%, and 23% of patients when comparing the Friedewald vs Martin/Hopkins, Friedewald vs Sampson, and Sampson vs Martin/Hopkins equations, respectively. CONCLUSIONS Clinically meaningful differences in estimated LDL-C exist among equations, particularly at TG levels of ≥150 mg/dL and/or lower LDL-C levels. Reliance on the Friedewald and Sampson equations may result in the underestimation and undertreatment of LDL-C in those at increased risk.
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Affiliation(s)
- Aparna Sajja
- Medstar Georgetown University Hospital-Washington Hospital Center, Division of Cardiology, Washington, DC, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Hsin-Fang Li
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Research Network, Portland, Oregon, USA
| | - Kateri J Spinelli
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Research Network, Portland, Oregon, USA. https://twitter.com/kjspin7
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. https://twitter.com/rblument1
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA. https://twitter.com/virani_md
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. https://twitter.com/SethShayMartin
| | - Ty J Gluckman
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Research Network, Portland, Oregon, USA. https://twitter.com/tygluckman
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Sajja A, Park J, Sathiyakumar V, Varghese B, Pallazola VA, Marvel FA, Kulkarni K, Muthukumar A, Joshi PH, Gianos E, Hirsh B, Mintz G, Goldberg A, Morris PB, Sharma G, Blumenthal RS, Michos ED, Post WS, Elshazly MB, Jones SR, Martin SS. Comparison of Methods to Estimate Low-Density Lipoprotein Cholesterol in Patients With High Triglyceride Levels. JAMA Netw Open 2021; 4:e2128817. [PMID: 34709388 PMCID: PMC8554644 DOI: 10.1001/jamanetworkopen.2021.28817] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Low-density lipoprotein cholesterol (LDL-C) is typically estimated with the Friedewald or Martin/Hopkins equation; however, if triglyceride levels are 400 mg/dL or greater, laboratories reflexively perform direct LDL-C (dLDL-C) measurement. The use of direct chemical LDL-C assays and estimation of LDL-C via the National Institutes of Health Sampson equation are not well validated, and data on the accuracy of LDL-C estimation at higher triglyceride levels are limited. OBJECTIVE To compare an extended Martin/Hopkins equation for triglyceride values of 400 to 799 mg/dL with the Friedewald and Sampson equations. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study evaluated consecutive patients at clinical sites across the US with patient lipid distributions representative of the US population in the Very Large Database of Lipids from January 1, 2006, to December 31, 2015, with triglyceride levels of 400 to 799 mg/dL. Data analysis was performed from November 9, 2020, to March 23, 2021. MAIN OUTCOMES AND MEASURES Accuracy in LDL-C classification according to guideline-based categories and absolute errors between estimated LDL-C and dLDL-C levels. Patients were randomly assigned 2:1 to derivation and validation data sets. Levels of dLDL-C were measured by vertical spin-density gradient ultracentrifugation. The LDL-C levels were estimated using the Friedewald method, with a fixed ratio of triglycerides to very low-density lipoprotein cholesterol (VLDL-C ratio of 5:1), extended Martin/Hopkins equation with a flexible ratio, and Sampson equation with VLDL-C estimation by multiple least-squares regression. RESULTS A total of 111 939 patients (mean [SD] age, 52 [13] years; 65.0% male) with triglyceride levels of 400 to 799 mg/dL were included, representing 2.2% of 5 081 680 patients in the database. Across all individual guideline LDL-C classes (<40, 40-69, 70-99, 100-129, 130-159, 160-189, and ≥190), estimation of LDL-C by the extended Martin/Hopkins equation was most accurate (62.1%) compared with the Friedewald (19.3%) and Sampson (40.4%) equations. In classifying LDL-C levels less than 70 mg/dL across all triglyceride strata, the extended Martin/Hopkins equation was most accurate (67.3%) compared with Friedewald (5.1%) and Sampson (26.4%) equations. In addition, for classifying LDL-C levels less than 40 mg/dL across all triglyceride strata, the extended Martin/Hopkins equation was most accurate (57.2%) compared with the Friedewald (4.3%) and Sampson (14.4%) equations. However, considerable underclassification of LDL-C occurred. The magnitude of error between the Martin/Hopkins equation estimation and dLDL-C was also smaller: at LDL-C levels less than 40 mg/dL, 2.7% of patients had 30 mg/dL or greater differences between dLDL-C and estimated LDL-C using the Martin/Hopkins equation compared with the Friedewald (92.5%) and Sampson (38.7%) equations. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the extended Martin/Hopkins equation offered greater LDL-C accuracy compared with the Friedewald and Sampson equations in patients with triglyceride levels of 400 to 799 mg/dL. However, regardless of method used, caution is advised with LDL-C estimation in this triglyceride range.
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Affiliation(s)
- Aparna Sajja
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jihwan Park
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bibin Varghese
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vincent A. Pallazola
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Francoise A. Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Parag H. Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas /Southwestern Medical Center, Dallas
| | - Eugenia Gianos
- Department of Cardiology, North Shore University Hospital, Northwell Health, Zucker School of Medicine, New York, New York
| | - Benjamin Hirsh
- Department of Cardiology, North Shore University Hospital, Northwell Health, Zucker School of Medicine, New York, New York
| | - Guy Mintz
- Department of Cardiology, North Shore University Hospital, Northwell Health, Zucker School of Medicine, New York, New York
| | - Anne Goldberg
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Pamela B. Morris
- Department of Cardiology, Medical University of South Carolina, Columbia
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Wendy S. Post
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohamed B. Elshazly
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Cardiovascular Medicine, Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
| | - Steven R. Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Sajja A, Li HF, Spinelli KJ, Ali A, Virani SS, Martin SS, Gluckman TJ. A simplified approach to identification of risk status in patients with atherosclerotic cardiovascular disease. Am J Prev Cardiol 2021; 7:100187. [PMID: 34611633 PMCID: PMC8387292 DOI: 10.1016/j.ajpc.2021.100187] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/26/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The 2018 American Heart Association/American College of Cardiology (AHA/ACC) Blood Cholesterol Guideline recommendation to classify patients with atherosclerotic cardiovascular disease (ASCVD) as very high-risk (VHR) vs not-VHR (NVHR) has important implications for escalation of medical therapy. We aimed to define the prevalence and clinical characteristics of these two groups within a large multi-state healthcare system and develop a simpler means to assist clinicians in identifying VHR patients using classification and regression tree (CART) analysis. METHODS We performed a retrospective analysis of all patients in a 28-hospital US healthcare system in 2018. ICD-10 codes were used to define the ASCVD population. Per the AHA/ACC Guideline, VHR status was defined by ≥2 major ASCVD events or 1 major ASCVD event and ≥2 high-risk conditions. CART analysis was performed on training and validation datasets. A random forest model was used to verify results. RESULTS Of 180,669 ASCVD patients identified, 58% were VHR. Among patients with a history of myocardial infarction (MI) or recent acute coronary syndrome (ACS), 99% and 96% were classified as VHR, respectively. Both CART and random forest models identified recent ACS, ischemic stroke, hypertension, peripheral artery disease, history of MI, and age as the most important predictors of VHR status. Using five rules identified by CART analysis, fewer than 50% of risk factors were required to assign VHR status. CONCLUSION CART analysis helped to streamline the identification of VHR patients based on a limited number of rules and risk factors. This approach may help improve clinical decision making by simplifying ASCVD risk assessment at the point of care. Further validation is needed, however, in more diverse populations.
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Affiliation(s)
- Aparna Sajja
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Hsin-Fang Li
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, OR, United States
| | - Kateri J. Spinelli
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, OR, United States
| | - Amir Ali
- Evaluation and Research, Providence Research Network, Renton, WA, United States
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, United States
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Ty J. Gluckman
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, OR, United States
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Li W, Liu C, Burns N, Hayashi J, Yoshida A, Sajja A, González-Hernández S, Gao JL, Murphy PM, Kubota Y, Zou YR, Nagasawa T, Mukouyama YS. Alterations in the spatiotemporal expression of the chemokine receptor CXCR4 in endothelial cells cause failure of hierarchical vascular branching. Dev Biol 2021; 477:70-84. [PMID: 34015362 DOI: 10.1016/j.ydbio.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/02/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022]
Abstract
The C-X-C chemokine receptor CXCR4 and its ligand CXCL12 play an important role in organ-specific vascular branching morphogenesis. CXCR4 is preferentially expressed by arterial endothelial cells, and local secretion of CXCL12 determines the organotypic pattern of CXCR4+ arterial branching. Previous loss-of-function studies clearly demonstrated that CXCL12-CXCR4 signaling is necessary for proper arterial branching in the developing organs such as the skin and heart. To further understand the role of CXCL12-CXCR4 signaling in organ-specific vascular development, we generated a mouse model carrying the Cre recombinase-inducible Cxcr4 transgene. Endothelial cell-specific Cxcr4 gain-of-function embryos exhibited defective vascular remodeling and formation of a hierarchical vascular branching network in the developing skin and heart. Ectopic expression of CXCR4 in venous endothelial cells, but not in lymphatic endothelial cells, caused blood-filled, enlarged lymphatic vascular phenotypes, accompanied by edema. These data suggest that CXCR4 expression is tightly regulated in endothelial cells for appropriate vascular development in an organ-specific manner.
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Affiliation(s)
- Wenling Li
- Laboratory of Stem Cell and Neuro-Vascular Biology, Cell and Development Biology Center, USA
| | - Chengyu Liu
- Transgenic Core, National Heart, Lung, and Blood Institute, USA
| | - Nathan Burns
- Laboratory of Stem Cell and Neuro-Vascular Biology, Cell and Development Biology Center, USA
| | - Jeffery Hayashi
- Laboratory of Stem Cell and Neuro-Vascular Biology, Cell and Development Biology Center, USA
| | - Atsufumi Yoshida
- Laboratory of Stem Cell and Neuro-Vascular Biology, Cell and Development Biology Center, USA
| | - Aparna Sajja
- Laboratory of Stem Cell and Neuro-Vascular Biology, Cell and Development Biology Center, USA
| | - Sara González-Hernández
- Laboratory of Stem Cell and Neuro-Vascular Biology, Cell and Development Biology Center, USA
| | - Ji-Liang Gao
- Molecular Signaling Section, Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Philip M Murphy
- Molecular Signaling Section, Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yoshiaki Kubota
- Department of Anatomy, Institute for Advanced Medical Research, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yong-Rui Zou
- The Feinstein Institute for Medical Research, Center for Autoimmune and Musculoskeletal Diseases, Manhasset, NY 11030, USA
| | - Takashi Nagasawa
- Laboratory of Stem Cell Biology and Developmental Immunology, Graduate School of Frontier Biosciences, Graduate School of Medicine, Immunology Frontier Research Center, World Premier International Research Center, Osaka University, Osaka 565-0871, Japan
| | - Yoh-Suke Mukouyama
- Laboratory of Stem Cell and Neuro-Vascular Biology, Cell and Development Biology Center, USA.
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Teklu M, Zhou W, Kapoor P, Patel N, Dey AK, Sorokin AV, Manyak GA, Teague HL, Erb-Alvarez JA, Sajja A, Abdelrahman KM, Reddy AS, Uceda DE, Lateef SS, Shanbhag SM, Scott C, Prakash N, Svirydava M, Parel P, Rodante JA, Keel A, Siegel EL, Chen MY, Bluemke DA, Playford MP, Gelfand JM, Mehta NN. Metabolic syndrome and its factors are associated with noncalcified coronary burden in psoriasis: An observational cohort study. J Am Acad Dermatol 2021; 84:1329-1338. [PMID: 33383084 DOI: 10.1016/j.jaad.2020.12.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/01/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Psoriasis is associated with a heightened risk of cardiovascular disease and higher prevalence of metabolic syndrome. OBJECTIVE Investigate the effect of metabolic syndrome and its factors on early coronary artery disease assessed as noncalcified coronary burden by coronary computed tomography angiography in psoriasis. METHODS This cross-sectional study consisted of 260 participants with psoriasis and coronary computed tomography angiography characterization. Metabolic syndrome was defined according to the harmonized International Diabetes Federation criteria. RESULTS Of the 260 participants, 80 had metabolic syndrome (31%). The metabolic syndrome group had a higher burden of cardiometabolic disease, systemic inflammation, noncalcified coronary burden, and high-risk coronary plaque. After adjusting for Framingham risk score, lipid-lowering therapy, and biologic use, metabolic syndrome (β = .31; P < .001) and its individual factors of waist circumference (β = .33; P < .001), triglyceride levels (β = .17; P = .005), blood pressure (β = .18; P = .005), and fasting glucose (β = .17; P = .009) were significantly associated with noncalcified coronary burden. After adjusting for all other metabolic syndrome factors, blood pressure and waist circumference remained significantly associated with noncalcified coronary burden. LIMITATIONS Observational nature with limited ability to control for confounders. CONCLUSIONS In psoriasis, individuals with metabolic syndrome had more cardiovascular disease risk factors, systemic inflammation, and noncalcified coronary burden. Efforts to increase metabolic syndrome awareness in psoriasis should be undertaken to reduce the heightened cardiovascular disease risk.
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Affiliation(s)
- Meron Teklu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Wunan Zhou
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Promita Kapoor
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nidhi Patel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexander V Sorokin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Grigory A Manyak
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Julie A Erb-Alvarez
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aparna Sajja
- Department of Internal Medicine, Johns Hopkins University Medical Center, Baltimore, Maryland
| | - Khaled M Abdelrahman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aarthi S Reddy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Domingo E Uceda
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sundus S Lateef
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sujata M Shanbhag
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Colin Scott
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nina Prakash
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Maryia Svirydava
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Philip Parel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Evan L Siegel
- Department of Rheumatology, Arthritis and Rheumatism Associates, Rockville, Maryland
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Sajja A, Abdelrahman KM, Reddy AS, Dey AK, Uceda DE, Lateef SS, Sorokin AV, Teague HL, Chung J, Rivers J, Joshi AA, Elnabawi YA, Goyal A, Rodante JA, Keel A, Alvarez JE, Lockshin B, Prussick R, Siegel E, Playford MP, Chen MY, Bluemke DA, Gelfand JM, Mehta NN. Chronic inflammation in psoriasis promotes visceral adiposity associated with noncalcified coronary burden over time. JCI Insight 2020; 5:142534. [PMID: 33104056 PMCID: PMC7710282 DOI: 10.1172/jci.insight.142534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease associated with increased obesity, noncalcified coronary artery burden (NCB), and incident myocardial infarction. Here, we sought to assess the relationship among inflammation, visceral adipose tissue (VAT), and NCB. Furthermore, we evaluated whether improvement in VAT would be associated with reduction in NCB over time in psoriasis. METHODS Consecutive psoriasis patients underwent coronary CT angiography to quantify NCB and abdominal CT to calculate VAT at baseline (n = 237), 1 year (n = 176), and 4 years (n = 50). RESULTS Patients with high levels of high-sensitivity C-reactive protein (hs-CRP) had significantly greater visceral adiposity (17,952.9 ± 849.2 cc3 vs. 13370.7 ± 806.8 cc3, P < 0.001) and noncalcified coronary burden (1.26 ± 0.03 vs. 1.07 ± 0.02 mm2) than those with low levels of hs-CRP. Those with higher levels of VAT had more systemic inflammation (hs-CRP, median [IQR], 2.5 mg/L [1.0–5.3 mg/L] vs. 1.2 mg/L [0.6–2.9 mg/L]), with approximately 50% higher NCB (1.42 ± 0.6 mm2 vs. 0.91 ± 0.2 mm2, P < 0.001). VAT associated with NCB in fully adjusted models (β = 0.47, P < 0.001). At 1-year follow-up, patients who had worsening hs-CRP had an increase in VAT (14,748.7 ± 878.1 cc3 to 15,158.7 ± 881.5 cc3; P = 0.03), whereas those who had improved hs-CRP improved their VAT (16,876.1 ± 915.2 cc3 to 16310.4 ± 889.6 cc3; P = 0.04). At 1 year, there was 10.3% reduction in NCB in those who had decreased VAT (β = 0.26, P < 0.0001), which persisted in a subset of patients at 4 years (β = 0.39, P = 0.003). CONCLUSIONS Inflammation drives development of VAT, increased cardiometabolic risk, and NCB in psoriasis. Reduction of inflammation associated with reduction in VAT and associated with longitudinal improvement in NCB. These findings demonstrate the important role of inflammation in the development of VAT in humans and its effect on early atherogenesis. TRIAL REGISTRATION ClinicalTrials.gov NCT01778569. FUNDING This study was supported by the National Heart, Lung, and Blood Institute Intramural Research Program (HL006193-05), the NIH Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation (no. 2014194), the American Association for Dental Research, the Colgate-Palmolive Company, Genentech, and Elsevier as well as private donors. Inflammation is associated with development of visceral adiposity and coronary artery disease in humans.
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Affiliation(s)
- Aparna Sajja
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Aarthi S Reddy
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Domingo E Uceda
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Sundus S Lateef
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Heather L Teague
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Jonathan Chung
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Joshua Rivers
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | | | - Justin A Rodante
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Julie E Alvarez
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Ronald Prussick
- Washington Dermatology Center, Rockville, Maryland, USA; George Washington University, Washington, DC, USA
| | - Evan Siegel
- Arthritis and Rheumatism Associates, Rockville, Maryland, USA
| | | | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joel M Gelfand
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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12
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Varghese B, Park J, Chew E, Sajja A, Brownstein A, Pallazola VA, Sathiyakumar V, Jones SR, Sniderman AD, Martin SS. Importance of the triglyceride level in identifying patients with a Type III Hyperlipoproteinemia phenotype using the ApoB algorithm. J Clin Lipidol 2020; 15:104-115.e9. [PMID: 33189625 DOI: 10.1016/j.jacl.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/06/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hyperlipoproteinemia Type III (HLP3), also known as dysbetalipoproteinemia, is defined by cholesterol and triglyceride (TG) enriched remnant lipoprotein particles (RLP). The gold standard for diagnosis requires demonstration of high remnant lipoprotein particle cholesterol (RLP-C) by serum ultracentrifugation (UC), which is not readily available in daily practice. The apoB algorithm can identify HLP3 using total cholesterol (TC), plasma triglyceride (TG), and apoB. However, the optimal TG cutoff is unknown. OBJECTIVE We analyzed apoB algorithm defined HLP3 at different TG levels to optimize the TG cutoff for the algorithm. METHODS 128,485 UC lipid profiles in the Very Large Database of Lipids (VLDbL) were analyzed. RLP-C was assessed at TG ≥ 133 mg/dL, ≥175 mg/dL, ≥200 mg/dL, and ≥ 250 mg/dL. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and prevalence adjusted and bias-adjusted kappa (PABAK) were calculated against UC Criterion (VLDL-C/TG ≥ 0.25) for HLP3. RESULTS The median age (IQR) was 57 years (46-68). 45% were men, 20.1% had diabetes, and 25.5% had hypertension. The median RLP-C level for the TG cutoffs (mg/dL) of ≥ 133, ≥ 175, ≥ 200, and ≥ 250 were 34, 43, 50, and 62 mg/dL, respectively, compared to 67 mg/dL in UC defined HLP3. TG ≥ 133 mg/dL yielded optimal results (Sn 29.5%, Sp 98.5%, PABAK 0.96, PPV 13.6%, NPV 99.4%). CONCLUSION TG ≥ 133 mg/dL allows for high sensitivity in screening for HLP3. Higher TG cutoffs may identify more severe HLP3 phenotypes, but with a large loss in sensitivity for HLP3.
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Affiliation(s)
- Bibin Varghese
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jihwan Park
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin Chew
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aparna Sajja
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam Brownstein
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vincent A Pallazola
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan D Sniderman
- Mike and Valeria Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Quebec, Canada
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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13
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Varghese B, Park J, Sajja A, Brownstein A, Pallazola V, Jones S, Sniderman A, Martin S. Importance of the Triglyceride Level in the Identification of Patients with a Type III Hyperlipoproteinemia Phenotype using the ApoB Method. J Clin Lipidol 2020. [DOI: 10.1016/j.jacl.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Sajja A, Ali A, Li HF, Spinelli K, Virani SS, Martin SS, Gluckman TJ. CLINICAL CHARACTERISTICS OF PATIENTS CLASSIFIED AS VERY HIGH RISK AND NOT VERY HIGH RISK BASED ON THE 2018 AHA/ACC MULTI-SOCIETY CHOLESTEROL GUIDELINE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32538-9] [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: 11/26/2022]
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15
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Dudum R, Sajja A, Amdur RL, Choi BG. Analysis of American College of Cardiology/American Heart Association Guideline Author Self-Disclosure Compared With Open Payments Industry Disclosure. Circ Cardiovasc Qual Outcomes 2019; 12:e005613. [PMID: 32522012 DOI: 10.1161/circoutcomes.119.005613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ramzi Dudum
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD (R.D., A.S.)
| | - Aparna Sajja
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD (R.D., A.S.)
| | - Richard L Amdur
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (R.L.A., B.G.C.)
| | - Brian G Choi
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (R.L.A., B.G.C.)
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Pallazola VA, Sajja A, Derenbecker R, Ogunmoroti O, Park J, Sathiyakumar V, Martin SS. Prevalence of familial chylomicronemia syndrome in a quaternary care center. Eur J Prev Cardiol 2019; 27:2276-2278. [PMID: 31718261 DOI: 10.1177/2047487319888054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vincent A Pallazola
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, USA
| | - Aparna Sajja
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, USA
| | - Robert Derenbecker
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, USA
| | - Jihwan Park
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, USA
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17
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Dey A, Gaddipati R, Elnabawi Y, Ongstad E, Goyal A, Rodante J, Sajja A, Sorokin A, Teague H, Aksentijevich M, Khalil N, Reddy A, Choi H, Argueta-Amaya J, Shukla P, Baumer Y, Joshi A, Sandfort V, Playford M, Chen M, Bluemke D, Karathanasis S, Gelfand J, Gupta R, Mehta N. SOLUBLE LECTIN-LIKE OXIDIZED LOW-DENSITY LIPOPROTEIN RECEPTOR-1 IS ASSOCIATED WITH SUBCLINICAL CORONARY ARTERY DISEASES IN PSORIASIS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32364-2] [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: 10/27/2022]
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18
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Joshi AA, Lerman J, Sajja A, Dey A, Patarroyo M, Raina A. TEMPORAL TRENDS IN CLINICAL AND FINANCIAL BURDEN OF HEART FAILURE HOSPITALIZATIONS IN CHRONIC INFLAMMATORY DISEASES: INSIGHTS FROM NATIONWIDE INPATIENT SAMPLE 2004-2016. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31596-7] [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: 11/16/2022]
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Affiliation(s)
- Aparna Sajja
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Christina Puchalski
- George Washington Institute for Spirituality and Health, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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20
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Abstract
Spirituality is increasingly recognized as an essential element of patient care and health. It is often during illness that patients experience deep spiritual and existential suffering. With clinicians' care and compassion, patients are able to find solace and healing through their spiritual beliefs and values. This article chronicles a history of spirituality and health education, including the development of consensus-based clinical guidelines and competencies in health professions education that have influenced the curricular development.
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Affiliation(s)
- Aparna Sajja
- an internal medicine resident at Johns Hopkins Hospital in Baltimore and a recent graduate of the George Washington University School of Medicine
| | - Christina Puchalski
- the founder and director of the George Washington Institute for Spirituality and Health (GWish) and a professor of medicine at the George Washington University in Washington, DC, and directs an interdisciplinary outpatient supportive and palliative care clinic and is a medical hospice director
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21
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Sajja A. Where is the value in care? Ann Palliat Med 2017; 6:S122-S123. [DOI: 10.21037/apm.2017.08.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/06/2022]
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Affiliation(s)
- Aparna Sajja
- Corresponding to Aparna Sajja, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA;
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Sajja A, Tsering D, Mooser AC, DeFreitas TA, Carpenter J, Magge SN. Patient With Severe Moyamoya Disease Who Presents With Acute Cortical Blindness. Stroke 2017; 48:e126-e129. [PMID: 28411258 DOI: 10.1161/strokeaha.116.015548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Aparna Sajja
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Deki Tsering
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Annie C Mooser
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Tiffani A DeFreitas
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Jessica Carpenter
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Suresh N Magge
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.).
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Burton C, Sajja A, Latthe PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn 2012; 31:1206-16. [PMID: 22581511 DOI: 10.1002/nau.22251] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 03/05/2012] [Indexed: 11/07/2022]
Abstract
AIM To evaluate the effectiveness of posterior percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder (OAB) symptoms by systematic review of the literature. METHODS Systematic literature search was carried out (up to April 2011) using relevant search terms in Medline, EMBASE, CINAHL, CENTRAL, National Library for Health, MetaRegister of controlled trials, LILACS, and Google Scholar. Relevant randomized controlled trials (RCTs) and prospective studies were selected and then analyzed by two-independent reviewers. Meta-analysis was performed with random effects model using STATA 8 for non-randomized prospective studies and with Review Manager 5.1 for RCTs. RESULTS The studies report variable initial success rates (37-82%) for treating OAB symptoms with PTNS. Four randomized trials compared PTNS with Sham treatment showing a significant difference favoring PTNS [RR 7.02 95% confidence interval (CI) 1.69-29.17]. Two randomized trials compared PTNS with antimuscarinic medication with no significant difference in the change in bladder diary parameters between the treatments. Ten prospective non-randomized studies were included. The definitions of success were varied. The pooled subjective success rate was 61.4% (95% CI 57.5-71.8) and objective success rate was 60.6% (95% CI 49.2-74.7). CONCLUSION There is evidence of significant improvement in OAB symptoms using PTNS which is comparable to the effect of antimuscarinics but with a better side effect profile. The studies included in the review only considered short-term outcomes after initial treatment. In order to recommend PTNS as a practical treatment option, long-term data and health economic analysis are needed.
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Affiliation(s)
- C Burton
- Department of Obstetrics & Gynaecology, Birmingham Women’s NHS Foundation Trust, Birmingham, United Kingdom.
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Abstract
Surveys to determine learning and behavioral changes that result from education about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) should be constructed to account for high levels of background knowledge and knowledge of safer sex practices among college students. This article evaluates the learning and behavioral changes of students enrolled in an HIV/AIDS education course offered by the Department of Biological Sciences at Rutgers University as part of a university-wide HIV/AIDS education program. Responses of students in the HIV/AIDS class were compared with those of students enrolled in other biology classes, using paired and unpaired t tests and multivariate discriminant analysis. Participants revealed they had significant knowledge about HIV/AIDS as a result of the HIV/AIDS class, but students campus-wide had a far higher level of general knowledge about HIV/AIDS than the authors expected. In addition, many students already were practicing behaviors that would reduce their risk of HIV infection. Because students were so knowledgeable about HIV and claimed they practiced safer sex, it was difficult to demonstrate significant changes in behavior as a result of the classroom experience.
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Affiliation(s)
- D Schneider
- Rutgers, State University of New Jersey, New Brunswick
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