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Abohashem S, Sayed A, Aldosoky W, Diab M, Mir T, Sattar Y, Dar T. Burden and disparities in cardiovascular mortality rates associated with obesity prevalence in United States: county-level analysis from 2010 to 2019. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Obesity is a grave public health threat linked to high morbidity and mortality rates. A significant rise in obesity rates amongst U.S. adults and worldwide has been observed in recent decades. Although associations between obesity and cardiovascular mortality (CVM) are well-known, impact and disparities in CVM attributable to obesity at a nationwide community level, aren't well defined.
Purpose
At county level, we sought to evaluate the independent impact of adult obesity on CVM in overall population and within different age, sex, and race/ethnic subgroups.
Methods
Age-adjusted CVM rates (ACVM) between 2010 to 2019, were obtained using Wide-ranging Online Data for Epidemiologic Research tool of Center for Disease Control (CDC). Using the Behavioral risk Factors Surveillance System (BRFSS), obesity rates per county was assessed as the percentage of adult population (age ≥20) that reports a body mass index ≥30 kg/m2. BRFSS, CDC Diabetes Interactive Atlas, census population estimates, environmental public health network and health county ranking project databases, were utilized to acquire county data of demographics, CV risk, socio-environmental, and health care access factors. Poisson multivariate generalized linear mixed models were employed to assess incidence rate ratios (IRR) of ACVM associated with obesity rates. To evaluate the absolute impact of obesity on ACVM, additional yearly deaths (AYD) per 100,000 individuals were calculated. All study analysis were weighted for the relevant county baseline population.
Results
Among 307,045,647 residents (50% women, 12% non-Hispanic blacks, 24% aged 45–64) lived at 2904 US counties in 2010, total 8,157,571 (2.7%) CV deaths occurred between 2010–2019. In fully adjusted model*, high obesity rates significantly associated with high ACVM (IRR: 1.015; 95% CI: 1.008 to 1.022), that translated to 3.5 AYD per 100,000 individuals. In a subgroup analysis, obesity rates associated with a relatively higher ACVM among overall middle aged adults [45 to 64] (IRR: 1.028; 95% CI: 1.018 to 1.037) versus elderly [≥65] (IRR: 1.013; 95% CI: 1.006 to 1.020), and in males (IRR: 1.018; 95% CI: 1.010 to 1.026) versus females (IRR: 1.014; 95% CI: 1.006 to 1.022), and in Hispanics (IRR: 1.035; 95% CI: 1.005 to 1.065) versus non-Hispanic Whites (IRR: 1.020; 95% CI: 1.012 to 1.027). Interestingly, middle aged adults had higher ACVM IRRs as compared to elderly, among males (IRR: 1.022), females (IRR: 1.039), and non-Hispanic Whites (IRR: 1.044) (Figure).
Conclusions
Obesity prevalence is independently associated with high ACVM among different age, sex, and race/ethnic groups, and this impact is most pronounced in Hispanics and the middle-aged group of females and non-Hispanic Whites. More research is needed to further uncover the mechanisms leading to these observations a long with community-level interventions to reduce the burden of this ongoing epidemic, in overall and most impacted population groups.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Abohashem
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - A Sayed
- Ain Shams University , Cairo , Egypt
| | - W Aldosoky
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - M Diab
- Zagazig University , Zagazig , Egypt
| | - T Mir
- Wayne State University , Detroit , United States of America
| | - Y Sattar
- West Virginia University Hospital , Morgantown , United States of America
| | - T Dar
- University of Miami Leonard M. Miller School of Medicine , Miami , United States of America
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Abdul Razzack A, Rocha Castellanos D, Lopez Mendez A, Fernando Perez Paz M, Pothuru S, Pusa M, Patel V, Sattar Y. Efficacy and safety of doxycycline for the management of small abdominal aortic aneurysms- a meta analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background- Patients with small Abdominal Aortic Aneurysms are managed with surveillance as there is currently insufficient evidence to recommend surgical aneurysm repair. Hence, there is a dire need and interest in pharmacotherapy like tetracycline antibiotics to reduce the need for aneurysm repair.
Purpose- To determine the efficacy and safety of doxycycline in the management of small abdominal aortic aneurysms.
Methods- Electronic databases (PubMed, Scopus, Embase, Cochrane) were searched until 25th November 2020.The primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to Abdominal aortic aneurysm repair in each group.
Results- A total of three studies with 572 participants (Doxycycline = 290; Placebo = 282 ) were included in our analysis. Average follow up was a period of 18 months. For AAA expansion, the combined results demonstrated a statistically significant mean difference in expansion rates favoring the placebo groups over the intervention (WMD-0.75, 95%CI 0.12-1.38; p = 0.02;I2 = 0%) There was no statistically significant difference in the efficacy and safety of doxycycline as opposed to placebo groups for referral to AAA surgery (OR 1.01, 95%CI 0.61-1.69; p = 0.96, I2 = 0%) and all-cause mortality(OR 0.51; 95%CI 0.18-1.43; p = 0.20, I2 =0%)
Conclusion- Amongst patients with small abdominal aortic aneurysms, doxycycline did not significantly reduce aneurysm growth.
Abstract Figure. A) AAA expansion B)Surgery C)Mortality
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Affiliation(s)
- A Abdul Razzack
- Dr NTR University of Health Sciences, Department of Medicine, Vijayawada, India
| | - D Rocha Castellanos
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Departamento de Cirugía, Monterrey, Nuevo León, Mexico
| | - A Lopez Mendez
- Hospital Universitario Dr. José Eleuterio González, Monterrey, Nuevo Leon, Mexico
| | - M Fernando Perez Paz
- Hospital General de Matamoros Dr. Alfredo Pumarejo H. Matamoros, Tamaulipas, Mexico
| | - S Pothuru
- Ascension Via Christi Hospital, Department of Internal Medicine, Kansas, United States of America
| | - M Pusa
- Dr NTR University of Health Sciences, Department of Medicine, Vijayawada, India
| | - V Patel
- Medical College Baroda, Gujarat, India
| | - Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Abdul Razzack A, Pothuru S, Adeel Hassan S, Mandava S, Theja Reddy K, Missael Rocha Castellanos D, Rocha Castellanos D, Lilian Contreras Gallegos G, Sanchez Alfaro A, Arshad J, Sattar Y. Association of type 2 diabetes mellitus and mortality after coronary artery bypass graft surgery- a meta analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background- Recent studies have demonstrated the favorable cardiovascular outcomes of coronary artery bypass graft surgery (CABG) among patients with diabetes mellitus (DM). However, little is known regarding the impact of T2DM in patients undergoing CABG. We aimed to compare the long-term mortality following CABG in patients with and without T2DM.
Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcome was all-cause mortality.
Results-Sixteen studies with a total of 183,200 participants (DM = 51,474, Non-DM = 131,726) were included in our analysis. Average follow up was 3 years. Mean age was 56.7 and 54.8 in the DM and Non-DM groups respectively. A statistically significantly higher rate of mortality was observed in patients with T2DM (OR 1.54; 95%CI 1.40-1.69; p < 0.00001, I2 = 36)as opposed to patients without T2DM.
Conclusion- Although CABG is the better revascularization strategy as opposed to PCI, Type 2 DM is an independent predictor for long-term mortality after CABG surgery.
Abstract Figure.
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Affiliation(s)
- A Abdul Razzack
- Dr. N.T.R University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - S Pothuru
- Ascension Via Christi Hospital, Department of Internal Medicine, Kansas, United States of America
| | - S Adeel Hassan
- University of Louisville School of Medicine, Louisville, United States of America
| | - S Mandava
- Santa Barbara Cottage Hospital, California, United States of America
| | - K Theja Reddy
- UHS Southern California Medical Education Consortium, Temecula, California, United States of America
| | | | | | | | - A Sanchez Alfaro
- Facultad De Medicina Universidad Autónoma de Tamaulipas, Matamoros, Mexico
| | - J Arshad
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Abdul Razzack A, Pothuru S, Mandava S, Adeel Hassan S, Theja Reddy K, Missael Rocha Castellanos D, Arshad J, Sattar Y. Association between red blood cell transfusions and adverse effects after transcatheter aortic valve replacement- a meta analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background-Transcatheter aortic valve replacement (TAVR) is associated with periprocedural bleeding , mainly driven by vascular complications leading to blood cell transfusion. Additionally, anemia is highly prevalent in this population. The decision regarding the necessity for blood transfusion in patients undergoing TAVR is challenging.
Methods-Electronic databases (Medline, Embase, Scopus, Cochrane) were searched from inception to December 16th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcomes of interest were all-cause mortality, myocardial infarction(MI), Stroke(CVA), and acute kidney injury(AKI).
Results- A total of six studies with 6701 participants (Transfusions = 1505, Non-Transfusions = 5196) were included in our analysis. Average follow-up duration was 30 days. Mean age was 82.4 and 81.5 in the Transfusions and Non-transfusions group respectively. RBC transfusion was associated with higher 30-day mortality (OR-4.08; 95%CI 2.29-7.27; p < 0.00001; I2 = 77) as well as increased risk of acute kidney injury (AKI) (OR 2.97;95%CI 2.07-4.26; p < 0.00001; I2 = 77) and stroke (OR 2.44; 95%CI 1.78- 3.34; p < 0.00001,I2 = 0) However, there was no significant difference in the incidence of MI (OR 1.15;95%CI 0.50-2.64; p = 0.74,I2 = 0)
Conclusion- RBC transfusion is a correlate and an independent predictor of all-cause mortality, acute kidney injury and stroke in this patient population and should be used with caution
Abstract Figure.
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Affiliation(s)
- A Abdul Razzack
- Dr. N.T.R University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - S Pothuru
- Ascension Via Christi Hospital, Department of Internal Medicine, Kansas, United States of America
| | - S Mandava
- Santa Barbara Cottage Hospital, California, United States of America
| | - S Adeel Hassan
- University of Louisville School of Medicine, Louisville, United States of America
| | - K Theja Reddy
- UHS Southern California Medical Education Consortium, Temecula, California, United States of America
| | | | - J Arshad
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Abdul Razzack A, Mandava S, Pothuru S, Adeel Hassan S, Missael Rocha Castellanos D, Fernando Perez Paz M, Alsonso Elizarraras Aldrete O, Theja Reddy K, Sattar Y. Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown.
Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years.
Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p < 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at >5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p < 0.00001, I2 = 0) had similar outcomes.
Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes.
Abstract Figure.
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Affiliation(s)
- A Abdul Razzack
- Dr. N.T.R University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - S Mandava
- Santa Barbara Cottage Hospital, California, United States of America
| | - S Pothuru
- Ascension Via Christi Hospital, Department of Internal Medicine, Kansas, United States of America
| | - S Adeel Hassan
- University of Louisville School of Medicine, Louisville, United States of America
| | | | - M Fernando Perez Paz
- Hospital General de Matamoros Dr. Alfredo Pumarejo H. Matamoros, Tamaulipas, Mexico
| | | | - K Theja Reddy
- UHS Southern California Medical Educational Consortium, Temecula, California, United States of America
| | - Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Sattar Y, Ullah W, Mamtani S, Alraies C. Efficacy of epicardial and endocardial ablation in the prevention of ventricular tachycardia in arrythmogenic right ventricular cardiomyopathy- a meta analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ventricular tachycardia is a major complication associated with increased risk of sudden cardiac death in arrhythmogenic ventricular cardiomyopathy. Recurrence of VT status post catheter endocardial ablation with conventional mapping is a evolving discussion in management of VT prevention in ARVC. With the evolution of new mapping techniques to locate ectopic foci of VT, a combination of endo- and epicardial catheter ablation have proven to be efficacious in the prevention of frequency of VT recurrence and its duration.
Methods
Using PubMed, Ovid (MEDLINE) and Cochrane database we searched using the MeSH terms including: “arrhythmogenic right ventricular cardiomyopathy”, “arrhythmogenic right ventricular dysplasia”, “monomorphic ventricular tachycardia”, “polymorphic ventricular Tachycardia”, “endocardial catheter ablation”, “epicardial catheter ablation”. The primary outcomes were to assess VT frequency and duration status post endocardial or epicardial or a combination of both types of ablation. The secondary outcome includes sudden cardiac arrest or sudden cardiac death after procedure. ANOVA with post HOC analysis was performed using SPSS v.26 (IBM Corp, NY, USA)
Results
A total of 33 studies included 1437 patients with a mean male=67%. The data analysis showed a mean VT prevention for endocardial ablation was 65%, epicardial 78%, and for combined epi-endocardial was 89% (figure-1). The mean procedural mortality rate was 2%. In order to test the hypothesis that combined epi-endocardial ablation was more successful in the prevention of VT recurrence, we performed a one-way analysis of variance (ANOVA). The analysis was statistically significant F(2,14)=5.879, 95% CI, p=0.014. Post Hoc test (Tukey HSD test) with multiple comparisons indicated that patients who underwent combined epi-endocardial ablation experienced a statistically significant difference in VT prevention of 89% (95% CI p=0.01) compared to only endocardial ablation, mean VT prevention of 65% (95% CI, p=0.189) or only epicardial, mean VT prevention of 78% (95% CI, p=0.353).
Conclusion
With new mapping techniques, use of endocardial, and epicardial ablation is linked to decrease VT frequency, duration, ICD shocks, and sudden cardiac death in patients with ARVC in cohorts with prior failure of antiarrhythmics.
Total VT Prevention across target sites
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - W Ullah
- Abington Memorial Hospital, Abington, United States of America
| | - S Mamtani
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C Alraies
- Wayne State University, Detroit, United States of America
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Sattar Y, Rashid M, Ramli M, Sabariah B. Black carbon and elemental concentration of ambient particulate matter in Makassar Indonesia. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1755-1315/18/1/012099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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